Improving Antimicrobial Use to Protect the Environment: What Is the Role of Infection Specialists?
Abstract
:1. Introduction
2. Definitions and Terminologies
2.1. What Is Environmental Sustainability?
2.2. What Is a Carbon Footprint?
2.3. What Is Net Zero?
2.4. What Is an Ecological Footprint?
2.5. What Is One Health?
3. Four Key Principles of Sustainable Healthcare
- Prevention—The most effective way to reduce negative environmental impacts of healthcare activities is avoiding the need for them to begin with.
- Patient engagement and autonomy—Empowering patients and enabling self-care reduces unnecessary contact with health professionals and organizations.
- Lean service delivery—Streamlining care avoids waste from duplication or interventions that do not add value or extend benefits in care pathways [25].
- Low carbon alternatives—Prioritizing interventions with lower greenhouse gas emissions and other environmental impacts (ecological footprint) can improve the sustainability of healthcare.
3.1. Prevention
3.2. Patient Engagement and Autonomy
3.3. Lean Service Delivery
3.4. Low Carbon Alternatives
4. Recommendations
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
- Klein, E.Y.; Van Boeckel, T.P.; Martinez, E.M.; Pant, S.; Gandra, S.; Levin, S.A.; Goossens, H.; Laxminarayan, R. Global Increase and Geographic Convergence in Antibiotic Consumption between 2000 and 2015. Proc. Natl. Acad. Sci. USA 2018, 115, E3463–E3470. Available online: https://pnas.org/doi/full/10.1073/pnas.1717295115 (accessed on 18 January 2023). [CrossRef] [PubMed] [Green Version]
- Aspergillus and Aspergillosis. Antimicrobials in Agriculture and the Environment: Reducing Unnecessary Use and Waste. The Review on Antimicrobial Resistance [Internet]. 10 December 2015. Available online: https://www.aspergillus.org.uk/article_database/antimicrobials-in-agriculture-and-the-environment-reducing-unnecessary-use-and-waste-the-review-on-antimicrobial-resistance/ (accessed on 18 January 2023).
- Polianciuc, S.I.; Gurzău, A.E.; Kiss, B.; Ştefan, M.G.; Loghin, F. Antibiotics in the environment: Causes and consequences. Med. Pharm. Rep. 2020, 93, 231–240. [Google Scholar] [CrossRef] [PubMed]
- Woolhouse, M.; Ward, M.; van Bunnik, B.; Farrar, J. Antimicrobial resistance in humans, livestock and the wider environment. Phil. Trans. R. Soc. B 2015, 370, 20140083. [Google Scholar] [CrossRef] [PubMed]
- Larsson, D.G.J.; Flach, C.F. Antibiotic resistance in the environment. Nat. Rev. Microbiol. 2022, 20, 257–269. [Google Scholar] [CrossRef] [PubMed]
- Kotwani, A.; Joshi, J.; Kaloni, D. Pharmaceutical effluent: A critical link in the interconnected ecosystem promoting antimicrobial resistance. Environ. Sci. Pollut. Res. Int. 2021, 28, 32111–32124. [Google Scholar] [CrossRef]
- World Health Organization. Global Action Plan on Antimicrobial Resistance [Internet]. 2015. Available online: https://www.who.int/publications-detail-redirect/9789241509763 (accessed on 18 January 2023).
- OECD. Antimicrobial Resistance: A Frightening and Complex Public Health Challenge. In Stemming the Superbug Tide: Just A Few Dollars More [Internet]; OECD Publishing: Paris, France, 2019; pp. 43–72, OECD Health Policy Studies; Available online: https://www.oecd-ilibrary.org/social-issues-migration-health/stemming-the-superbug-tide/antimicrobial-resistance-a-frightening-and-complex-public-health-challenge_9789264307599-5-en (accessed on 26 November 2022).
- World Health Organization. Infection Prevention and Control [Internet]. Available online: https://www.who.int/health-topics/infection-prevention-and-control (accessed on 10 March 2023).
- NHS Health Careers. Infectious Diseases [Internet]. 2015. Available online: https://www.healthcareers.nhs.uk/explore-roles/doctors/roles-doctors/medicine/infectious-diseases (accessed on 11 March 2023).
