Less than 40% of hospitals fully implement CDC’s ASP elements
After conducting the largest national assessment of antibiotic stewardship programs in the United States, CDC researchers found that 39% of acute care hospitals applied all of the agency’s core elements recommended for successful program implementation, according to findings published in Clinical Infectious Diseases.
The CDC released its guidance on antibiotic stewardship programs in March 2014 to provide U.S. hospitals with a framework for antibiotic stewardship programs (ASPs), regardless of each facility’s size or resources. In the guidance, CDC identifies seven core elements needed for successful ASPs. These include infrastructure elements such as leadership commitment, a single program leader, and a pharmacy leader; and ASP implementation elements such as interventions that improve prescribing, surveillance of antibiotic use and resistance, provider feedback and education.
Lori A. Pollack
To determine how many facilities employ these elements, the CDC included questions assessing stewardship practices in the agency’s 2014 National Healthcare Safety Network (NHSN) Annual Hospital Survey. For a recent study, Lori A. Pollack, MD, MPH, of the CDC’s Division of Healthcare Quality Promotion, and colleagues evaluated NHSN responses to better understand how ASPs vary and to assess the association between infrastructure elements and ASP implementation elements.
More than 4,180 acute care hospitals responded to the survey. Among them, 55% reporting having the infrastructure needed for an effective ASP, and 51% reported practicing some core elements for implementation. Overall, 39% of hospitals met each of the seven core elements.
The percentage of hospitals implementing all core elements ranged by state from 7% to 58%. California (along with Massachusetts) had the highest percentage of hospitals that reported full implementation, likely because it was the only state in 2014 with a mandatory policy requiring all hospitals to improve antibiotic use, the researchers wrote.
The strongest predictor for having a comprehensive ASP encompassing all seven core elements was written support from facility administration (adjusted RR = 7.2; 95% CI, 6.2-8.4), followed by salary support (aRR = 1.5; 95% CI, 1.4-1.6) and being a major teaching hospital (aRR = 1.1; 95% CI, 1-1.1).
Survey responses also revealed that hospitals reporting all core elements were more likely to have more than 200 beds vs. those with 51 to 200 beds and 50 or fewer beds (56.1% vs. 38.9% vs. 22.4%).
“Although our study showed that small hospitals may need assistance or resources to implement stewardship programs, an encouraging finding was that almost 300 hospitals with fewer than 50 beds reported successful implementation of all elements,” Pollack and colleagues wrote. “Direct outreach to and discussions with some of these small hospitals to provide examples and offer key lessons is a high priority for CDC.”
While the CDC defines the components needed for ASPs, David N. Schwartz, MD, of John H. Stroger Jr. Hospital of Cook County and Rush Medical College, Chicago, wrote in a related editorial that a greater focus on improved patient outcomes is necessary to ensure the program’s success.
“Despite its urgency, emphasizing worsening antimicrobial resistance may be a failing strategy: physicians accept resistance as a reality to which their prescribing may contribute, yet they tend to minimize its importance in their own practices; they may choose broader-spectrum drugs as a hedge against it; and they must navigate a complex workplace dynamic of social and psychological influences in which antibiotic overtreatment becomes a way of prioritizing ‘individual patient care (the practical) and professional credibility over the threat of resistance (the abstract),’ ” Schwartz wrote. “While the best way to change this dynamic is unclear, a more patient-centered rationale and operational focus for [antimicrobial stewardship] in which resistance is emphasized as a threat primarily, if not exclusively, to patients who receive them might help.” – by Stephanie Viguers
Disclosure: The researchers report no relevant financial disclosures.