Clinicians' Perceptions of the Problem of Antimicrobial Resistance in Health Care Facilities

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Abstract
Antimicrobial resistance (AR) has increasingly become a threat to patient safety in health care settings. Several pathogens have developed resistance or multiple resistance to key antimicrobials, including vancomycin-resistant enterococci, extended-spectrum β-lactamases, methicillin-resistant Staphylococcus aureus (MRSA), and, most recently, vancomycin-resistant S aureus.1-4 Several studies2,3,5-9 have identified the inappropriate use of antimicrobials and noncompliance with infection control precautions as the main risk factors for AR and the main areas of opportunity for increasing patient safety and improving patient outcomes. High rates of antimicrobial use have been linked to high rates of resistance in the hospital, and increased exposure to antimicrobials has been associated with an increased probability of colonization with resistant pathogens.5 Inconsistent compliance with infection control precautions has exacerbated the problems associated with antimicrobial overuse and misuse through the transmission of resistant pathogens by clinicians.2,6-8 Person-to-person transmission via the hands of clinicians is the primary conduit for transmitting resistant pathogens; compliance with recommended hand-washing practices has been reported as little as 4% of the time among clinicians in direct patient contact, and compliance with isolation precautions for patients with antimicrobial-resistant pathogens has been reported less than 50% of the time.4,10-12