Antimicrobial Resistance: The Public Health Threat That Could Set Surgery Back Decades

Antimicrobial resistance (AMR) is arguably one of the greatest challenges we face in public health today. The healthcare agenda is rightly focussed on improving patient health outcomes, enhancing their satisfaction, and improving cost efficiency. At the same time, a critical threat lurks poised to undermine all this good work – more and more infections that are resistant to antibiotics. Antibiotics have saved countless lives and enabled surgery to be performed safely all over the world for decades. However, in many instances they have been misused, or overused, and the development of new antibiotics has not kept pace with demand. Soon we may run out of options.

Each year it is estimated that more than four million patients in Europe acquire an infection in a healthcare-associated setting,[i] yet many of these infections are preventable.[ii] Unnecessary infections lead to unnecessary prescribing of antibiotics, and the more antibiotics prescribed, the higher the likelihood of AMR. Sadly, hospital-associated infections are a leading cause of in-hospital death worldwide[iii] and – without antibiotics – even greater numbers of patients will be at risk of the devastating effects of infections that are no longer treatable.

If we don’t get on top of this, the types of surgeries we currently perform everyday will become riskier, and potentially impossible. This could wipe out 70 years of progress in some types of surgery.

The introduction of antibiotics was a key enabler in the evolution of surgical treatment options that were once beyond surgeons’ aspirations. Today, many surgery-related infections are only treatable with certain types of antibiotics. AMR is already here, and if the grip of AMR becomes tighter still, then a spectrum of surgeries may no longer be considered ethically appropriate or safe to perform. Surgical options for some conditions, and patients’ expectations and hopes from surgery, could diminish to levels not seen for generations.

To drive the AMR debate forward, Johnson & Johnson Medical Devices Companies partnered with the Clinical Services Journal to develop a platform for experts in infection prevention and patient safety to voice their perspectives on this important issue. The resulting supplement: ‘Through the Looking Glass: A World Without Surgery-Related Infections’ available here includes a collection of interviews that bring to life the impact that surgery-related infections has on patients, surgeons and the healthcare system, and discusses potential barriers and solutions to combat this burden.

What is evident from this compendium of expertise is that, while fighting surgery-related infections is complex, there is so much more that can be done in terms of prevention, detection, monitoring and treatment.

Change is needed now but this cannot be observed or approached in a vacuum. Furthermore, the onus cannot solely fall on those working within the surgical setting. Collaboration and commitment from all stakeholders at all levels and in all settings across the continuum of care is required; from the hospital, to the community, to the home. Education must also serve an important role for both patients and their families/carers, so they may be informed to act on guidelines such as preoperative bathing.[iv]

When we get infection prevention right, everyone wins. It can help improve patient experience, health outcomes and may support a faster and smoother journey back to health and a better quality of life. A reduction in infections may also expand patient access to care and reduce the total cost of treatment by helping to shorten inpatient bed days and prevent re-admissions and additional operations due to infection. We know all of this, yet despite decades of improvement and innovation in healthcare, infections remain a critical burden on patients, hospitals and public health.

At Johnson & Johnson Medical Devices Companies we believe combating AMR is everyone’s responsibility. Clinicians, patients, policy makers, the medical technology industry and all relevant stakeholders must speak up and act now.

The medical technology industry is at the forefront of innovation and we are well placed to use our collective capabilities to help reduce the rates and impact of surgery-related infections. We can do this by focusing on all steps in the care pathway to identify areas for improvement: from processes and practices, to services, education, training and products. Johnson & Johnson Medical Devices Companies are channeling best practice from every corner of the globe and drawing from 130+ years of infection prevention experience to combat surgery-related infections and AMR. For example, infection prevention was the founding focus of Johnson & Johnson when it was established in 1886. Our first mass produced product was the world’s first commercially available sterile suture, designed to reduce the spread of infection.

Today, our vision for the future centers around a world where surgery-related infections and AMR are a thing of the past, because patient safety always comes first.

To make this vision a reality we will continue to listen to, learn from and equip those on the frontlines of infection prevention with practical, innovative products and solutions that are backed by solid evidence. Only by deploying the latest technology, working alongside care providers, learning from best practice and continuously challenging ourselves to do more as an industry, can we support standards setting that will prevent AMR and protect the patients we serve today and will do for generations to come.

[i] WHO, Health care-associated infections, fact sheet, http://www.who.int/gpsc/country_work/gpsc_ccisc_fact_sheet_en.pdf. Accessed March 2019.

[ii] Odom-Forren, Preventing Surgical Site Infections. Nursing 2006;36:58-63.

[iii] Koch AM, et al. Mortality related to hospital-associated infections in a tertiary hospital; repeated cross-sectional studies between 2004-2011. Antimicrob Resist Infect Control. 2015;4:57.

[iv] WHO 2018, “Global Guidelines for the Prevention of Surgical Site Infection”, page 58, http://apps.who.int/iris/bitstream/10665/250680/1/9789241549882-eng.pdf?ua=1. Accessed March 2019.