Antimicrobial Stewardship Program - HAN
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Overview
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
1
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.
2
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%.
3
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.
4
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
Title |
Source |
Type |
---|---|---|
CDC Core Elements of Antimicrobial Stewardship for Nursing Homes |
CDC |
Website |
CDC Core Elements of Antimicrobial Stewardship for Nursing Homes - main pdf |
CDC |
|
CDC Core Elements of Antimicrobial Stewardship for Nursing Homes – Checklist |
CDC |
|
Agency for Healthcare Research and Quality (AHRQ): Nursing Home Antimicrobial Stewardship Guide |
AHRQ |
Website |
Telligen: Antimicrobial Stewardship in Long-term Care Resources |
Telligenqinqio |
Website |
Nebraska Medicine |
Website |
|
Rochester Patient Safety |
Website |
|
Minnesota Department Of Health |
Website |
|
Massachusetts Coalition: Improving Evaluation and Treatment of UTI in the Elderly |
Macoalition |
Website |
Alberta Health Services (AHS) and British Columbia Center for Disease Control (BC CDC) |
Do Bugs Need Drugs? |
Website |
Antimicrobial Stewardship Resources for Outpatient Clinics
Title |
Source |
Type |
---|---|---|
CDC Core Elements for Outpatient Antimicrobial Stewardship Website |
CDC |
Website |
CDC Core Elements for Outpatient Antimicrobial Stewardship - main pdf |
CDC |
|
CDC |
||
CDC |
Website |
|
Telligen Quality Innovation Network-Quality Improvement Organization (QIN-QIO) - Field Guide to Antimicrobial Stewardship in Outpatient Settings | QIN-QIO Guide |
|
Telligen (QIN-QIO) Outpatient Antimicrobial Stewardship Sample Policy |
Outpatient Antimicrobial |
|
Telligen (QIN-QIO) Antimicrobial Stewardship Outpatient Playbook |
Telligenqinqio |
Website |
MITIGATE Antimicrobial Stewardship Toolkit |
||
IDPH |
||
Illinois Department of Public Health Outpatient Antimicrobial Stewardship Toolkit for Dentists |
IDPH |
Antimicrobial Stewardship Resources for Hospitals
Title |
Source |
Type |
---|---|---|
CDC |
Website |
|
CDC Core Elements for Hospital Antimicrobial Stewardship - main pdf |
CDC |
|
CDC Core Elements for Hospital Antimicrobial Stewardship - Checklist |
CDC |
|
CDC |
Website |
|
National Quality Partners Playbook: Antimicrobial Stewardship in Acute Care |
National Quality Partners Playbook |
|
The Joint Commission New Standard for Antimicrobial Stewardship |
New Standard For Antimicrobial Stewardship |
|
Joint Commission Resources |
Website |
|
American Hospital Association – Antimicrobial Stewardship Tookit |
AHA |
|
CDC |
||
The PEW Charitable Trusts: 2018 Report on Trends in US Antibiotic Use |
PEW Trusts |
|
The PEW Charitable Trusts: Antibiotics and Antimicrobial Resistance |
PEW Trusts |
Website |
World Health Organization (WHO) Resources on Antimicrobial Resistance and Stewardship |
WHO |
Website |
Antimicrobial Stewardship Resources for Patients
Title |
Source |
Type |
---|---|---|
CDC |
Website |
|
CDC |
Website |
|
CDC Patient Education Video: Antibiotics Aren’t Always the Answer |
CDC |
YouTube Video |
CDC Patient Education Commercial: "The Right Tool" Public Service Announcement |
CDC |
YouTube Video |
AHRQ |
||
APIC |
Website |
|
APIC |
Website |
Additional Antimicrobial Stewardship Information
Educational References – Antimicrobial Stewardship Training for Healthcare Professionals
Title |
Source |
Type |
---|---|---|
CDC Antimicrobial Stewardship Continued Education for Healthcare Professionals |
CDC |
Website |
Society of Infectious Disease Pharmacist (SIDP) Stewardship Certificate Education |
SIDP |
Website |
Treatment Guidelines - Infectious Disease & Antimicrobial Stewardship
Title |
Source |
Type |
---|---|---|
IDSA |
||
CDC |
Website |
|
CDC |
Website |
|
Adult Antibiotic Prescribing Guidelines |
||
Rochester Nursing Home Collaborative: Guidelines for Urinary Tract Infections |
Guidelines For Urinary Tract Infections |
|
Rochester Nursing Home Collaborative: Guidelines for Respiratory Tract Infections |
Guidelines For Respiratory Tract Infections |
|
Rochester Nursing Home Collaborative: Guidelines for Skin and Soft Tissue Infections |
Guidelines For Skin And Soft Tissue Infections |
|
Guide For Oregon Clinicians - Third Edition |
Key Antimicrobial Stewardship Articles
Title |
Source |
Type |
---|---|---|
JAMDA: Template for an Antibiotic Stewardship Policy for Post-Acute and Long-Term Care Settings |
JAMDA |
|
NIH Public Access |
||
NEJM: The STOP-IT Study – Trial for Short-Course Antimicrobial Therapy for Intraabdominal Infections |
NEJM |
|
JAMA Intern Med: The New Antibiotic Mantra—“Shorter Is Better” |
HHS Public Access |
|
CID |
||
JAMA: Comparison of 8 vs 15 days of antibiotic therapy for ventilator-associated pneumonia in adults |
Antibiotic Therapy For Ventilator-Associated Pneumonia |
|
CID: Best Care for Patients Achieved through Multidisciplinary Stewardship |
CID |
Website |
JAMA Network |
Website |
|
CID |
||
CID: Review of Rapid Diagnostic Tests Used by Antimicrobial Stewardship Programs |
CID |
|
Clinical Therapeutics: National Survey of Antimicrobial Stewardship Practices 2013 |
Clinical Therapeutics |
|
CID: The Impact of Repored Penicillin Allergy on Surgical Site Infection Risk |
CID |
Related Links
Chicago Outpatient Antimicrobial Stewardship Campaign 2019:
https://www.chicagohan.org/antimicrobialstewardship/outpatienttoolkit
https://www.chicagohan.org/antimicrobialstewardship/dentaltoolkit
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Chicago Department of Public Health & Illinois Department of Public Health:
Chicago Department of Public Health Healthcare Associated Infections
Illinois Department of Public Health - Antimicrobial Stewardship Website
Other Antimicrobial Stewardship Related Links:
Infectious Disease Society of America Practice Guidelines
CDC Core Elements of Antimicrobial Stewardship in Nursing Homes Website
CDC Core Elements of Hospital Antimicrobial Stewardship Programs Website
CDC Core Elements of Outpatient Antimicrobial Stewardship Website
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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Jamie Jacob, PharmD, BCIDP
Antimicrobial Stewardship Program Coordinator, IDPH
Jamie.jacob@illinois.gov