The White House recently announced a national action plan to combat antibiotic-resistant bacteria. The aggressive plan calls for specific actions and milestones for the healthcare industry to adopt best practices for antimicrobial management, communication of antibiotic utilization and resistance information to the Center for Disease Control, and a national surveillance and benchmarking strategy. The National Action Plan was developed in response to Executive Order 13676: Combating Antibiotic Resistant Bacteria, issued by President Barack Obama in conjunction with the National Strategy for Combating Antibiotic-Resistant Bacteria.
National Action Plan Goals*:
- GOAL 1: Slow the Emergence of Resistant Bacteria and Prevent the Spread of Resistant Infections.
- GOAL 2: Strengthen National One-Health Surveillance Efforts to Combat Resistance.
- GOAL 3: Advance Development and Use of Rapid and Innovative Diagnostic Tests for Identification and Characterization of Resistant Bacteria.
- GOAL 4: Accelerate Basic and Applied Research and Development for New Antibiotics, Other Therapeutics, and Vaccines.
- GOAL 5: Improve International Collaboration and Capacities for Antibiotic-resistance Prevention, Surveillance, Control, and Antibiotic Research and Development.
Impact on Healthcare Antimicrobial Stewardship Programs (Select Milestones and Timelines)*:
Within one year:
- The National Healthcare Safety Network (NHSN) will begin tracking the number of healthcare facilities with stewardship policies and programs in place.
- CDC will finalize arrangements for the purchase of proprietary data on inpatient antibiotic use to supplement NHSN data until a larger number of hospitals begin to utilize the NHSN module for antibiotic use reporting.
- CDC will work with healthcare and public health partners to propose new healthcare-facility antibiotic use measures to the National Quality Forum.
Within three years:
- All hospitals that participate in Medicare and Medicaid programs must comply with Conditions of Participation (COP).
- The Centers for Medicare & Medicaid Services (CMS) will issue new COPs or revise current COP Interpretive Guidelines to advance compliance with recommendations in CDC’s Core Elements of Hospital Antibiotic Stewardship Programs.
- HHS, DOD, and VA will also implement policies that:
All acute care hospitals governed by the CMS COP will implement antibiotic stewardship programs. CMS will expand COP requirements to apply to long-term acute care hospitals, other post-acute facilities, ambulatory surgery centers, and dialysis centers.
- CMS will revise existing Interpretive Guidelines (IGs), as needed, to include antimicrobial stewardship improvements.
- CMS will expand the Physician Quality Reporting System (PQRS) to include quality measures that discourage inappropriate antibiotic use to treat non-bacterial infections, such as respiratory tract infections.
- CDC will use data collected through the NHSN AU module to provide annual national estimates of aggregated inpatient antibiotic use and feedback to healthcare facilities on antibiotic use, indicating whether antibiotic use rates are above or below the national average.
- CDC will establish routine reporting of antibiotic use and resistance data from select hospital systems via the NHSN AU and AR modules.
*Abstracted from the National Action Plan for Combating Antibiotic Resistant Bacteria
Healthcare organizations across the United States will need to provide dedicated clinical, quality, and technical resources to address the impending reporting requirements and programatic development for comprehensive antimicrobial stewardship programs. This national action plan represents an aggressive policy to curb antibiotic resistance and provides specific steps for healthcare organizations to create comprehensive programs. Hospital executives will need to provide adequate resources to build the infrastructure to combat antibiotic resistance and address the intent of the national action plan.