With antibiotic resistance, or “superbugs,” on the rise, a program within the Wexner Medical Center is on a mission to train pharmacists how to responsibly dispense antibiotics by bringing them across the Atlantic Ocean to Columbus.
Four pharmacists from South Africa came to Ohio State to train in infectious disease in the neonatal intensive care unit through the Antimicrobial Stewardship Program Aug. 4 – 15, which has focused on adult care for the last nine years. After their visit, the pharmacists will return to South Africa to train more pharmacists in a “train the trainer” style program.
Debbie Goff, Ohio State infectious disease clinical pharmacist, said that South Africa is in an infant mortality crisis. Some of the problems contributing to that, Goff said, are the lack of health care providers and specialized pharmacists, the large volume of patients, and lack of prenatal care, which has led to the irresponsible use of antibiotics.
Goff said she helped to implement the stewardship program in partnership with Nationwide Children’s Hospital to increase the number of specialized clinical pharmacists in South Africa and help combat the crisis.
Pablo Sanchez, professor of pediatrics in the Ohio State College of Medicine and neonatologist at Nationwide Children’s Hospital, said that the goal of the program is to limit antibiotic use for specific infections instead of as a generalized treatment.
“Our goal is to contain these multidrug resistant organisms so that we can save the antibiotics that we have for treatment of real infections, and we can do that by limiting the antibiotic use in babies who really are not infected or we think may be infected, but we don’t have a specific organism,” Sanchez said.
Goff said that the program consists of preparation with online reading, and when the pharmacists arrive on campus they study the “one health” approach, a comprehensive approach with a team from multiple departments, including a pharmacist as well as the individual roles of each team member.
After training, the visiting pharmacists return to South Africa with a “tool kit” that consists of a handbook and written material, and in turn they will train more people, Goff said. So far, 200 pharmacists have been trained under this style of “training the trainers” for a similar program focused on adult care.
Although this specific training program focused on infant care is the first of its kind, Goff said she has had documented success with this style of training for adult care. In the first analysis of 47 hospitals, antibiotic use decreased 18 percent.
“It’s hard to work towards a goal if you’ve never actually seen someone succeed at it, so by coming here, they actually see a very successful program,” Goff said. “Although they might not have all of our resources, they now know it actually is possible.”
Sanchez said that his motto — which the South African pharmacists picked up on — is that “we can all do better” in the way that antibiotics are used in medical care.
“We’re physicians. We want to improve the condition of these babies in the neonatal ICU that are high risk for a number of conditions, but we also need to realize we all can do better and we can learn from past experience, and that’s what I’ve been trying to implement,” Sanchez said.
Despite the intensity of the two-week training session, Goff said the pharmacists are also introduced to the student perspective of campus, not only as a way to understand cultural differences in health care, but also because they are closer in age to the students. In South Africa, students enter pharmacy school right after high school and receive a degree in four years.
“They must leave Ohio State and understand what a Buckeye is. They have to tell me what it is,” Goff said. “They have to know who Brutus is. They must know what O-H-I-O stands for and be able to do it. They must know what Buckeye Donuts are.”
Goff and professor emeritus in internal medicine in the division of infectious diseases Julie Mangino will travel to South Africa in September to oversee the implementation of the skills learned.
“When we travel back to South Africa, we will be meeting with both medical and pharmacy leadership to bolster support for the interventions by the four pharmacists who came to OSU over this summer,” Mangino said in an email.
They will work with the four visiting pharmacists and the mentors who previously trained in the United States in South Africa on a NICU stewardship tool kit, so that other NICUs in South Africa can benefit from the framework they put together.