Recent legislation passed in California mandates as of July 1, 2015, California hospitals must have antimicrobial stewardship programs (ASPs) in places that follow federal and professional society guidelines. These hospitals must also incorporate a process to evaluate the appropriate use of antimicrobials.1 This new law requires hospitals to form physician-supervised multidisciplinary antimicrobial stewardship teams that include at least one pharmacist or physician with training and expertise in antimicrobial stewardship. The team should report ASP activities to hospital committees involved in clinical quality improvement activities.
California first enacted legislation requiring ASPs in hospitals in 2006. The recent legiselation builds on the existing law and more clearly defines antimicrobial stewardship practices and program components by incorporating the standards established by organizations such as the Centers for Disease Control and Prevention (CDC), the Society for Healthcare Epidemiology of America (SHEA), and other professional organizations.
According to California State Senator Jerry Hill, who first introduced the new legislation, only 50% of California hospitals had established an antimicrobial stewardship program as of 2014 as a result of ambiguity in the 2006 law.2
So far, other states have not followed California’s example, but federal regulations may soon require hospitals nationwide to implement ASPs. In September 2014, President Obama issued an executive order that directed the U.S. Department of Health and Human Services to move toward mandating ASPs for hospitals.
The executive order came on the heels of the Report to the President on Combating Antibiotic Resistance by the President’s Council of Advisors on Science and Technology, which recommended that the Centers for Medicare and Medicaid Services (CMS) require ASPs as a condition of participation in Medicare and Medicaid by the end of 2017. The SHEA and the Infectious Disease Society of America have supported making antimicrobial stewardship a requirement for hospital participation in Medicare and Medicaid.
The CDC named antibiotic resistance the top public health threat of 2014 and formally recommended ASPs for all hospitals last year. The CDC estimates that antibiotic resistance costs U.S. hospitals up to $35 billion in medications, labor and care expenses and costs the nation’s economy an additional $35 billion in lost productivity.
In 2012, non-federal US hospitals spent about $75 billion on antimicrobial medications, according to the American Journal of Health-System Pharmacy. 3 Studies estimate that up to 50% of antimicrobial usage in hospitals is unnecessary or inappropriate.4
1 California Legislative Information. SB-1311 Hospitals: antimicrobial stewardship. http://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201320140SB1311
3 National trends in prescription drug expenditures and projections for 2014. Am J Health Syst Pharm. March 15, 2014. 71:482-499.
4 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. 44(2):159-177.