- Romanello, M.; Di Napoli, C.; Drummond, P.; Green, C.; Kennard, H.; Lampard, P.; Scamman, D.; Arnell, N.; Ayeb-Karlsson, S.; Ford, L.B.; et al. The 2022 report of the Lancet Countdown on health and climate change: Health at the mercy of fossil fuels. Lancet 2022, 400, 1619–1654. [Google Scholar] [CrossRef] [PubMed]
- Watts, N.; Adger, W.N.; Agnolucci, P.; Blackstock, J.; Byass, P.; Cai, W.; Chaytor, S.; Colbourn, T.; Collins, M.; Cooper, A.; et al. Health and climate change: Policy responses to protect public health. Lancet 2015, 386, 1861–1914. [Google Scholar] [CrossRef]
- Tennison, I.; Roschnik, S.; Ashby, B.; Boyd, R.; Hamilton, I.; Oreszczyn, T.; Owen, A.; Romanello, M.; Ruyssevelt, P.; Sherman, J.D.; et al. Health care’s response to climate change: A carbon footprint assessment of the NHS in England. Lancet Planet Health 2021, 5, e84–e92. [Google Scholar] [CrossRef] [PubMed]
- United Nations. Report of the World Commission on Environment and Development: Our Common Future [Internet]. 1987. Available online: https://www.are.admin.ch/are/en/home/medien-und-publikationen/publikationen/nachhaltige-entwicklung/brundtland-report.html (accessed on 18 January 2023).
- Rockström, J.; Steffen, W.; Noone, K.; Persson, A.; Chapin, F.S.; Lambin, E.F.; Lenton, T.M.; Scheffer, M.; Folke, C.; Schellnhuber, H.J.; et al. A safe operating space for humanity. Nature 2009, 461, 472–475. [Google Scholar] [CrossRef]
- ISO 14040:2006; International Organization for Standardization. Environmental Management—Life Cycle Assessment—Principles and Framework. ISO: Geneva, Switzerland, 2006.
- Net Zero Climate. What Is Net Zero? [Internet]. Available online: https://netzeroclimate.org/what-is-net-zero/ (accessed on 21 December 2022).
- National History Museum. What Does Carbon Neutral Mean and What Is Net Zero? [Internet]. Available online: https://www.nhm.ac.uk/discover/quick-questions/what-do-carbon-neutral-and-net-zero-mean.html (accessed on 10 March 2023).
- Stabinsky, D.; Dooley, K. Forests Can’t Handle All the Net-Zero Emissions Plans—Companies and Countries Expect Nature to Offset Too Much Carbon [Internet]. The Conversation. 5 November 2021. Available online: http://theconversation.com/forests-cant-handle-all-the-net-zero-emissions-plans-companies-and-countries-expect-nature-to-offset-too-much-carbon-170336 (accessed on 5 February 2023).
- Greener NHS. Delivering a ‘Net Zero’ National Health Service—July 2022 [Internet]. 4 July 2022. Available online: https://www.england.nhs.uk/greenernhs/publication/delivering-a-net-zero-national-health-service/ (accessed on 27 October 2022).
- Global Footprint Network. Ecological Footprint [Internet]. Available online: https://www.footprintnetwork.org/our-work/ecological-footprint/ (accessed on 18 January 2023).
- World Health Organization. One Health [Internet]. 21 September 2017. Available online: https://www.who.int/news-room/questions-and-answers/item/one-health (accessed on 10 March 2023).
- NHS Digital. Latest Hospital Admission Data Published [Internet]. 16 September 2021. Available online: https://digital.nhs.uk/news/2021/latest-hospital-admission-data-published (accessed on 10 March 2023).
- Centre for Sustainable Healthcare. What We Do [Internet]. Centre for Sustainable Healthcare. 2015. Available online: https://sustainablehealthcare.org.uk/what-we-do (accessed on 5 February 2023).
- Hensher, M.; Canny, B.; Zimitat, C.; Campbell, J.; Palmer, A. Health care, overconsumption and uneconomic growth: A conceptual framework. Soc. Sci. Med. 2020, 266, 113420. [Google Scholar] [CrossRef]
- Murray, C.J.; Ikuta, K.S.; Sharara, F.; Swetschinski, L.; Robles Aguilar, G.; Gray, A.; Han, C.; Bisignano, C.; Rao, P.; Wool, E.; et al. Global burden of bacterial antimicrobial resistance in 2019: A systematic analysis. Lancet 2022, 399, 629–655. [Google Scholar] [CrossRef] [PubMed]
- HM Government. Tackling Antimicrobial Resistance 2019–2024: The UK’s Five-Year National Action Plan [Internet]. 24 January 2019. Available online: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/1070263/UK_AMR_5_year_national_action_plan.pdf (accessed on 21 December 2022).
