Combating the rising rates of healthcare-associated infections (HAI) and antimicrobial resistance (AMR) remains a significant issue across various healthcare environments. This article discusses the potential integrated utilization of Infection Prevention and Control (IPC) practices and Antibiotic Stewardship (ABS) programs in mitigating this issue, specifically emphasizing insights from the REVERSE trial that is backed by the European Union’s Horizon 2020 program. The REVERSE trial, featuring 24 acute care hospitals from four European countries with high AMR and HAI rates, intends to determine whether implementing an IPC and ABS consecutively is feasible, sustainable and superior in yielding improved clinical outcomes as compared to basic conditions. Essentially, it aims to shed light on effective integration strategies for IPC and ABS in routine healthcare setups.
AMR is a global challenge that particularly threatens the successful treatment of infections, with Europe being one of the many significant hotspots. According to 2019 data, AMR-associated deaths in the WHO European Region stood at 674,000, with high death rates being reported particularly in Eastern and Central Europe. HAIs contribute to prolonged hospital stays, thereby presenting a substantial cost challenge. Several European countries including Italy, Greece, Romania, and Spain report high AMR rates compared to the European average.
IPC and ABS have been identified as potential strategies to counter AMR. IPC aims to decrease microbial transmission to patients and healthcare workers, prevent HAIs through preventive practices such as the implementation of programs and guidelines, training and education, surveillance, and adherence to minimum staffing, workload and bed occupancy ratios. On the other hand, ABS strategies promote the appropriate use of antibiotics in healthcare settings to lessen AMR.
The current literature, however, tends to assess IPC and ABS separately. The combined and integrated application of both programs is consequently being increasingly advocated for, given the potential to further enhance effectiveness in combating AMR. An aspect of crucial importance that needs more attention is the quality of implementation of IPC and ABS. This is where the REVERSE trial comes in, aiming to combine use and implementation of IPC and ABS.
The REVERSE trial is designed as a stepped wedge cluster randomized hybrid type 2 trial. It strives to determine the effectiveness of both the clinical intervention and the implementation strategy, thereby accelerating the incorporation of research findings in routine healthcare settings. Moreover, the core of the REVERSE implementation evaluation lies in finding whether facilitated, tailored implementation of IPC and ABS is superior to basic implementation, identifying the anticipated and encountered contextual barriers and facilitators in implementing IPC and ABS in different healthcare settings, and assessing the level of implementation with fidelity of IPC, ABS and tailoring.
To sum up, the execution and results of the REVERSE trial will indeed make a significant stride towards understanding the most effective ways to combat AMR and HAIs. Its focus on the combined use and implementation of IPC and ABS strategies, along with an emphasis on a tailored approach, allows for significant contributions to both the infection prevention and control field and the broader healthcare landscape.
Source: https://trialsjournal.biomedcentral.com/articles/10.1186/s13063-025-09132-x