Improper use of antibiotics is very common in hospitals: studies suggest that 30-50% of antibiotic use may not be correct. Such incorrect use may include prescribing antibiotics that can kill more types of bacteria than are needed, use of antibiotics on bacteria that are resistant to them, incorrect duration of therapy, or incorrect dosage. Incorrect use is a major driver of the development of serious antibiotic resistance among bacteria that cause infections, including MRSA. Also, because antibiotics can kill normal bacteria, they can also allow other organisms, such as Clostridium difficile, to grow and cause disease. In addition to these problems, antibiotics also can have serious side effects, such as antibiotic drug allergy, that can be reduced by proper antibiotic use.

One of the best ways to fight antibiotic resistance is for healthcare facilities, such as hospitals, to have antimicrobial stewardship (AMS) programs. These programs have been shown to improve the use of antibiotics, which reduced antibiotic resistance in those facilities. The CDC has condensed research and evidence of best practices into seven “core elements” that an effective AMS needs to have. The elements include leadership commitment, professional expertise, documentation and tracking of antibiotic use, and education, etc.

Acute care hospitals across the nation are now building these programs. AMS program implementation is self-reported by hospitals through the National Healthcare Safety Network (NHSN). Each year all hospitals must fill out a facility survey on NHSN about hospital infrastructure for infection prevention. Questions about AMS were added in 2014.

For 2014 and 2015, the AMS implementation goal was to have at least 80% of acute care hospitals with at least four or more of the AMS core elements. As progress was made, in 2016 the CT DPH HAI Program decided to increase that goal to 80% of acute care hospitals implementing at least five of the AMS core elements. The AMS dashboard shows that Connecticut hospitals have improved, and in 2019, 100% of acute care hospitals reached the target. As progress is being made, the 2020 goal set by the CT DPH HAI Program will be for all acute care hospitals to have all seven of the AMS core elements.

Hospital medical and non-medical staff, quality program staff, including infection prevention and control staff (infection preventionists and hospital epidemiologists), and especially hospital pharmacists and hospital antimicrobial stewardship program directors. Academic pharmacy programs, including the University of St. Joseph and University of Connecticut. Connecticut Hospital Association. Qualidigm, the Connecticut CMS Quality Improvement Organization (QIO). The Connecticut Healthcare Associated Infections Advisory Committee. The Connecticut Chapter of the Infections Diseases Society of America (CIDS). Centers for Disease Control and Prevention, Division of Healthcare Quality and Prevention. National Healthcare Safety Network. Council of State and Territorial Epidemiologists. The Association of Professionals in Infection Control, Inc. The Society for Healthcare Epidemiology in America. Connecticut Department of Public Health.

The Centers for Disease Control and Prevention (CDC) developed a set of core elements that summarizes evidence-based practices for antibiotic stewardship programs that can effectively promote proper use of antibiotics that can lead to reductions in drug resistant bacteria in those facilities. It includes seven key elements: leadership commitment, accountability, pharmacy expertise, measurable actions and objectives, tracking of progress, reporting, and education of staff and patients. Encouragement of the development of such programs may lead to improved antibiotic use in facilities and reductions in antimicrobial resistant infections.

AMS vary considerably between facilities, and most facilities lack key evidence-based elements for an effective AMS. Using CDC’s technical assistance tools, Connecticut quickly developed a baseline dataset to inform future collaboration with facilities and pharmacists. Because this survey is now incorporated into the National Healthcare Safety Network (NHSN) surveillance system already used by Connecticut DPH to track healthcare assorted infections, tracking trends in AMS capacity and activities in facilities throughout the state will be facilitated. These data are useful for ongoing prevention planning and evaluation. AMS surveys could be useful for assessment in other facility types across the spectrum of healthcare that also are important sources of antimicrobial resistance (e.g., long term acute care hospitals, long term care facilities).