- Wilkinson, J.L.; Boxall, A.B.A.; Kolpin, D.W.; Leung, K.M.Y.; Lai, R.W.S.; Galbán-Malagón, C.; Adell, A.D.; Mondon, J.; Metian, M.; Marchant, R.A.; et al. Pharmaceutical pollution of the world’s rivers. Proc. Natl. Acad. Sci. USA 2022, 119, e2113947119. [Google Scholar] [CrossRef] [PubMed]
- World Health Organization. One Health Joint Plan of Action (2022–2026): Working Together for the Health of Humans, Animals, Plants and the Environment [Internet]. 14 October 2022. Available online: https://www.who.int/publications-detail-redirect/9789240059139 (accessed on 4 February 2023).
- Department of Health and Social Care; UK Health Security Agency; Department for Environment, Food & Rural Affairs, and Veterinary Medicines Directorate. Antimicrobial Resistance (AMR) [Internet]. 1 July 2022. Available online: https://www.gov.uk/government/collections/antimicrobial-resistance-amr-information-and-resources (accessed on 4 February 2023).
- European Commission. EU Action on Antimicrobial Resistance [Internet]. 2022. Available online: https://health.ec.europa.eu/antimicrobial-resistance/eu-action-antimicrobial-resistance_en (accessed on 4 February 2023).
- Diel, R.; Vandeputte, J.; de Vries, G.; Stillo, J.; Wanlin, M.; Nienhaus, A. Costs of tuberculosis disease in the European Union: A systematic analysis and cost calculation. Eur. Respir. J. 2014, 43, 554–565. [Google Scholar] [CrossRef] [Green Version]
- Public Health England. What the Public Know about Antibiotic Use and Resistance, and How We May Influence It: Findings from a 2017 National Survey. [Internet]. 10 November 2020. Available online: https://www.gov.uk/government/publications/antibiotic-use-and-resistance-what-the-public-know (accessed on 21 December 2022).
- Liew, K.; Wilkinson, A. How Do We Choose Inhalers? Patient and Physician Perspectives on Environmental, Financial and Ease-of-Use Factors. In Pharmacotherapies for COPD [Internet]; BMJ Publishing Group Ltd.: London, UK; British Thoracic Society: London, UK, 2017; pp. A235–A237. Available online: https://thorax.bmj.com/lookup/doi/10.1136/thoraxjnl-2017-210983.422 (accessed on 25 November 2022).
- Cameron, G.; Göpfert, A.; Gardner, T. Going Green: What Do the Public Think about the NHS and Climate Change? [Internet]. 25 October 2021. Available online: https://www.health.org.uk/publications/long-reads/going-green-what-do-the-public-think-about-the-nhs-and-climate-change (accessed on 25 November 2022).
- van Wijk, M.; Naing, S.; Diaz Franchy, S.; Heslop, R.T.; Novoa Lozano, I.; Vila, J.; Ballesté-Delpierre, C. Perception and knowledge of the effect of climate change on infectious diseases within the general public: A multinational cross-sectional survey-based study. PLoS ONE 2020, 15, e0241579. [Google Scholar] [CrossRef] [PubMed]
- World Health Organization. World Antimicrobial Awareness Week [Internet]. Available online: https://www.who.int/campaigns/world-antimicrobial-awareness-week (accessed on 10 March 2023).
- NHS Birmingham and Solihull. Public Urged to Join the Antibiotic Amnesty to Help Keep Antibiotics Working [Internet]. 10 November 2022. Available online: https://www.birminghamsolihull.icb.nhs.uk/news-and-events/news/public-urged-join-antibiotic-amnesty-help-keep-antibiotics-working (accessed on 21 December 2022).
- Kümmerer, K. The presence of pharmaceuticals in the environment due to human use—Present knowledge and future challenges. J. Environ. Manag. 2009, 90, 2354–2366. [Google Scholar] [CrossRef]
- Watkins, S.; Barnett, J.; Standage, M.; Kasprzyk-Hordern, B.; Barden, R. Household disposal of pharmaceuticals: Attitudes and risk perception in a UK sample. J. Mater. Cycles Waste Manag. 2022, 24, 2455–2469. [Google Scholar] [CrossRef]
- EHMA. EHMA White Paper: Reducing the Environmental Impact of Medicines from Procurement to Disposal [Internet]. 2022. Available online: https://ehma.org/2022/11/22/title-ehma-white-paper-reducing-the-environmental-impact-of-medicines-from-procurement-to-disposal/ (accessed on 26 November 2022).
