Introduction to General Practice Principles of Antimicrobial Stewardship

Improving antibiotic use is a medication-safety and patient safety issue.  Research indicates that 30-50% of antibiotics prescribed in hospitals is either not indicated or not appropriate.  Overprescribing and misprescribing is contributing to the growing challenges posed by Clostridiodies difficile infections and antibiotic-resistant bacteria. Studies have demonstrated that improved prescribing practices in hospitals can not only help reduce rates of C. difficile infections and antibiotic resistance, but can also improve patient outcomes, all while reducing healthcare costs. Interventions to improve antibiotic use can be implemented in any healthcare setting - from the smallest to the largest.  This site contains resources to build and sustain antimicrobial stewardship programs in a variety of healthcare settings, including long-term care, acute care, and outpatient clinics.  

New Gain Collaborative: Generating Antimicrobial Stewardship Initiatives In Chicago Nursing Homes 

Antimicrobial Stewardship in Nursing Homes 


Defining the Need for Antimicrobial Stewardship in Nursing Homes

Antibiotics are among the most frequently prescribed medications in nursing homes, with up to 70% of residents in a nursing home receiving one or more courses of systemic antibiotics when followed over a year.  Similar to the findings in hospitals, studies have shown that 40–75% of antibiotics prescribed in nursing homes may be unnecessary or inappropriate. Harms from antibiotic overuse are significant for the frail and older adults receiving care in nursing homes. These harms include risk of serious diarrheal infections from C. difficile, increased adverse drug events and drug interactions, and colonization and/or infection with antibiotic-resistant organisms.


Chicago Department of Public Health (CDPH) can help you address the CMS antimicrobial stewardship requirement: the GAIN Collaborative 

CDPH is inviting Chicago nursing homes to participate in a site-visit for establishing and/or enhancing the facility's Antimicrobial Stewardship Program (ASP).  The goal is 100% facility participation in the GAIN collaborative, Generating Antimicrobial Stewardship Initiatives in Chicago Nursing Homes.  A comprehensive ASP that complies with the 7 CDC Core Elements of Antimicrobial Stewardship in Nursing Homes is already required for nursing homes as a participation in the Centers for Medicare and Medicaid Services (CMS), and surveyors are likely to visit in 2019 (if they haven't already).  To get facilities "surveyor ready", CDPH is offering a free consultation by an Infectious Disease Pharmacist that has experience establishing an Antimicrobial Stewardship Program at a large, academic medical center in Chicago.  The free consultation is completely confidential, involves no penalties (CDPH is not part of the regulatory surveying process), and is completely quality improvement focused.  Other similar initiatives have noted several improved outcomes, including: (1) reduction in overall antibiotic prescribing by 10-28%, (2) reduced hospitalizations between 8-11%, (3) reduced C. difficile infections between 11-21%, and (4) reduced multi-drug resistant infections, such as methicillin-resistant Staphylococcus aureus (MRSA), by 8%. 


Where is your facility with Antimicrobial Stewardship activities? Take the CDPH survey.

The identified point-person for an antimicrobial stewardship program (administrator, director of nursing, assistant director of nursing, and/or infection prevention nurse) will be receiving the "Antimicrobial Stewardship for Chicago Nursing Homes" survey from CDPH in February 2019.  Any key stakeholders in antimicrobial stewardship activities at the facility are encouraged to review the intake survey.


Earn an online MEDAL of Antimicrobial Stewardship Excellence for others to see!

Participation in the on-site visit and demonstrating compliance with the 7 CDC Core Elements will result in achieving a Bronze level in a new CDPH Center of Excellence designation for Chicago Nursing Home Antimicrobial Stewardship Programs. Within 3-6 months of the site-visit, completion of the recommended action plan discussed in follow-up to the initial site-visit will move your facility to Silver level Center of Excellence. Demonstrating improved antimicrobial use and/or improved clinical outcomes after participation in the GAIN collaborative will result in your facility earning a Gold level Center of Excellence designation.

More information on this exciting new antimicrobial stewardship initiative can back found here.

Antimicrobial Stewardship Resources

Additional Antimicrobial Stewardship Resources for Nursing Homes

Antimicrobial Stewardship Resources for Outpatient Clinics

Antimicrobial Stewardship Resources for Hospitals

Antimicrobial Stewardship Resources for Patients

Additional Antimicrobial Stewardship Information

Educational References – Antimicrobial Stewardship Training for Healthcare Professionals

Treatment Guidelines - Infectious Disease & Antimicrobial Stewardship

Key Antimicrobial Stewardship Articles

Antimicrobial Stewardship Reporting

For questions related to Healthcare Associated Infection/Antibiotic Resistance, please contact the Chicago Department of Public Health at:  CDPHHAIAR@cityofchicago.org 

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PALASE Collaborative

A 1:1 collaborative approach to support nursing homes and skilled nursing facilities with implementing a robust Antimicrobial Stewardship Program (ASP) by leveraging acute care hospital (ACH) antimicrobial stewardship (AS) expertise

Jamie Jacob, PharmD, BCIDP
Antimicrobial Stewardship Program Coordinator, IDPH