Antimicrobial Stewardship

Antimicrobial Stewardship

Antimicrobial resistance has become a high priority for healthcare systems worldwide due to its negative impact on patient outcomes and high monetary costs. Due to these issues, the United States has produced the National Action Plan for Combating Antibiotic-Resistance Bacteria that aims to help the nation to overcome these challenges. Antimicrobial Stewardship Programs (ASPs) have proven to be effective in slowing the growth of antimicrobial resistance, improving patient outcomes, and saving healthcare systems money. The goal of the Michigan Society of Health-System Pharmacists (MSHP) Antimicrobial Stewardship Task Force is to provide clinicians with the tools they need to be successful in the implementation and optimization of ASPs within their practice setting.

The Joint Commission Preliminary Standards
As of Jan. 1, 2017, the Joint Commission has issued a mandate that acute health-care settings (i.e. hospitals, critical access hospitals, and nursing care centers) implement an antimicrobial stewardship program. The Joint Commission has published an accreditation survey guide that can be utilized to determine how to prepare your institution for the new antimicrobial stewardship standards. 

CDC Get Smart About Antibiotics Week

Get Smart About Antibiotics Week is a one-week observance aimed at raising awareness about antibiotic resistance and appropriate prescribing and use. As of September 2014, the White House announced an Executive Order to combat the increasing rates of antibiotic resistance infections both domestically and internationally as over 2 million people in the U.S. become infected with bacteria that are resistant to antibiotics every year. This observance recognizes that antibiotic use is one of the single most important factors leading to the antibiotic resistance around the world, so this observance is collaborated with the European Antibiotic Awareness Day, Australian Antibiotic Awareness Week and Canadian Antibiotic Awareness Week.

The 2017 Get Smart About Antibiotics Week will be observed in November 2017. Visit the CDC's website to gather more information about the initiative, access materials to share with patients in your practice setting and learn more about how you can continue your antibiotic stewardship efforts.


Getting Started

The Joint Commission recommends that an institution’s Antimicrobial Stewardship Program should have seven main components. These components are referred to as “Core Elements of an Antimicrobial Stewardship Program” and are discussed in detail by the CDC.

The CDC has also created recommendations on the formation of an outpatient antimicrobial stewardship program in the long-term care setting. These recommendations can be found in "The Core Elements of Antibiotic Stewardship for Nursing Homes." 

In 2016 The Centers for Disease Control and Prevention released The Core Elements of Outpatient Antibiotic Stewardship as a framework for antimicrobial stewardship in the outpatient setting. Although the Core Elements are intended for a wide variety of intended audiences, community pharmacies and ambulatory care clinics are specifically listed as focal stewardship practice sites.

In February 2016, the Infectious Diseases Society of America (IDSA) in partnership with the Society for Healthcare Epidemiology of America (SHEA) published updated guidelines on implementing an inpatient Antibiotic Stewardship Program. When used in conjunction with the CDC Core Elements of a Hospital Antibiotic Stewardship Program, these guidelines provide specific details on what to include in your institution’s ASP, as well as, providing details on how to implement your interventions.

The National Quality Forum (NQF) has published a “Practical Playbook” on antimicrobial stewardship. This playbook provides extensive detail on the CDC Core Elements of an Antimicrobial Stewardship Program, as well as, examples on how to implement each core element.

The Society of Infectious Diseases Pharmacists (SIDP) and Making a Difference in Infectious Diseases (MAD-ID) have created certificate programs focusing on the pharmacist’s role in the appropriate use of antimicrobial agents. This program seeks to create a strong knowledgebase in infectious diseases in order to successfully implement an Antimicrobial Stewardship Program.

Helpful Antimicrobial Stewardship Websites

The following websites consist of both local and national organizations that may be helpful when seeking additional antimicrobial stewardship resources.

Statewide Organizations
National Organizations
  • The CDC Get Smart for Healthcare is a national campaign focused on improving antimicrobial prescribing practices within inpatient healthcare facilities.
  • The Society for Healthcare Epidemiology of America (SHEA) is a national leader in infection control & antimicrobial stewardship. Their official publication, Infection Control & Hospital Epidemiology (ICHE), offers clinically applicable, peer-reviewed articles on pertinent infectious diseases topics.
  • In addition to publishing the guidelines on ASP implementation, the Infectious Diseases Society of American (IDSA) is also an excellent online resource for antimicrobial stewardship. Their official publication, Clinical Infectious Diseases, is an excellent resource for the management of infectious diseases. 
  • The Society of Infectious Diseases Pharmacists (SIDP) is a national organization for pharmacists specializing in infectious diseases. Their website offers resources on antimicrobial stewardship, infectious diseases practice, networking opportunities, and much more.
  • The American Society of Health-System Pharmacists (ASHP) has resources available to help guide clinicians as they implement an Antimicrobial Stewardship Program and what a pharmacist’s role in the program should look like.

Michigan Antimicrobial Stewardship Experts

The following clinicians have been identified as local experts in the field of antimicrobial stewardship and infectious diseases. Through an MSHP initiative to support antimicrobial stewardship, these individual have agreed to serve as mentors for others within Michigan . Please feel free to contact them with questions or concerns you have on antimicrobial stewardship.

Adam Utley (McLaren Northern Michigan) 
Christine Yost (Beaumont Hospital) 
Curtis Collins (St. Joseph Mercy Health System)
Dean Van Loo (Ferris State University)
Donald Scott (Spectrum Health Butterworth Campus)
Elaine Bailey (Michigan Antibiotic Resistance Reduction Coalition [MARR])
Greg Eschenauer (University of Michigan)
Michael Klepser (Ferris State University)
Michael Tiberg (Antimicrobial Stewardship Optimization, LLC [ASO])
Nicholas Torney (Munson Medical Center)
Ryan Mynatt (Detroit Medical Center)
Sara Ogrin (Helen DeVos Children's Hospital)

Infectious Diseases Treatment Guidelines

The following websites are resources for clinicians to use for guidance on treating infectious diseases in both the inpatient and outpatient setting.

Statewide and National Infectious Diseases Meetings

Statewide
The Great Lakes Infectious Diseases Conference is an annual infectious diseases conference that occurs every spring at the Ferris State University College of Pharmacy in Grand Rapids, Michigan.

National
The SIDP website has a list of national infectious diseases meetings for clinicians wishing to attend to expand their infectious diseases knowledge base.