In New York’s Montefiore Health System, Belinda Ostrowsky, known as the hospital’s antibiotic steward, has made reducing the use of powerful antibiotics her priority. Dr. Ostrowsky, who helps oversee a 64-hospital effort to reform antibiotic use sponsored by the United Hospital Fund, a nonprofit health research organization, and the Greater New York Hospital Association, says while “cleaning is very important, you can’t only clean the environment and not do the antibiotics.”
Powerful, broad-spectrum antibiotics kill the “bad” bacteria that make a person sick as well as the “good” bacteria in the patients’ systems, leaving them vulnerable. A doctor at Montefiore who wants to prescribe one of several strong antibiotics must get the case reviewed and seek permission, Dr. Ostrowsky says.
Dr. Koll says he is also grappling with antibiotic overuse at the Mount Sinai system. He recommends a “time out,” reassessing patients a couple of days after they start antibiotics to see if a more targeted drug could be used. And he urges a return in some cases to “older, cheaper, narrower spectrum antibiotics,” whose use has at times faded as powerful, broad-spectrum antibiotics came on the market. The old workhorse penicillin, for instance, won’t work on many severe infections common in hospitals, but there are times it could be used effectively, including for meningitis and pneumococcal pneumonia , Dr. Koll says. He also favors an older antibiotic from the 1970s called Bactrim. “Newer is not better. You don’t need to use these super, super drugs,” he says.
Dr. Fauci, of the National Institute of Allergy and Infectious Diseases, agrees older drugs might be very useful in the fight against antibiotic-resistant bugs, though he has doubts about penicillin. It is important “to go back to antibiotics we haven’t used to try to repurpose them again,” he says.
In another initiative, Dr. Koll installed “secret shoppers,” similar to the people stores use to spot shoplifters, who roamed hospitals checking if workers and doctors were cleaning their hands. But there was pushback, and they were renamed “anonymous observers,” which he says is less “gotcha.” He and his team also use a product called Glo Germ. To demonstrate its use, Dr. Koll applies some to a table, scrubs it and shines a special light to look for the presence of germs.
Dr. Koll, named executive director of infection control and prevention over the Mount Sinai system about a year and a half ago, says he is seeing some results. C. diff-infection rates at three hospitals are below the state level. Rates of surgical-site infections are also down, particularly in cardiac surgery.
Sinai’s flagship hospital, with its complex patient population, poses some of the toughest challenges. On a recent October afternoon, Dr. Koll toured Mount Sinai’s neurosurgical intensive care unit, which had an outbreak of C. diff last spring. Alarmed, staff sprang to action. Patients were moved to other units while crews engaged in “terminal cleaning,” scrubbing rooms from top to bottom.
Desktops and shelves were stripped of books and papers, which are a draw for germs, leaving only patient charts. Bleach was used liberally.
The measures appear to be working. C. diff cases plunged to zero in the past couple of months. Dr. Koll smiled as he walked around the unit. He could smell the bleach.