Collaborating with the Intensive Care Society
In September 2023, the BIA launched a collaboration with the Intensive Care Society. The aim of the collaboration is to provide a forum for infection and critical care specialists to discuss how we can improve patient care whilst minimising antibiotic usage and future resistance. The steering committee consists of consultants in infection, critical care and pharmacy who meet four times are year.
Why Collaborate?
One of the reasons I was keen to pursue this collaboration was to consider how we deliver infection services to ICUs, most frequently in the form of microbiology ward rounds. This timely publication by Kordo and colleagues highlighted the variability in how microbiology ward rounds are delivered. The publication was based on a survey that was completed by 40% of the intensive care units in the UK. This survey showed that three quarters of the units had access to regular specialist infection advice either daily (48.3%) or three times a week (20.7%) and all units could obtain telephone advice when needed. Most units used hospital or Trust-wide antimicrobial guidance but 8% had local ICU-specific antibiotic guidance.
Optimising Services Provided
The ICS guidelines for the provision of intensive care services recommend seven days a week input from microbiology in the form of timetabled rounds with a adequately senior clinician which would ideally be face-to-face. The BIA workforce standards document propose a ward round three times a week, with the addition of telephone and bedside consults as needed for urgent cases. Provision of daily in-person ward rounds are not always practical for microbiology services which may cover multiple hospital sites and are challenged by work force shortages. So, how can we optimise the services we provide?
When microbiologist first conducted ward rounds within ICUs, laboratory results were provided on paper, antibiotic guidelines were less developed and virtual meetings not in existence. In most Trusts laboratory results are now reported via electronic systems, guidelines are readily available, and virtual meetings are frequently the default way we meet. In addition to the day-to-day advice, we also have more pressing need to ensure appropriate antibiotic use and limit the transmission of infection. The survey demonstrated that half of ITUs had access to local epidemiology data, including susceptibility profiles and rates of antibiotic resistance. In 23% of ICUs local antibiotic consumption data were provided but these data were only discussed in 13% of units. The remaining 50% of respondents either did not have access or were unsure whether they received antibiotic consumption data.
Our First Collaborative Project
How do we ensure that we are adding value above just reiterating guidelines and providing results which are readily available? How do we maintain high standards of care and keep with changes such as the rapid molecular diagnostics and implement new evidence? These are some of the questions that we will tackle in our first collaborative project creating standards for microbiology intensive care ward rounds. Alongside we are planning regular education sessions to provide teaching from the infection and critical care perspectives. These sessions will be aimed at intensive care and infection trainees. The first session will be in early 2025, starting with a session on the prevention, diagnosis and management of ventilator associated pneumonia.