IPC and antimicrobial stewardship: hand in hand or on different floors of the hospital?

If we get it right, IPC should work in partnership with antimicrobial stewardship (AMS). You could even argue that AMS should be seen as one of the “deliverables” of IPC (along with surveillance, environmental IPC, outbreak management etc). Many of the same people are involved with the delivery of the programmes, and yet, those working in IPC and AMS often find themselves on different floors of the hospital (literally and metaphorically). The article that has inspired this blog introduces some really practical suggestions on how IPC and AMS can be integrated more effectively, Sierra Leone as a bit of a case study. using I’ve written this post in preparation for tomorrow’s Journal Club in partnership with the Healthcare Infection Society (HIS).

Why I chose this article:

The combined threat from healthcare-associated infections (HCAIs) and antimicrobial resistance (AMR) represents one of the most pressing global health threats. This article stood out because it uses some data from Sierra Leone, part of the low- and middle-income countries (LMICs) group of countries, to illustrate some practical and scalable ideas around the integration of IPC and AMS. The study’s focus on real-world implementation across multiple hospitals offers valuable insights for IPC professionals, policymakers, and global health practitioners.

Design and methods:

The authors conducted a cross-sectional survey in October 2024 involving 12 hospitals (six secondary and six tertiary) across Sierra Leone. Hospitals were selected based on the presence of both a hospital pharmacist and an IPC focal point, and their participation in the national antibiotic use point-prevalence survey. The survey used selected indicators from the WHO AMS toolkit and IPC core components to assess infrastructure, policy, and practice. Data were collected via a short online survey completed jointly by pharmacists and IPC leads.

Key findings:

• Infrastructure gaps: While all hospitals had IPC programs, only 25% had formal AMS committees—all in tertiary hospitals. Only one hospital had a combined IPC/AMS committee.
• Laboratory access: Only half of the hospitals had access to microbiological labs, mostly in tertiary settings.
• Policy and practice deficiencies (92% lacked AMS education/training; 100% lacked an antibiotic formulary; 92% lacked prescription/treatment guidelines; 83% lacked AMR and antibiotic use surveillance).
• One of the hospitals stood out as an example of best practice: Connaught Hospital, with a joint IPC/AMS committee.

Strengths and limitations:

• Multi-site design across diverse hospital levels and regions.
• Use of standardized WHO tools enhances comparability and relevance.
• Highlights a feasible, context-sensitive model for AMS integration via existing IPC structures.
• 'Convenience’ sampling may limit generalisability.
• Self-reported data could introduce bias.
• The study did not assess clinical outcomes or AMR trends directly.

Points for discussion:

• Would the model of an integrated IPC / AMS programme work in all settings? Thinking about my own IPC committees and how congested they are, I can’t see how our IPC programme could be fully implemented in a fully combined structure with our AMS programme – the committee meetings would take days! But there is certainly more that could be done in terms of integration.
• How can secondary hospitals in LMICs be supported to establish AMS programs?
• What are the barriers to implementing antibiotic formularies and treatment guidelines?
• How can laboratory structures be strengthened?
• Could national policy mandate the integration of IPC and AMS committees?
• How can training and surveillance be scaled sustainably in resource-limited settings?

What this means for IPC:

• This study reinforces the critical role of IPC as a foundation for AMS, especially in LMICs.
• IPC structures are often more established and can serve as a launchpad for AMS initiatives. By leveraging existing IPC committees, hospitals can accelerate AMS implementation, even in the absence of dedicated resources.
• This integrated approach not only improves antimicrobial use but also strengthens overall patient safety.