Advertisement

Leading Practices in Antimicrobial Stewardship: Conference Summary

      Background

      The Joint Commission’s hospital antimicrobial stewardship (AS) standards became effective in January 2017. Surveyors’ experience to date suggests that almost all hospitals have established AS leadership commitment and organized structures. Thus, The Joint Commission sought to examine advances in AS interventions and measures that hospitals could implement to strengthen their existing AS programs.

      Methods

      The Joint Commission and Pew Charitable Trusts sponsored a meeting to bring together experts and key stakeholder organizations from around the country to identify leading practices for AS interventions and measurement. Presenters were asked to summarize the AS activities they thought were most important for the success of their own AS program and leading practices that all hospitals should be able to implement.

      Results

      The panel highlighted two interventions as leading practices that go beyond current guidelines and established practices (that is, preauthorization and prospective audit and feedback). The first is diagnostic stewardship. This type of intervention addresses errors in diagnostic decision making that lead to inappropriate antibiotic prescribing. The second is handshake stewardship, a method of engaging frontline providers on a regular basis for education and discussions about barriers to AS from the clinician’s perspective. The panel identified days of therapy (or defined daily dose, when days of therapy is not possible), Clostridioides difficile rates, and adherence to facility-specific guidelines as the preferred measures for assessing stewardship activities.

      Conclusion

      The practices highlighted should be given greater emphasis by The Joint Commission in their efforts to improve hospital AS, and the Centers for Disease Control and Prevention will be updating the Core Elements of Hospital Antibiotic Stewardship Programs.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Joint Commission Journal on Quality and Patient Safety
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

      1. Centers for Disease Control and Prevention. Antibiotic / Antimicrobial Resistance (AR / AMR). (Updated Sep 10, 2018.) Accessed Apr 30, 2019. https://www.cdc.gov/drugresistance/index.html.

        • The White House
        National Action Plan for Combating Antibiotic-Resistant Bacteria. Mar 2015.
        • Counts G.W.
        Review and control of antimicrobial usage in hospitalized patients: a recommended collaborative approach.
        JAMA. 1977 Nov 14; 238: 2170-2172
        • Fishman N.
        Antimicrobial stewardship.
        Am J Infect Control. 2006; 34: S55-S73
        • Dellit T.H.
        • et al.
        Infectious Diseases Society of America and the Society for Healthcare Epidemiology of America guidelines for developing an institutional program to enhance antimicrobial stewardship.
        Clin Infect Dis. 2007 Jan 15; 44: 159-177
      2. Centers for Disease Control and Prevention. The Core Elements of Hospital Antibiotic Stewardship Programs. 2014. Accessed Apr 30, 2019. https://www.cdc.gov/antibiotic-use/healthcare/pdfs/core-elements.pdf.

      3. The Joint Commission. 2017 Comprehensive Accreditation Manual for Hospitals. Oak Brook, IL: Joint Commission Resources, 2016.

        • Barlam T.F.
        • et al.
        Implementing an antibiotic stewardship program: guidelines by the Infectious Diseases Society of America and the Society for Healthcare Epidemiology of America.
        Clin Infect Dis. 2016 May 15; 62: 1197-1202
        • Tamma P.D.
        • et al.
        What is the more effective antibiotic stewardship intervention: preprescription authorization or postprescription review with feedback?.
        Clin Infect Dis. 2017 Mar 1; 64: 537-543
        • Hurst A.L.
        • et al.
        Handshake stewardship: a highly effective rounding-based antimicrobial optimization service.
        Pediatr Infect Dis J. 2016; 35: 1104-1110
        • Pimentel M.P.
        • Klompas M.
        • Kachalia A.
        Quality measurement for Clostridium difficile infection: turning lemons into lemonade.
        BMJ Qual Saf. 2018; 27: 414-416
        • Polage C.R.
        • Solnick J.V.
        • Cohen S.H.
        Nosocomial diarrhea: evaluation and treatment of causes other than Clostridium difficile.
        Clin Infect Dis. 2012; 55: 982-989
        • McDonald L.C.
        • et al.
        Clinical practice guidelines for Clostridium difficile infection in adults and children: 2017 update by the Infectious Diseases Society of America (IDSA) and Society for Healthcare Epidemiology of America (SHEA).
        Clin Infect Dis. 2018 Mar 19; 66: 987-994
        • Newland J.G.
        • et al.
        Sharing Antimicrobial Reports for Pediatric Stewardship (SHARPS): a quality improvement collaborative.
        J Pediatric Infect Dis Soc. 2018 May 15; 7: 124-128
        • Feazel L.M.
        • et al.
        Effect of antibiotic stewardship programmes on Clostridium difficile incidence: a systematic review and meta-analysis.
        J Antimicrob Chemother. 2014; 69: 1748-1754
        • Lambl B.B.
        • et al.
        Leveraging quality improvement science to reduce C. difficile infections in a community hospital.
        Jt Comm J Qual Patient Saf. 2019; 45: 285-294
        • The Joint Commission
        Comprehensive Accreditation Manual for Hospitals. Oak Brook, IL: Joint Commission.
        Resources. 2018; : MM23-MM25

      Biography

      David W. Baker, MD, MPH, FACP, is Executive Vice President, Healthcare Quality Evaluation, The Joint Commission, Oakbrook Terrace, Illinois, and Editor-in-Chief, The Joint Commission Journal on Quality and Patient Safety.

      Biography

      David Hyun, MD, is Senior Officer, Antibiotic Resistance Project, The Pew Charitable Trusts, Philadelphia.

      Biography

      Melinda M. Neuhauser, PharmD, MPH, FCCP, FASHP, is Pharmacist and Acute Care Lead, Office of Antibiotic Stewardship, Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta.

      Biography

      Jay Bhatt, DO, MPH, MA, FACP, is Senior Vice President and Chief Medical Officer, American Hospital Association, Chicago.

      Biography

      Arjun Srinivasan, MD, is Associate Director for Healthcare Associated Infection Prevention Programs, Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention.