Stewardship: Key features and six checklist questions
A proposed guideline by the Centers for Disease Control and Prevention on hospital antimicrobial stewardship programs includes the following key aspects, as outlined recently in Atlanta at a meeting of the CDC Healthcare Infection Control Practices Advisory Committee.
Core Recommendation: All hospitals should take action to improve antibiotic use by implementing an antimicrobial stewardship program.
Required Elements for a Stewardship Program
- Implement policies and interventions to improve antimicrobial use.
- Monitor the use of antimicrobials.
- Educate providers on optimal antibiotic use and issues in antibiotic resistance
- A designated physician who is responsible for efforts to improve antimicrobial use.
- A designated pharmacist who is responsible for efforts to improve antimicrobial use.
- ID training (for both) is ideal
Program Structure- Supplemental
- Programs are more effective if the physician and pharmacist have access to experts in and direct support from infection prevention and information technology
Program Functions- Policies and Procedures
- Optimize the antibiotic formulary
- Develop local treatment recommendations for commonly encountered infections.
- Develop order-sets and clinical pathways that incorporate treatment recommendations.
- Develop plans to educate providers on clinical microbiology
- Ensure antimicrobial courses have proper documentation of dose, duration, indication.
- Ensure all providers re-assess courses of antimicrobials after 2-3 days of treatment ("antibiotic time out")
Program Functions- Monitoring Use
- Measures of consumption- overall use
- NHSN Antimicrobial Use module
- Local monitoring of use
- Measures of appropriate use
- Appropriate therapy for select agents and/or infections (e.g. CDC tools, drug use evaluations)
Proposed Stewardship Checklist
- Does this facility have a physician leader identified to optimize antibiotic use?
- Does this facility have a pharmacist leader identified to optimize antibiotic use?
- Does facility leadership support efforts to optimize antibiotic use at this facility?
- Is there at least one intervention to optimize antibiotic use integrated into clinical care at this facility?
- Does this facility monitor antibiotic use?
- Is information on optimizing antibiotic use provided to prescribers at least annually?