NQF, CDC release practical antibiotic stewardship playbook: 6 things to know

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The National Quality Forum, the CDC and Nashville, Tenn.-based Hospital Corporation of America led a team of experts to create a guide for hospitals of all sizes on how to implement an antibiotic stewardship program, and the guide, "Antibiotic Stewardship in Acute Care: A Practical Playbook" was released Wednesday.

The following are six things to know about antibiotic resistance and the newly released playbook.

1. The growing issue. The consequences of antibiotic overuse and misuse have turned into a "very important and serious public health problem in the United States," Arjun Srinivasan, MD, associate director for healthcare-associated infection prevention programs within the CDC, said during a press briefing webinar Wednesday. In fact, per CDC data, drug-resistant bacteria cause 2 million illnesses and 23,000 deaths each year.

2. The hospital size problem. The CDC recommended in 2014 that all acute care hospitals in the U.S. implement an antibiotic stewardship program, and also released the "Core Elements of Hospital Antibiotic Stewardship Programs," which outlines seven elements essential to a successful program. However, data from a 2015 survey found that less than 40 percent of responding acute care hospitals had actually implemented all seven elements, and that percentage was even lower for small hospitals, experts explained during the briefing.

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3. How the playbook helps. The playbook pulls real-world experience from more than 40 experts from around the country to provide advice on how to implement the seven core elements in any hospital, regardless of size. The playbook breaks down the CDC's seven core elements and provides a variety of implementation examples, ranging from basic to advanced. It also presents potential barriers to implementing each element, as well as suggested solutions, Edward Septimus, MD, medical director of infection prevention and epidemiology at HCA, explained during the briefing.

4. A practical resource. According to Sara Cosgrove, MD, director of Baltimore-based Johns Hopkins Hospital's antimicrobial stewardship program, the playbook is "probably the most practical document on stewardship out there," as it puts best practices and implementation advice all in one convenient location, eliminating the need for stewardship leaders to scrounge the Internet for multiple sources.

5. CMS, Joint Commission pressures. Hospitals may soon have more reason to implement antibiotic stewardship programs, beyond the fact that they can help curb bacterial resistance and save lives — per Dr. Cosgrove, CMS is working on a draft to make antibiotic stewardship a condition of participation, and the Joint Commission is developing a standard requiring antimicrobial stewardship in various care settings.

6. Future resources. The playbook is only applicable to acute care hospitals at this time, but antibiotic stewardship is an issue across the care continuum, including in nursing homes and outpatient care clinics. According to Dr. Srinivansan, putting together a playbook for nursing homes would be difficult at this point, as the experience there on how best to implement a program is "limited." However, he said there is "definitely interest in continuing to build out this work in other settings."

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