While preventing drug-resistant bugs is a national public health priority, critical access hospitals should adopt antibiotic stewardship programs in line with their own needs and resources, the CDC states in new guidelines.

“Flexibility and tailoring approaches to local needs is essential,” the CDC states in the guidelines.¹ “The options presented are not intended as a checklist of ‘must-dos.’ Rather, the goal is to present options that might help small and critical access hospitals ensure that each of the core elements is in place.”

The seven core elements for antibiotic stewardship programs in critical access hospitals are summarized as follows. For more details and examples, see the full CDC report at: http://bit.ly/2kvGIGV.

1, 2. Leadership Commitment/Accountability: “Obtain leadership commitment from the chief medical officer, pharmacy director, and nursing leaders, as this can encourage physician, pharmacist, infection preventionist, and nurse engagement to implement stewardship initiatives,” the CDC recommends. “For example, integrate stewardship activities into ongoing quality improvement and patient safety efforts. … Issue a statement from the hospital leadership to all providers and patients highlighting the hospital’s commitment to improving antibiotic use.”

3. Drug Expertise: “In most critical access hospitals, a pharmacist, usually one who is onsite, provides the leadership and expertise for the antibiotic stewardship program. When possible, having a physician leader is helpful to support the pharmacist,” the CDC recommends.

4. Action: “There are a number of evidenced-based interventions that can improve antibiotic use,” the CDC notes. “Decisions on which to use should be based on local needs, which are best determined through discussions with providers and a review of your antibiotic use. The majority of all antibiotic use in hospitals is driven by just three conditions: community-acquired pneumonia, urinary tract infections, and skin and soft tissue infections. … [T]hese are often high-yield targets for improvement.”

5. Tracking: “Data are essential for informing and assessing stewardship actions,” the CDC advises. “The key is to have a measure that is useful for stewardship activities, meaningful to providers, and that can be tracked over time to assess improvements. … For example, days of therapy is considered the most useful measure of antibiotic use to inform stewardship efforts.”

6. Reporting: “Prepare regular reports on the measures being tracked related to antibiotic use. Data on stewardship efforts should be reported not just to providers, but also to the hospital leadership and board,” the CDC recommends.

7. Education: “The pharmacist and/or physician leader can provide stewardship education (e.g., optimizing diagnosis and treatment for the commonly encountered infections, reducing unnecessary duplicate therapy, etc.) to individual providers and pharmacists,” the CDC notes. “Specific education for nurses could also be very helpful; for example, criteria for intravenous to oral conversion, optimal technique for culture collection, and criteria for when to obtain a urine culture.”

REFERENCE

1. CDC. Implementation of Antibiotic Stewardship Core Elements at Small and Critical Access Hospitals. 2017. Available at: http://bit.ly/2kvGIGV.