Antimicrobial Resistance and Antimicrobial Stewardship

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About Healthcare-Associated Infections (HAI) and Antimicrobial Resistance (AR)

Healthcare-associated infections (HAIs) and antimicrobial resistance overlap but are not the same. HAIs are sometimes but not always caused by antimicrobial-resistant organisms. Resistant organisms that sometimes cause HAIs include methicillin-resistant Staphylococcus aureus (MRSA), carbapenem-resistant Enterobacterales (CRE), and Candida auris. Antibiotic-resistant bacteria can cause infections in the community (such as resistant pneumococcal infections or community-associated MRSA) and in animals. Resistant organisms may also be found in the environment, such as soil, water, and some foods.

Central Line-Associated Bloodstream Infections

A central line is a long tube (catheter) that goes into a large vein in the chest or upper arm. Central lines are used to put medicines, nutrients, or fluids into the patient's blood and to remove blood for laboratory testing.

Central lines are typically kept in place longer than a regular peripheral  intravenous (PIV) catheter. They can be used for treatment of kidney disease (dialysis) or cancer (chemotherapy) and can be left in place even after discharge from the hospital.

Infections that occur with a central line are called Central Line-Associated Bloodstream Infections (CLABSI).

• Preventing CLABSI – what to know and look for to prevent CLABSI

Surgical Site Infections

Infections that occur after surgery are called Surgical Site Infections (SSI). SSIs can be superficial, involving just the skin, or deep, involving a body cavity. through resources for both patients and healthcare providers. Find resources here about SSIs.

• FAQs about Surgical Site Infection – what to know before you have surgery

How can I prevent an HAI?

Be informed, be empowered, be prepared!

• Be an active member of your health care team—speak up!
• Clean your hands. Washing hands with soap and water is the best way to get rid of germs. If soap and water are not available, use an alcohol-based sanitizer. To wash your hands, rub your hands with soap and running water for at least 20 seconds. Key times to clean your hands are - after blowing your nose, after using the toilet, and before eating or touching food.
• Ask all health care workers and visitors to clean their hands before touching you.
• Know the signs and symptoms of infection.
• Don't be afraid to ask questions.
• Get smart about antibiotics. Ask if tests will be done to make sure the right antibiotic is prescribed.
• If your family or friends have a cold or the flu, ask them to refrain from visiting you in the hospital until they are feeling better.

Antimicrobial Resistance

Antimicrobial resistance means germs, like bacteria, viruses, fungi, or parasites, have changed to resist the killing effects of a medication used for treatment. Once germs become resistant to antimicrobials, they can continue to multiply, causing more harm. Infections due to antimicrobial resistant organisms are more difficult to treat, require more toxic and expensive treatments, lead to longer hospital stays, and can spread from person to person, compounding the problem.

According to the US Centers for Disease Control, more than 2.8 million antimicrobial-resistant infections occur in the U.S. each year, and more than 35,000 people die as a result.

Frequently Asked Questions

What are antimicrobials?

Antimicrobials are a group of medications that treat microorganisms or germs.

• Antibiotics treat bacterial infections, like strep throat.
• Antifungals treat fungal infections, like ringworm.
• Antivirals treat viral infections, like influenza.
• Antiparasitics treat parasitic infections, like malaria.  

When can antibiotics help?

Antibiotics are effective against bacterial illnesses like strep throat or urinary tract infection.

They are not effective against viral illnesses like a cold or the flu.

When can antibiotics cause harm?

Taking antibiotics when they are not needed exposes patients to risk of antibiotic-associated harms without any benefits. Harms from antibiotics include antibiotic resistance, allergic reactions, disruption of intestinal flora, and severe antibiotic associated diarrhea due to Clostridioides difficile infection.

Combating Antimicrobial Resistance

The Washington State Department of Health works to combat antimicrobial by helping healthcare providers and facilities improve their antibiotic use and strengthen their infection prevention programs. We also promote a One Health approach to preventing and reducing antimicrobial resistance through our One Health Combating Antimicrobial Resistance Collaborative.

Antibiotic Stewardship

Antibiotic stewardship promotes appropriate use of antibiotics: the right antibiotic, at the right dose, for the right duration, at the right time. The Washington State Department of Health works to improve use of antibiotics in all healthcare settings and for all patients. See our Antibiotic Stewardship page for more information.

Multi-drug Resistant Organisms (MDRO)

Multidrug resistant organisms (PDF)are germs that are resistant to one or more classes of antimicrobial medications.

Targeted MDROs are germs that are resistant to most or all available antibiotics and have the potential to spread widely. This important category of MDROs are targeted by public health for special interventions or investigation. In Washington, targeted MDROs include:

• Candida auris
• Carbapenemase-producing organisms such as
  • Carbapenemase-producing Acinetobacter
  • Carbapenemase-producing Enterobacterales
  • Carbapenemase-producing Pseudomonas
• Pan-resistant organisms
• Vancomycin-resistant Staphylococcus aureus

The Targeted MDRO Prevention and Response Toolkit has valuable information for healthcare professionals and organizations about how to prevent, detect and contain targeted MDROs.

MDRO Dashboard

The Department of Health tracks reported cases of targeted MDROs in Washington and displays the data on a public dashboard. These visualizations allow users to:

• Interact with charts, maps, and graphs
• Export the data as a spreadsheet.

The data for these dashboards comes from samples submitted and tested through the Washington State Public Health Laboratory, as well as cases reported to us from other states. The dashboard displays data reported since 2012 and is updated monthly.

Access the MDRO Dashboard

Contact Us

For more information, please contact us at hai@doh.wa.gov