Exploration of BSAC and EWMA position paper on antimicrobial stewardship in wound care

You have almost completed week 2 and you have also reflected in practice with clinicians and multidisciplinary teams. In this step, Professor Karen Ousey summarises the antimicrobial stewardship in wound care position paper.

Why is antimicrobial stewardship so essential for wound management?

In the past two weeks, we’ve discussed and highlighted that the world is facing a rapidly worsening crisis related to antimicrobial resistance, and there’s very little published guidance on prudent antimicrobial therapy being used to treat infected wounds. And yet, hospitals and clinics across the world have to deal with infected wounds on a daily basis.

We should not be taking wound swabs and prescribing antibiotics if there are no clinical signs and symptoms of wounds infection, yet we still see this happening. Additionally, patients often demand a wound swab or antibiotics because they feel they are getting some treatment and the wound will then improve. Hence, we need to teach patients, relatives, and carers about antimicrobial resistance, and how they can play a pivotal role in managing this.

In the position paper:

The position paper on antimicrobial stewardship has a resource table that can be accessed in the downloads section below. It shows us the opportunities, good practice, and the antimicrobial stewardship goal of all our interventions. It’s worth taking a few minutes to read this, and reflect on how you can translate this information to other health care professionals, members of the multidisciplinary and inter-professional team, and patients and carers. We should also be very aware that antimicrobial stewardship should cover both acute, and primary and secondary care settings. We need to ensure that clinicians and in-hospital people are aware of this important area.

It also highlights topical antimicrobial use, and they identify that non-antibiotic antimicrobials are widely used in wound care such as antiseptics (e.g. chlorhexidine, povidone or cadexomer iodine), heavy metals (e.g. silver, mercury [mercurochrome]) and natural products (e.g. honey, charcoal), yet we have limited data supporting their usefulness. This is an area that we need to be looking at and developing more evidence and research.

Remember, antimicrobial stewardship isn’t just about using antimicrobial wound dressings, but it’s also about antiseptics and antibiotics, so we need to look at this as a package of interventions. Some clinicians prefer antiseptics, and are aware of its ability to cleanse the wound and make the wound bed clean. However, some antiseptics may delay healing, so it is crucial to understand which antiseptics are safe and to appreciate the holistic assessment required of a patient to ensure that we know if they’re allergic to anything and any past medical history.

It has lots of other handy guides, like the one below. The full position paper is available for further reading.

Algorithmic approach to antibiotic therapy for wounds. Click to enlarge

Future Research

  • We need to find accurate methods to determine whether or not a wound is infected. Perhaps a tool or technological advance, that would help us diagnose wound infection at an early stage and in a timely manner.

  • The efficacy and safety of various types of antimicrobial dressings on wounds needs to be looked into further.

  • We must investigate simple ways to detect biofilm in wounds. Often, it can go undetected as we may not be able to visualise it.

  • The effectiveness of shorter durations of antibiotic therapy on resolution of infection must be tested.

  • We need rapid diagnostic tests that can tell us the type of bacteria, presence of virulence factors, or antibiotic resistance genes so that the most appropriate treatments can be administered in time.

  • Conduct clinical studies to test the value of various antiseptics in treating colonised and infected wounds, especially to see if these can reduce the need for antibiotic therapy.

We have to take control of antimicrobial resistance now, and not just think about it. Prevention is better than cure. The cure at the moment is antibiotics and antimicrobial therapy, for which we have limited research in wound care. We need to look at how we can best prevent and manage infection. This can only be achieved through educating the interdisciplinary team; educating and involving patients and carers in their own interventions so they can take responsibility as one’s self care; and to undertake good research that is shared to all professional groups.

In the comments section, please share what you think about how schemes for antimicrobial stewardship in wound management are being implemented, and whether or not you agree with the contents of the position paper.

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This article is from the free online course:

Antimicrobial Stewardship in Wound Management

BSAC

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