In my 23 years of practicing infection prevention, it has been interesting to observe paradigm shifts in our collective efforts to improve healthcare-associated infection (HAI) prevention, patient safety, patient outcomes, and institutional financial stability. Remember when nosocomial infection rates were "confidential"? Now we have HospitalCompare.gov, mandated public reporting of HAIs, and CMS-driven pay-for-performance related to HAIs.
A more recent paradigm shift involves greater infection preventionist engagement in antimicrobial stewardship. Implementing an antimicrobial stewardship program in a hospital is proven to increase positive patient outcomes, decrease antibiotic resistance, decrease C.diff infections, and decrease costs. Infection preventionists certainly bring additional expertise to these efforts.
Regardless of where your facility is in its antimicrobial stewardship efforts, an extremely helpful resource is in the March 2014 edition of CDC Vital Signs. The CDC also includes two documents that I find very helpful: a facility-assessment checklist and a review of the core elements of antimicrobial stewardship.
The CDC recommends that all hospitals implement antimicrobial stewardship programs that include seven core elements :
- Leadership commitment: Dedicating necessary human, financial, and information technology resources.
- Accountability: Appointing a single leader responsible for program outcomes. Experience with successful programs has shown that a physician leader is effective.
- Drug expertise: Appointing a single pharmacist leader responsible for working to improve antibiotic use.
- Action: Implementing at least one recommended action, such as systemic evaluation of ongoing treatment need after a set period of initial treatment (i.e., "antibiotic time out" after 48 hours).
- Tracking: Monitoring antibiotic prescribing and resistance patterns.
- Reporting: Regular reporting information on antibiotic use and resistance to doctors, nurses and relevant staff members.
- Education: Educating clinicians about resistance and optimal prescribing.
A recent webinar presentation by Linda Greene, RN, MPS, CIC  reviewed the role of infection prevention in antimicrobial stewardship. More than 300 infection preventionists were asked in an online survey to describe antimicrobial stewardship efforts at their facility.
The responses were as follows:
- No antimicrobial stewardship (AS) program at the facility – 12%
- An AS program exists but infection preventionists are not involved – 11%
- An AS program is just getting started – 28%
- Infection prevention is represented on the Pharmacy & Therapeutics Committee or a related antibiotic subcommittee – 37%
Whatever your responses would be to these questions, challenge yourself professionally to be a strong clinical participant in antimicrobial stewardship at your facility. If you are new at it, take advantage of the referenced websites and other literature. If you are more advanced in your personal and institutional AS efforts, share your accomplishments at your local APIC chapter or through blogging or publishing. We all have more to learn and teach!
1. CDC. Core elements of hospital antibiotic stewardship programs. Atlanta, GA: US Department of Health and Human Services, CDC; 2014. Available athttp://www.cdc.gov/getsmart/healthcare/implementat
2. Wolters Kluwer Health Sentri7. 2014. Antibiotic Stewardship: the Role of Infection Prevention [Webinar]. Retrieved from http://forums.pharmacyonesource.com/t5/Webinar-Blo