Antimicrobial Stewardship Introduction

***Featured Programs:***  https://www.chicagohan.org/antimicrobialstewardship/outpatienttoolkit and https://safetyprogram4antibioticstewardship.org/ 

Visit this new sub-site to learn more about current Outpatient Antimicrobial Stewardship Efforts from two campaigns:  Chicago Department of Public Health (local) and AHRQ (national) 

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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 antibitoic 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 requireemnt: 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 pentalties (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 

CDC Core Elements of Antimicrobial Stewardship for Nursing Homes

CDC Core Elements of Antimicrobial Stewardship for Nursing Homes - main pdf

CDC Core Elements of Antimicrobial Stewardship for Nursing Homes – Checklist

Agency for Healthcare Research and Quality (AHRQ): Nursing Home Antimicrobial Stewardship Guide

Telligen: Antimicrobial Stewardship in Long-term Care Resources

Nebraska Antimicrobial Stewardship Assessment and Promotion Program (ASAP) Tool and Templates for Long-Term Care

Rochester Patient Safety Clostridium difficile Prevention Collaborative – Resources for Nursing Homes

Minnesota Department of Public Health Antimicrobial Stewardship Program Toolkit for Long-term Care Facilities

Massachusetts Coalition: Improving Evaluation and Treatment of UTI in the Elderly

Alberta Health Services (AHS) and British Columbia Center for Disease Control (BC CDC)

Antimicrobial Stewardship Resources for Outpatient Clinics

CDC Core Elements for Outpatient Antimicrobial Stewardship Website

CDC Core Elements for Outpatient Antimicrobial Stewardship - main pdf

CDC Core Elements for Outpatient Antimicrobial Stewardship Appendix A: Supplemental Evidence Supporting Outpatient Stewardship

CDC Print Materials for Doctor’s Offices

Telligen Quality Innovation Network-Quality Improvement Organization (QIN-QIO) - Field Guide to Antimicrobial Stewardship in Outpatient Settings

Telligen (QIN-QIO) Outpatient Antimicrobial Stewardship Sample Policy

Telligen (QIN-QIO) Antimicrobial Stewardship Outpatient Playbook

MITIGATE Antimicrobial Stewardship Toolkit (A Multifaceted Intervention to Improve Prescribing for Acute Respiratory Infection for Adults and Children in Emergency Departments and Urgent Care Settings)

Illinois Department of Public Health Outpatient Antimicrobial Stewardship Toolkit for Primary Care Providers

Illinois Department of Public Health Outpatient Antimicrobial Stewardship Toolkit for Dentists

Antimicrobial Stewardship Resources for Hospitals

CDC Core Elements for Hospital Antimicrobial Stewardship

CDC Core Elements for Hospital Antimicrobial Stewardship - main pdf

CDC Core Elements for Hospital Antimicrobial Stewardship - Checklist

CDC Antimicrobial Stewardship Implementation Resources

National Quality Partners Playbook: Antimicrobial Stewardship in Acute Care

The Joint Commission New Standard for Antimicrobial Stewardship

The Joint Commission: Antimicrobial Stewardship Toolkit

American Hospital Association – Antimicrobial Stewardship Tookit

American Nurses Association-CDC White Paper: Role of Registered Nurses in Hospital Antibiotic Stewardship Practices

The PEW Charitable Trusts: 2018 Report on Trends in US Antibiotic Use

The PEW Charitable Trusts: Antibiotics and Antimicrobial Resistance

World Health Organization (WHO) Resources on Antimicrobial Resistance and Stewardship

Antimicrobial Stewardship Resources for Patients 

CDC Patient Education on Appropriate Antimicrobial Prescribing for Common Illnesses and Symptom Relief

CDC Appropriate Antibiotic Prescribing Print Materials

CDC Patient Education Video: Antibiotics Aren’t Always the Answer

CDC Patient Education Commercial: "The Right Tool" Public Service Announcement 

 

AHRQ Patient Education - Be Smart about Antibiotic Use 

 

APIC Patient Education on Clostridium Difficile

APIC ABC of Antibiotics - Patient Education 

Additional Antimicrobial Stewardship Resources

Educational References – Antimicrobial Stewardship Training for Healthcare Professionals

CDC Antimicrobial Stewardship Continued Education for Healthcare Professionals

Society of Infectious Disease Pharmacist (SIDP) Stewardship Certificate Education

Treatment Guidelines - Infectious Disease & Antimicrobial Stewardship 

CID:  Implementing an Antibiotic Stewardship Program: Guidelines by the Infectious Diseases Society of America and the Society for Healthcare Epidemiology of America

CDC Outpatient Adult Treatment Recommendations

CDC Outpatient Pediatric Treatment Recommendations

New York Department of Health: Adult Antibiotic Prescribing Guidelines/Pediatric Antibiotic Prescribing Guidelines

Rochester Nursing Home Collaborative: Guidelines for Urinary Tract Infections 

Rochester Nursing Home Collaborative: Guidelines for Respiratory Tract Infections 

Rochester Nursing Home Collaborative: Guidelines for Skin and Soft Tissue Infections 

Oregon Alliance Working for Antibiotic Resistance Education (AWARE) Judicious Use of Antibiotics – A Guide for Oregon Clinicians – Third Edition

Key Antimicrobial Stewardship Articles 

JAMDA: Template for an Antibiotic Stewardship Policy for Post-Acute and Long-Term Care Settings

ICHE: Surveillance Definitions of Infections in Long-Term Care Facilities: Revisiting the McGeer Criteria

 

NEJM: The STOP-IT Study – Trial for Short-Course Antimicrobial Therapy for Intraabdominal Infections

 

JAMA Intern Med: The New Antibiotic Mantra—“Shorter Is Better”

 

CID: Comparing the Outcomes of Adults with Enterobacteriaceae Bacteremia Receiving Short-Course versus Prolonged-Course Antibiotic Therapy

 

JAMA: Comparison of 8 vs 15 days of antibiotic therapy for ventilator-associated pneumonia in adults

CID:  Best Care for Patients Achieved through Multidisciplinary Stewardship

JAMA: Prevalence of Inappropriate Antibiotic Prescriptions Among US Ambulatory Care Visits, 2010-2011

CID: Use of Electronic Health Records and Clinical Decision Support Systems for Antimicrobial Stewardship

CID: Review of Rapid Diagnostic Tests Used by Antimicrobial Stewardship Programs

Clinical Therapeutics: National Survey of Antimicrobial Stewardship Practices 2013

CID: The Impact of Repored Penicillin Allergy on Surgical Site Infection Risk 

Antimicrobial Stewardship Contact Us

Amy Hanson, PharmD, BCPS AQ-ID

Project Administrator, Antimicrobial Stewardship

Infectious Disease Pharmacist, Chicago Department of Public Health

West Side Center for Disease Control

2160 West Ogden Ave

Chicago, IL 60612

Office: 312-746-0304

Email: Amy.Hanson@cityofchicago.org

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

312-746-4683 (Fax)