Uptake of Antibiotic Stewardship Programs in US Acute Care Hospitals: Findings From the 2015 National Healthcare Safety Network Annual Hospital Survey

O’Leary, Erin; Santen, Katharina L. van; Webb, Amy K; Pollock, Daniel A.; Edwards, Jonathan R.; Srinivasan, Arjun

doi:10.1093/cid/cix651

Cited by 42 publications

(32 citation statements)

References 4 publications

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“…Stewardship programs are extensively used in the United States and compliance with the various recommendations is monitored annually by the National Healthcare Safety Network Annual Hospital Survey (3,4). In Spain, different scientific societies promoted the development of a consensus document for optimizing the use of antimicrobials in hospitals (PROA project) (5).…”

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confidence: 99%

A Before-and-After Study of the Effectiveness of an Antimicrobial Stewardship Program in Critical Care

Álvarez-Lerma

Grau

Echeverría-Esnal

et al. 2018

Antimicrob Agents Chemother

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We evaluated the use of antimicrobials expressed as defined daily doses (DDDs) per 1,000 patient days and days of therapy (DOT) per 100 occupied bed-days in a intensive care unit (ICU) of a general hospital in Barcelona, Spain, before and after implementation of an antimicrobial stewardship (AMS) program (2007 to 2010 versus 2011 to 2015). The quarterly costs of antimicrobials used in the ICU and its weight in the overall hospital costs of antimicrobials were calculated. The effect of the applied AMS program on DDDs and DOT time series data was analyzed by means of intervention time series analysis. A total of 5,002 patients were included (1,971 for the first [before] period and 3,031 for the second [after] period). The percentage of patients treated with one or more antimicrobials decreased from 88.6 to 77.2% ( < 0.001). DDDs decreased from 246.8 to 192.3 (mean difference, -54.5; = 0.001) and DOT from 66.7 to 54.6 (mean difference, -12.1; = 0.066). The mean cost per trimester decreased from €115,543 to €73,477 (mean difference, -42,065.4 euros; < 0.001), and the percentage of ICU antimicrobials cost with respect to the total cost of hospital antimicrobials decreased from 28.5 to 22.8% (mean difference, -5.59; = 0.023). Implementation of an AMS program in the ICU was associated with a marked reduction in the use of antimicrobials, with cost savings close to one million euros since its implementation. An AMS program can have a significant impact on optimizing antimicrobial use in critical care practice.

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confidence: 99%

A Before-and-After Study of the Effectiveness of an Antimicrobial Stewardship Program in Critical Care

Álvarez-Lerma

Grau

Echeverría-Esnal

et al. 2018

Antimicrob Agents Chemother

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“…4 In contrast, by 2015, only 48% of US hospitals nationally met all core elements of antibiotic stewardship (as defined by the Centers for Disease Control and Prevention). 39 Though we did not assess implementation of antibiotic stewardship, previous studies have shown widespread use of multiple stewardship initiatives in VA hospitals, 4 likely owing to Veterans Health Administration Directive 1031, which in 2013, established a policy for implementation and maintenance of Antimicrobial Stewardship Programs at all VA medical facilities. 4 Similar programs did not become mandatory in non-VA hospitals until 2017.…”

Section: Discussionmentioning

confidence: 99%

Trends in Health Care–Associated Infection Prevention Practices in US Veterans Affairs Hospitals From 2005 to 2017