- Jakobsen, K.A.; Melbye, H.; Kelly, M.J.; Ceynowa, C.; Mölstad, S.; Hood, K.; Butler, C.C. Influence of CRP testing and clinical findings on antibiotic prescribing in adults presenting with acute cough in primary care. Scand. J. Prim. Health Care 2010, 28, 229–236. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- National Institute for Health and Care Excellence. Procalcitonin Testing for Diagnosing and Monitoring Sepsis (ADVIA Centaur BRAHMS PCT Assay, BRAHMS PCT Sensitive Kryptor Assay, Elecsys BRAHMS PCT Assay, LIAISON BRAHMS PCT Assay and VIDAS BRAHMS PCT Assay) DG18 [Internet]; NICE: London, UK, 2015; Available online: https://www.nice.org.uk/guidance/dg18/chapter/2-The-technologies (accessed on 7 October 2015).
- Calderon, M.; Li, A.; Bazo-Alvarez, J.C.; Dennis, J.; Baker, K.F.; Schim van der Loeff, I.; Hanrath, A.T.; Capstick, R.; Payne, B.A.I.; Weiand, D.; et al. Evaluation of procalcitonin-guided antimicrobial stewardship in patients admitted to hospital with COVID-19 pneumonia. JAC-Antimicrob. Resist. 2021, 3, dlab133. [Google Scholar] [CrossRef]
- Aung, A.K.; Haas, D.W.; Hulgan, T.; Phillips, E.J. Pharmacogenomics of antimicrobial agents. Pharmacogenomics 2014, 15, 1903–1930. [Google Scholar] [CrossRef] [Green Version]
- McDermott, J.H.; Mahaveer, A.; James, R.A.; Booth, N.; Turner, M.; Harvey, K.E.; Miele, G.; Beaman, G.M.; Stoddard, D.C.; Tricker, K.; et al. Rapid Point-of-Care Genotyping to Avoid Aminoglycoside-Induced Ototoxicity in Neonatal Intensive Care. JAMA Pediatr. 2022, 176, 486. [Google Scholar] [CrossRef]
- Lubell, Y.; Do, N.T.T.; Nguyen, K.V.; Ta, N.T.D.; Tran, N.T.H.; Than, H.M.; Hoang, L.B.; Shrestha, P.; van Doorn, R.H.; Nadjm, B.; et al. C-reactive protein point of care testing in the management of acute respiratory infections in the Vietnamese primary healthcare setting—A cost benefit analysis. Antimicrob. Resist. Infect. Control. 2018, 7, 119. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Ashiru-Oredope, D.; Hopkins, S.; Vasandani, S.; Umoh, E.; Oloyede, O.; Nilsson, A.; Kinsman, J.; Elsert, L.; Monnet, D.L.; the #ECDCAntibioticSurvey Project Advisory Group. Healthcare workers’ knowledge, attitudes and behaviours with respect to antibiotics, antibiotic use and antibiotic resistance across 30 EU/EEA countries in 2019. Eurosurveillance 2021, 26, 1900633. [Google Scholar] [CrossRef] [PubMed]
- Scottish Antimicrobial Prescribing Group. Scottish Reduction in Antimicrobial Prescribing (ScRAP) [Internet]. Available online: https://www.sapg.scot/guidance-qi-tools/quality-improvement-tools/scottish-reduction-in-antimicrobial-prescribing-scrap/ (accessed on 10 March 2023).
- Jones, L.F.; Verlander, N.Q.; Lecky, D.M.; Altaf, S.; Pilat, D.; McNulty, C. Self-Reported Antimicrobial Stewardship Practices in Primary Care Using the TARGET Antibiotics Self-Assessment Tool. Antibiotics 2020, 9, 253. [Google Scholar] [CrossRef]
- Public Health England. Start Smart—Then Focus Antimicrobial Stewardship Toolkit for English Hospitals [Internet]. March 2015. Available online: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/417032/Start_Smart_Then_Focus_FINAL.PDF (accessed on 6 February 2023).
- UK Health Security Agency. English Surveillance Programme for Antimicrobial Utilisation and Resistance (ESPAUR) Report [Internet]. 21 November 2022. Available online: https://www.gov.uk/government/publications/english-surveillance-programme-antimicrobial-utilisation-and-resistance-espaur-report (accessed on 21 December 2022).
