Accreditation, certification and standard-setting organizations are ramping up pressure on hospitals to reduce the overuse of antibiotics and, importantly, create antibiotic stewardship programs.

A new program from DNV GL to certify hospitals as Centers of Excellence in Managing Infection Risk includes requirements aimed at reducing the overuse of antibiotics.

The decision to include that makes sense. Even if antimicrobial stewardship is more of a population health improvement strategy that may not directly benefit the hospital being certified, reducing antibiotic overuse is an important part of reducing unnecessary infections.

The significance of antimicrobial stewardship has been pushed hard by the CDC and others within health care, and has begun to spill into the public's awareness.

Making it a requirement of the DNV program can only help the cause, particularly given that DNV officials say there's a lot of interest from hospitals in getting certified. "I've got 20 in the queue right now that are going through their gap assessments," which is the first step in getting certified, says Patrick Horine, CEO of DNV Healthcare in the United States.

Inclusion of the requirement was welcomed by medical staff leaders at Sentara Leigh Hospital, one of the two hospitals that were the first to be certified in infection risk management certification. Scott Miller, M.D., vice president, medical affairs, says that an antibiotic stewardship program was something that he's wanted to create for sometime, but having it as part of the process jump-started that process.

"DNV comes along and says, 'If you're going to manage the risks of infections in a hospital, you really do need to start tracking your antibiotic usage,' " Miller says. As a result, Sentara has stewardship committees in place at two hospitals and plans to expand them across the system, he says.

The Joint Commission also is active in promoting antibiotic stewardship. The organization doesn't have a standard in place requiring a stewardship committee to be in place, but promotes stewardship in other ways, says Ana Pujols McKee, M.D., executive vice president and chief medical officer.

For example, Joint Commission officials are working with National Quality Forum representatives to come up with a plan to address the issue. "We've just begun conversations with NQF, [which is interested] in bringing together multiple stakeholders to look at the issue of stewardship in antibiotics," Pujols McKee says. NQF officials couldn't be reached for comment.

"The first step would be to gain consensus and to drive the field in implementing such programs," McKee says.

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