Editor's note: This is the second installment in a two-part series on appropriate use of medical resources. Part 1 (July 3, 2014) identified five areas in which hospitals, in partnership with their clinical staff and patients, should look to reduce non-beneficial care. It also described the first in a series of toolkits targeting each of the five areas.

The American Hospital Association released its first toolkit in April 2014 on appropriate blood management in inpatient services. A second toolkit released in June focuses on antimicrobial stewardship. To offer this toolkit, AHA is partnering with the Centers for Disease Control and Prevention, the American Society of Health-System Pharmacists, the Association for Professionals in Infection Control and Epidemiology, the Infectious Diseases Society of America, the Pediatric Infectious Diseases Society and the Society for Healthcare Epidemiology of America. 

Antibiotics have been one of the greatest breakthroughs in medicine and the most important weapon in fighting bacterial diseases. Infections that once were deadly now can be cured, and they've made organ transplantation and other life-saving treatments possible. However, when it comes to antibiotics, more is not always better.

The CDC estimates that anywhere from 30 to 50 percent of antibiotic usage is either inappropriate or unnecessary. Overuse can lead to serious and unnecessary side effects for patients as well as the growth of antibiotic-resistant bacteria. According to the CDC, antibiotic resistance is associated with increased hospitalizations, length of stay, hospital costs, risk of transfer to the intensive care unit and risk of death.

Upward of 23,000 deaths a year are due to antibiotic-resistant bacteria. It will be years before new antibiotics are available to treat resistant infections, so it's imperative to improve the way antibiotics currently are being used. By implementing antibiotic stewardship programs, hospitals can ensure antimicrobial efficacy and safety for their patients. These programs help to ensure that patients receive the right antibiotics at the right time and for the right duration.

Numerous studies have shown that implementing an antibiotic stewardship program not only saves lives, but also can save money for health care providers and organizations. According to the IDSA, changing how antibiotics are prescribed and used in a hospital setting can reduce the complications of serious Clostridium difficile infections, lower bacterial resistance and improve surgical prophylaxis, all while achieving significant cost-savings for the hospital.  

Core Elements

To be effective, antimicrobial stewardship programs need to engage patients, providers and administrators to work together to improve antibiotic use. Clinicians, in particular, need to take ownership and lead the charge for establishing antibiotic stewardship programs. The CDC offers a general strategy on the core elements for implementing an antibiotic stewardship program, which include:

Leadership commitment. Make a firm commitment to creating and running an antibiotic stewardship program, including ensuring that all necessary resources (human, financial, technology, etc.) are in place and that support and education are offered.

Accountability. Identify a single leader, preferably a physician with training in infectious diseases and committed to quality improvement, who will be responsible for all outcomes. This person should have the support of and be able to work with all hospital groups.

Drug expertise. Identify a pharmacy leader who will help to co-lead the program.

Actions to support optimal antibiotic use. Pick interventions based on the needs of the facility. Do not try to implement too many changes at once. Interventions, such as antibiotic time-outs or requiring prior authorization, can be broad in nature, or they can be more specifically focused on certain syndromes like urinary tract infections or community-acquired pneumonia.

Tracking antibiotic prescribing and resistance patterns. Measure whether antibiotic processes and policy, their usage, and the outcomes associated with such usage are working.

Reporting. On a regular basis, make sure that all staff members are aware of antibiotic use and resistance. Also, if possible, link your hospital with the CDC's Antibiotic Use Option, which, on a monthly basis, reports outcomes on specific agents and locations using days of therapy data.

Education. Make sure a variety of educational resources are available, including having didactic presentations, providing messaging through newsletters and flyers, and making use of Web-based resources.

In addition, health care providers can promote correct antibiotic use by educating patients on the proper use of antibiotics and the consequences of overuse. The CDC encourages health care providers to collaborate with patients on appropriate use, stop and assess whether antibiotics are working or needed, and embrace antibiotic stewardship programs.

The CDC's seven points for developing an antimicrobial stewardship program have been used to create this newest toolkit's readiness assessment. The remainder of the toolkit provides hospitals and health systems with the best of the resources developed by our partners and of most use to them as they initiate or enhance their antimicrobial stewardship programs. The toolkit also highlights key resources for clinicians and patients to help them understand the importance of antimicrobial stewardship and the dangers of antibiotic resistance.  

To know whether hospitals and health systems are ready to establish an antibiotic stewardship program, they should evaluate themselves by using the checklist for Core Elements of Hospital Antibiotic Stewardship Programs. By completing the checklist, hospitals will understand if they have the necessary resources in place to run such a program. The program can help hospitals to seize yet another opportunity to reduce non-beneficial care in their communities.

John R. Combes, M.D., is a senior vice president of the American Hospital Association and president of the Center for Healthcare Governance, an AHA affiliate. He is also a member of Speakers Express.