Kim Romberg, MSN, RN, CIC discusses antibiotic resistance. She explains theories of what's causing the resistance, and strategies to decrease the resistance to "super bugs."
Melanie Cole, MS (Host): In recent decades, we've been hearing more and more about antibiotic resistant bacteria. That’s bacteria that isn’t susceptible to the actions of antibiotics. Why is this happening? My guest today is Kim Romberg. She’s an infection preventionist at Shriners Hospitals for Children in Chicago. Kim, tell us a little bit about the current state of antibiotic use today. What’s the prevalence? What do we know now about antibiotics that we did not know 20 years ago?
Kim Romberg, MSN, RN, CIC (Guest): Well one thing we do know is that we’re overusing and misusing antibiotics. It’s a world wide health issue that is causing a risk to the public’s health. In the United States, there’s about two million people a year that develop antibiotic resistance and about 23,000 people die annually from it.
Host: Wow. You know it’s quite prevalent and we hear more and more about it now in the media. Before we get into this resistant, tell us a little bit about… When you say that we’re overusing them, people go to their doctors, they ask for an antibiotic if they have a cold or the flu or a virus. And why we shouldn’t really be doing that.
Kim: That’s correct. We actually are seeing when people go to their physician, they want a quick fix a lot of times. Antibiotics will not cover a virus. It will only cover bacteria. It’s easier for a lot of people to just think that the antibiotic is going to cover them. Physicians think also that it’s helping their patients sometimes that they over prescribe them. They order them when they're not indicated. Patients also don’t follow the rules of antibiotics. They start feeling a little better after taking them, so they stop taking them. Then they keep them around. When they're not feeling well again, they start taking those antibiotics. Or they might have a friend that’s not feeling well and decide that oh here take my antibiotics. Which can also be very dangerous and deadly.
Host: It’s not just really taking antibiotics either, isn’t it? There’s in our food, there’s antibiotics. In milk, there’s antibiotics. In animals. So along those lines, that overuse. Do you see, and this is just in your opinion, more of an awareness about this resistance and the antibiotics that seem to be everywhere in our lives?
Kim: I know in livestock that’s one thing that they use antibiotics in because it makes the animals grow bigger faster. So that’s one area that the FDA and that is trying to regulate, and the Department of Agriculture is trying to regulate why are we giving antibiotics to healthy animals and healthy poultry. That is not going to decrease any type of infection because that’s not why they're giving it for. Another area why we’re seeing resistance is because people are travelling. So we’re getting organisms and germs from other areas of countries that are more resistance to maybe us in the United States. Patients are also sicker these days. They're more exposed to healthcare, hospitals, clinics, offices. These are other reasons that we’re also seeing. The organisms are smart. They can survive on surfaces outside the body for extended periods of time. They can also then be picked up and transferred to other people.
Host: That’s a really great point because the fact is Kim that these bacteria are smart. How do you feel this has changed the landscape? I mean if we want to use antibiotics, but these bacteria are getting smarter and smarter, what has that done for you in the healthcare sector as far as responsible use of antibiotics when they are warranted?
Kim: Correct. We actually have an antibiotic stewardship program which indicates when antibiotics should be used, for how long they should be used. At 48 hours there should be an antibiotic timeout to see are we using the correct antibiotic once we have culture results back. Need to narrow coverage to that antibiotic for that organism. We also should use a deceleration approach in healthcare if we’re on IV antibiotics to switch over to oral as soon feasible. Follow treatment guidelines so we know we’re using the appropriate drug for the appropriate type of infection.
Host: You know we hear about hospital acquired infections and resistance to that. What are hospitals doing and educating the staff as well as patients that come and go from the hospital? Tell us a little bit about the Chicago Hospital hand hygiene program.
Kim: Correct. Hand hygiene, again, is still the number one way to prevent infection and illness in anybody. We have a very strong hand hygiene program here. We call it High Five for Hand Hygiene. The idea is that if I see a coworker who has not cleaned their hands when they should have, maybe after they’ve touched the patient or the patients environment, I can just say, “Hey Sue, high five.” And she knows I'm not embarrassing her in front of the patient. That it’s an indication. She knows also to go clean her hands. It’s one part we try to do. The aspect of foam in, foam out before we go into a patient room and when we come out.
I do have secret observers that are watching staff in their day to day activities and they fill out a form for me. At the end a quarter, we actually will tally up our results in that. Our hand hygiene rate is about 93%, which is actually very good in healthcare these days. We’re very strong on it. We educate our staff when they come in, annually, and throughout the year during infection prevention week. I try and do something fun. This year we did some plates with cultures and did some cell phones. We cultured them on there. So I did two nurses and I’d also do two office people. Which showed our nurses had barely anything on these plates where the other had an overgrowth of bacteria on these plates.
Host: Wow. What an interesting way to show that. When you mentioned cell phones, that image just popped into my head because I imagine our cell phones are just covered with all kinds of nasty little crawling things. So what do you want consumers to know about antibiotic stewardship? They hear this term and they don’t really know what it means. What do you want them to know about when their child has a cold or a virus or they're reading the labels on their food? What do you want us to do about this as consumers?
Kim: I think as consumers we need to be aware, do I really need that antibiotic? Also if it is prescribed for me, am I following it completely as it’s prescribed for me? Not to share your antibiotics with others? We need to know that there are side effects of antibiotics which can be severe and also life threatening in some people. That antibiotic is not always a quick fix or a safe thing. A lot of parents of school aged children don’t have the time to take their kids out of school. Don’t have the time to take off of work and that. So they feel it’s an easier quick fix, which isn’t always the answer to that. I mean sometimes they don’t need—a virus needs to run its course. Bronchitis may need to run its course.
Host: No body likes to hear you say that, really. I mean I feel the same way, but it’s so important that we learn about these antibiotic resistant bacteria and why we shouldn’t be using antibiotics as much as we have been. When you give us your best advice, wrap it up for us what you want us to know about hygiene in general, Kim. When we’re going to the grocery store, our kids are at school, and some of the most important things that you would like us to do as a healthcare professional and an infection preventionist. How we can look towards the future and maybe not use antibiotics so much so that they are effective when we need them to be.
Kim: Sure. Keep your hands clean, hand gel. The alcohol water based hand gels that’s at least above 60% alcohol will kill 99.9% of germs on your hands. So it’s much more useful in soap and water in many instances. If you're out and about, carry it with you. Clean and disinfect the surfaces of frequently touched areas. Door knobs, telephones, computer keyboards, iPads, iPhones. Those types of things. Try and keep those clean will also help. When patient gets to a hospital and the things that we do, we screen patients that are high-risk for antibiotic resistant organisms. We isolate them if needed. We test them, we screen them. We keep them in isolation until we’ve treated the antibiotic resistant organism. We also make sure that we’re using gloves. We’re cleaning our hands after gloves. We’re putting on PPE as we call it, protective equipment. Then cleaning and disinfecting the equipment and surfaces appropriately is extremely important in the healthcare field.
Host: It certainly is. I know I’ve turned into one of those ladies that uses the thing at the grocery store and wipes down the handle before I use the grocery cart. So I know. I think that it’s things that we can all do, small things. It’s great information you’ve given us today, Kim, and it’s so useable and thank you so much for educating us today about antibiotic resistance. This is Pediatric Specialty Care Spotlight with Shriners Hospitals for Children Chicago. For more information, please visit shrinerschicago.org. That’s shrinerschicago.org. This is Melanie Cole. Thanks for tuning in.
About the Speaker
Kim Romberg, MSN, RN
Kim Romberg is the Infection Preventionist at Shriners Children's Chicago
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