On this World Patient Safety Day 2022, we are reminded of how unsafe medical practices can exacerbate existing medical conditions or even create additional health issues. This is particularly the case in the use of medication, where errors can significantly harm patients. This year, the WHO has chosen the slogan “Medication without harm” to raise awareness about this major problem, and the circumstances and conditions that give rise to it. These include poor training of both of healthcare professionals and patients, staff shortages, and a lack of infection prevention and control measures, among other factors.
One of the most far-reaching and impactful consequences of these errors, to a large extent, is Antimicrobial Resistance (AMR), where the inappropriate use of antibiotics leads to bacteria becoming resistant to them. This makes regular medical interventions increasingly dangerous, in particular intensive care, cancer treatment, and organ transplantation. The development of so-called “superbugs”, bacteria resistant to the most used antibiotics, represents a threat to modern medicine and could go so far as to push back decades of medical advances. AMR does not discriminate in its potential to harm patients: complications from drug-resistant bacteria can affect anyone, no matter their health status, of any age, and in any country, leading to increased medical costs, prolonged hospital stays, greater demands on healthcare infrastructure and capacity, and increased mortality. This is to say nothing of the implications of AMR beyond human health: resistance can build as medication cycles across humans, animals, and the environment, with antibiotics in livestock and in agricultural uses contributing to AMR in humans and vice versa.
Several factors lead to this misuse or overuse of antibiotics. To begin with, there is a general lack of awareness among the public. A 2015 WHO survey conducted in 12 countries revealed that while 64% of people knew about antimicrobial resistance, around the same number incorrectly believed antibiotics can be used to treat colds and flu. As viral infections, antibiotics have no effect as the health of the patient is concerned – although attempting to treat viruses with antibiotics does exacerbate AMR. Additionally, while most healthcare professionals are aware of the risk of excessive antimicrobial use, there are still some gaps. A 2019 ECDC survey showed that only 75% of healthcare professionals were aware of the link between treatment with antibiotics and an increased risk of antibiotic-resistant infection. Many also recognised that they have prescribed antibiotics to patients when they would have preferred not to, for “fear of patient deterioration” or “fear of complications”.
Several measures need to be implemented urgently to address this truly global public health threat. First, better infection prevention measures are needed. During the Covid-19 pandemic, citizens around the world came to realise the importance of their own actions in preventing infections, and how individual efforts can make a widely felt difference. Similar measures to the ones taken during that health emergency, building on this awareness and sense of shared mobilisation, can also be applied to AMR. First, better hand hygiene, particularly in healthcare settings, is essential. Local advocacy groups, working together with healthcare professionals, should help create and disseminate checklists with key hygiene measures that can easily be followed by everyone. Second, to avoid unnecessary consumption of antibiotics, healthcare professionals should make sure that a specific antibiotic is needed before prescribing it when a patient shows symptoms of infection. A better use of point-of-care rapid testing could reassure them about whether and which antibiotics are needed. Existing medical technologies are already effective in determining the relevant pathogen, but further investment is necessary to make them even more accurate and to reduce the instances of healthcare professionals who felt compelled to unnecessarily prescribe out of fear or uncertainty. Finally, awareness raising among the public is also indispensable. If patients are better informed, they will be aware that they should only be taking antibiotics if prescribed to them and in the manner prescribed to them (i.e., they should follow the antibiotic treatment as prescribed, not stop it prematurely once the symptoms disappear).
AMR is a serious health concern, but it is one where greater leadership from policy makers, healthcare professionals, and patient advocates can help reduce harm, improve outcomes, and make global progress. World Patient Safety Day remains a positive occasion to reflect on where that leadership is most needed and what we can do to find solutions that would help everyone address the major public health threat that Antimicrobial Resistance represents. In Europe, both the EU and Member States, together with all relevant stakeholders, should work together to find a common approach to urgently address this problem, doing the necessary work to raise awareness and promote best practices, gathering and sharing key health data, and endorsing a comprehensive “One Health” approach that brings all sectors together.