Nurses’ antimicrobial infusion practice under the spotlight

A report on a study on antibiotic underdosing and disposal in NHS organisations in England, Scotland and Wales, raises the concern that practices by clinical nurses may contribute to antimicrobial resistance (AMR) (Fady and Bennett, 2023). The report was sent to Baroness Bennett of Manor Castle at the House of Lords to raise for comment by the Department of Health and Social Care (DHSC) (UK Parliament, 2023).

Although great advances have been made in antimicrobial stewardship (AMS) in the past two decades, with changes in prescriber behaviour and improved infection prevention and control (IPC), it is clear that AMR remains a challenge. Increases in drug-resistant infections, both bacterial and fungal, and the sparse pipeline of antimicrobial medicines to treat these, remains a constant challenge in healthcare in this century, with little reassurance that relief lies ahead.

Many antibiotics and antifungal medications are best given by IV infusion. Fady and Bennett's report (2023) clearly highlights two main nursing practice concerns. The first is that these antimicrobial medicines are being delivered in such a manner that the patient does not receive the full prescribed dose. The lack of comprehensive ‘flushing’ guidelines within the NHS healthcare system (and elsewhere), results in a situation where nurses may not understand, or comply with, best practice. Further findings are that this nursing practice was generally unaudited. The second concern is the environmental contamination from discarded infusion items containing undelivered antimicrobial medicines. It must be recognised that both these practice issues may be drivers of AMR.