Infection Control

Building an antimicrobial stewardship program

Briefings on Infection Control, September 1, 2009

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Preventing the spread of MDROs in your facility is increasingly important. With close attention from The Joint Commission through the National Patient Safety Goals and an increased cost association with these organisms, infection prevention efforts have never been more vital.

But infection prevention may not be the only way to reduce MDRO infections in your facility. Although hand washing will always remain the most effective way to halt the spread of diseases, you may find that appropriate use of antibiotics can provide additional support in cutting down your infection rate.

Antimicrobial stewardship programs elicit the help of several departments, including pharmacy, information technology (IT), administration, and perhaps most importantly, IC. The joint effort alleviates the strain on just one department.

Judicious and regulated use of antibiotics can reduce infections, save your facility money, and provide much more control over infections in the future, says Richard H. Drew, PharmD, MS, BCPS, professor at Campbell University College of Pharmacy and Health Sciences and associate professor of medicine (infectious diseases) at Duke University School of Medicine in Durham, NC.

“To use [antibiotics] optimally relative to dose, and relative to selection and duration, obviously is all already part of that equation,” Drew says. “There is no question whatever we are doing wrong now we are going to pay for and we are already paying for.”

Starting the program

In many hospitals, particularly small community hospitals, the IC department is often the strongest, most established program in the facility. For this reason, IC usually takes the lead in building an antimicrobial stewardship program while reaching out to other departments such as pharmacy, infectious disease physicians, IT, administration, and microbiology, Drew says. But most importantly, IC is usually the eyes and ears of the facility in terms of infection rates and specific problems with MDROs.

“For facilities that are kind of starting these things and don’t formally have either the authority or the resources, many times it begins with infection control as the administrative experience to start to make these things happen,” Drew says.

In other cases, programs have been directed by a physician or codirected by a pharmacist and a physician who has close involvement with infectious diseases, says ¬Allison V. Tauman, PharmD, MPH, implementation manager at VHA Performance Services in Irving, TX, who helped set up an antimicrobial stewardship program at Hospital of Saint Raphael in New Haven, CT. ¬Tauman published the results in the May Hospital Pharmacy.

“To make it successful, it does need to be collaborative. You can’t just work in your own separate silos,” Tauman says. “We were collaborative in the best manner possible with as many people as we could. I think just being up on the floors and showing your face day in and day out was very helpful in just setting the tone and just changing the culture of how we prescribed antibiotics at our hospital.”

This is an excerpt from a member only article. To read the article in its entirety, please login or subscribe to Briefings on Infection Control.

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