- Chapman, A.L.N.; Patel, S.; Horner, C.; Green, H.; Guleri, A.; Hedderwick, S.; Snape, S.; Statham, J.; Wilson, E.; Gilchrist, M.; et al. Updated good practice recommendations for outpatient parenteral antimicrobial therapy (OPAT) in adults and children in the UK. JAC-Antimicrob. Resist. 2019, 1, dlz026. [Google Scholar] [CrossRef] [Green Version]
- Tan, S.J.; Ingram, P.R.; Rothnie, A.J.; Whitmore, T.J.; Robinson, J.O.; Hatch, J.B.; Italiano, C.M.; Heath, C.J. Successful outpatient parenteral antibiotic therapy delivery via telemedicine. J. Antimicrob. Chemother. 2017, 72, 2898–2901. [Google Scholar] [CrossRef] [Green Version]
- Sumpter, C.; Russell, C.D.; Mackintosh, C. Inequitable access to an outpatient parenteral antimicrobial therapy service: Linked cross-sectional study. Int. J. Equity Health 2020, 19, 150. [Google Scholar] [CrossRef] [PubMed]
- Heintz, B.H.; Halilovic, J.; Christensen, C.L. Impact of a multidisciplinary team review of potential outpatient parenteral antimicrobial therapy prior to discharge from an academic medical center. Ann. Pharmacother. 2011, 45, 1329–1337. [Google Scholar] [CrossRef]
- McAlister, S.; Ou, Y.; Neff, E.; Hapgood, K.; Story, D.A.; Mealey, P.; McGain, F. The environmental footprint of morphine: A life cycle assessment from opium poppy farming to the packaged drug. BMJ Open 2016, 6, e013302. [Google Scholar] [CrossRef] [Green Version]
- Greener NHS. Net Zero Supplier Road Map, Suppliers. [Internet]. 2021. Available online: https://www.england.nhs.uk/greenernhs/get-involved/suppliers/ (accessed on 27 October 2022).
- Myo, J.; Pooley, S.; Brennan, F. Oral, in place of intravenous, paracetamol as the new normal for elective cases. Anaesthesia 2021, 76, 1143–1144. [Google Scholar] [CrossRef]
- UK Health Security Agency. Antimicrobial Intravenous-to-Oral Switch (IVOS) Decision Aid [Internet]. 1 January 2023. Available online: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/1133525/Final_IV_to_Oral_Switch_Decision_Aid_based_on_NationalCriteria_UKHSA.pdf (accessed on 17 February 2023).
- Li, H.K.; Rombach, I.; Zambellas, R.; Walker, A.S.; McNally, M.A.; Atkins, B.L.; Lipsky, B.A.; Hughes, H.C.; Bose, D.; Kümin, M.; et al. Oral versus Intravenous Antibiotics for Bone and Joint Infection. N. Engl. J. Med. 2019, 380, 425–436. [Google Scholar] [CrossRef]
Disclaimer/Publisher’s Note: The statements, opinions and data contained in all publications are solely those of the individual author(s) and contributor(s) and not of MDPI and/or the editor(s). MDPI and/or the editor(s) disclaim responsibility for any injury to people or property resulting from any ideas, methods, instructions or products referred to in the content. |
© 2023 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
Share and Cite
Walpole, S.C.; Eii, M.N.; Lyons, T.; Aldridge, C. Improving Antimicrobial Use to Protect the Environment: What Is the Role of Infection Specialists? Antibiotics 2023, 12, 640. https://doi.org/10.3390/antibiotics12040640
Walpole SC, Eii MN, Lyons T, Aldridge C. Improving Antimicrobial Use to Protect the Environment: What Is the Role of Infection Specialists? Antibiotics. 2023; 12(4):640. https://doi.org/10.3390/antibiotics12040640
Chicago/Turabian StyleWalpole, Sarah Catherine, Min Na Eii, Tracy Lyons, and Catherine Aldridge. 2023. "Improving Antimicrobial Use to Protect the Environment: What Is the Role of Infection Specialists?" Antibiotics 12, no. 4: 640. https://doi.org/10.3390/antibiotics12040640
APA StyleWalpole, S. C., Eii, M. N., Lyons, T., & Aldridge, C. (2023). Improving Antimicrobial Use to Protect the Environment: What Is the Role of Infection Specialists? Antibiotics, 12(4), 640. https://doi.org/10.3390/antibiotics12040640