et al. 2020

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IMPORTANCE Health care-associated infection (HAI) is associated with substantial harm. To reduce HAI, the largest integrated health care system in the United States-the Veterans Health Administration-was an early adopter of infection prevention policies and initiatives. Whether these efforts translated into increased use of practices to prevent HAI in Veterans Affairs (VA) hospitals is unknown. OBJECTIVE To evaluate changes over time in infection prevention practices and the perception of the importance of infection prevention to hospital leadership. DESIGN, SETTINGS, AND PARTICIPANTS For this survey study, every 4 years between 2005 and 2017, infection preventionists were surveyed at all VA hospitals on use of practices associated with common HAIs, including central line-associated bloodstream infection (CLABSI), catheter-associated urinary tract infection (CAUTI), ventilator-associated pneumonia (VAP), and (beginning in 2013) Clostridioides difficile infection. Data analysis was performed from February 1, 2019, to July 1, 2019. MAIN OUTCOMES AND MEASURES Reported regular use of key infection prevention practices and perceived importance of infection prevention to hospital leadership. RESULTS Between 2005 and 2017, 320 total surveys were completed with response rates ranging from 59% (73 of 124) in 2017 to 80% (95 of 119) in 2005. Use of 12 different infection prevention practices increased. Since 2013, 92% (69 of 75) to 100% of VA hospitals reported regular use of key infection prevention practices for C difficile infection and CLABSI. In contrast, adoption of many practices to prevent CAUTI, although increasing, have lagged. Despite reported increases in the use of some practices for VAP such as semirecumbent positioning (89% [79 of 89] in 2005 vs 97% [61 of 63] in 2017, P = .007 for trend) and subglottic secretion drainage (23% [19 of 84] in 2005 vs 65% [40 of 62] in 2017, P < .001), use of other key practices such as daily interruptions of sedation (85% [55 of 65] in 2009 vs 87% [54 of 62] in 2017, P = .66) and early mobilization (81% [52 of 64] in 2013 vs 82% [51 of 62] in 2017, P = .88) has not increased. Antibiotic stewardship programs are now reported in nearly every VA hospital (97% [71 of 73]); however, some hospitals report practices for microbiologic testing for HAIs (eg, 22% [16 of 72] report routine urine culture testing in 2017) that could also contribute to antibiotic overuse. CONCLUSIONS AND RELEVANCE From 2005 to 2017, reported use of 12 different infection prevention practices increased in VA hospitals. Areas for continued improvement of infection prevention practices appear to include CAUTI, certain VAP practices, and diagnostic stewardship for HAI. The reported adoption of many infection prevention practices in VA hospitals was higher than in non-VA hospitals. As hospitals continue to merge and health systems become increasingly integrated, these successes could help inform patient safety broadly.

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“…Lack of ID-trained leaders at small hospitals may limit antibiotic stewardship: in 2015, only 31% of hospitals with ≤50 beds met all CDC core elements. 23 Although systematic changes to attract trainees to the field of ID and to antibiotic stewardship may help, this is a long-term solution. 24,25 Other options to help distribute ID expertise across hospitals include access to expertise through quality collaboratives 26 or "tele-stewardship" in which antibiotic use data are collected remotely and ID physicians are available via a stewardship "hotline."…”

Section: Discussionmentioning

confidence: 99%

Antibiotic stewardship teams and Clostridioides difficile practices in United States hospitals: A national survey in The Joint Commission antibiotic stewardship standard era

Vaughn

Greene

Ratz

et al. 2019

Infect. Control Hosp. Epidemiol.

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Objective: Clostridioides difficile infection (CDI) can be prevented through infection prevention practices and antibiotic stewardship. Diagnostic stewardship (ie, strategies to improve use of microbiological testing) can also improve antibiotic use. However, little is known about the use of such practices in US hospitals, especially after multidisciplinary stewardship programs became a requirement for US hospital accreditation in 2017. Thus, we surveyed US hospitals to assess antibiotic stewardship program composition, practices related to CDI, and diagnostic stewardship. Methods: Surveys were mailed to infection preventionists at 900 randomly sampled US hospitals between May and October 2017. Hospitals were surveyed on antibiotic stewardship programs; CDI prevention, treatment, and testing practices; and diagnostic stewardship strategies. Responses were compared by hospital bed size using weighted logistic regression. Results: Overall, 528 surveys were completed (59% response rate). Almost all (95%) responding hospitals had an antibiotic stewardship program. Smaller hospitals were less likely to have stewardship team members with infectious diseases (ID) training, and only 41% of hospitals met The Joint Commission accreditation standards for multidisciplinary teams. Guideline-recommended CDI prevention practices were common. Smaller hospitals were less likely to use high-tech disinfection devices, fecal microbiota transplantation, or diagnostic stewardship strategies. Conclusions: Following changes in accreditation standards, nearly all US hospitals now have an antibiotic stewardship program. However, many hospitals, especially smaller hospitals, appear to struggle with access to ID expertise and with deploying diagnostic stewardship strategies. CDI prevention could be enhanced through diagnostic stewardship and by emphasizing the role of non–ID-trained pharmacists and clinicians in antibiotic stewardship.

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Uptake of Antibiotic Stewardship Programs in US Acute Care Hospitals: Findings From the 2015 National Healthcare Safety Network Annual Hospital Survey

Cited by 42 publications

References 4 publications

A Before-and-After Study of the Effectiveness of an Antimicrobial Stewardship Program in Critical Care

A Before-and-After Study of the Effectiveness of an Antimicrobial Stewardship Program in Critical Care

Trends in Health Care–Associated Infection Prevention Practices in US Veterans Affairs Hospitals From 2005 to 2017

Antibiotic stewardship teams and Clostridioides difficile practices in United States hospitals: A national survey in The Joint Commission antibiotic stewardship standard era

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