Hi, I'm Dr. Arjun Srinivasan, the Associate Director for Healthcare Associated Infection
Prevention Programs in the Division of Healthcare Quality Promotion at CDC.
I'm pleased to share with you information on the 2019 update of the CDC's Core Elements
for Hospital Antibiotic Stewardship Programs.
Used when needed, antibiotics are life-saving.
However, giving patients antibiotics when they are not needed creates preventable harm.
Given that twenty percent of patients who get an antibiotic in a hospital experience
an adverse drug event, there are thousands of people we can protect by improving the
way we prescribe antibiotics.
The good news is that we have a solution.
Many studies have shown that antibiotic stewardship programs can improve antibiotic use, leading
not only to better treatment of infections, but to fewer patient harms.
In 2014, CDC called on all U.S. hospitals to have an antibiotic stewardship program
and developed the Core Elements of Hospital Antibiotic Stewardship Programs to help accomplish
that goal.
The Core Elements outlines the structures and functions associated with successful stewardship
programs in a framework that can be adapted to any hospital.
In 2019, we've updated the hospital Core Elements to reflect both lessons learned from
five years of experience as well as new evidence from the field of antibiotic stewardship.
This update comes at an important time as the Core Elements are referenced in the 2019
revision of the hospital Conditions of Participation from the Centers for Medicare and Medicaid
Services.
As before, there are seven Core Elements of Hospital Antibiotic Stewardship Programs.
The 1st is leadership commitment.
Backing from the senior leadership of the hospital is central to the success of any
quality improvement effort, and antibiotic stewardship is no exception.
Hospital leadership support is essential in ensuring that the stewardship program has
the staffing and resources necessary to do its job.
Program leadership is the 2nd Core Element.
To be effective, a stewardship program must have a leader or co-leaders.
Experience is demonstrating that co-leadership by a physician and pharmacist is an especially
popular model and is currently in place in 59% of US hospitals.
The growth of physician-pharmacist co-led stewardship programs influenced a renaming
of the 3rd Core Element, which is now called pharmacy expertise, rather than drug expertise,
to reflect the key role that pharmacists must play in improving antibiotic use in hospitals.
The 4th Core Element - action - has been revised quite a bit based on data published since 2014.
It is now clear that there are two key interventions that are most important in reducing unnecessary
antibiotic use in hospitals: prospective audit and feedback and pre-authorization.
The action Core Element also suggests that stewardship programs focus efforts on improving
antibiotic use for three conditions: community acquired pneumonia, urinary tract infection,
and skin and soft tissue infection.
These three infections account for more than half of all antibiotic use in U.S. hospitals
and studies have shown important opportunities to improve use for all three.
Tracking antibiotic use as well as other processes and outcomes, is the 5th Core Element.
The 2019 Core Elements update highlights the utility of reporting antibiotic use data to
CDC's National Healthcare Safety Network Antibiotic Use, or AU, Option, which allows
hospitals to both monitor antibiotic use and benchmark their use against other hospitals
through the Standardized Antimicrobial Administration Ratio.
There are currently more than 1,400 hospitals reporting data to the AU option, and that
number continues to grow.
The 6th Core Element, reporting, highlights the importance of giving information on antibiotic
use and resistance to leadership and providers who can use the data for action.
Education is the 7th and final Core Element.
In addition to education for providers, the 2019 Core Elements update highlights the importance
of educating patients about antibiotics, especially with respect to potential adverse events,
and underscores the importance of engaging nurses in patient education efforts.
We've made tremendous progress in antibiotic stewardship programs in U.S. hospitals - in
2018, 85% of hospitals reported that they had stewardship programs with all 7 of the
CDC Core Elements.
The goal now is to make those programs as effective as possible.
We hope this 2019 update of the Core Elements for Hospital Antibiotic Stewardship Programs
will serve as a valuable resource as hospitals look to expand and optimize their efforts
to improve antibiotic use.