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 Committee 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 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

Every November, the Centers for Disease Control and Prevention (CDC) hosts the U.S. Antibiotic Awareness Week, formally known as Get Smart About Antibiotics Week, as 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.

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. In addition to the originally published Hospital Core Elements, the CDC has also released core elements specifically geared toward small and critical access hospitals

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
  • The Michigan Infectious Disease Society (MIDS) is a local society for infectious diseases clinicians within the State of Michigan.
  • The Michigan Antibiotic Resistance Reduction Coalition (MARR) is a local organization that seeks to improve antimicrobial use and slow the growth of antimicrobial resistance within the State of Michigan via collaborative efforts of community, academic, government, labor, and industry partners.
  • The Michigan Hospital Medicine Safety Consortium (HMS) is a collaborative of hospitals across the state of Michigan with the goal of improving the quality of care for hospitalized medical patients who are at risk for adverse events. HMS has put together an Antimicrobial Toolkit complete with treatment guidelines, training courses, pocket cards and more!
  • The Michigan Department of Health and Human Services (MDHHS) has a very helpful site on antimicrobial stewardship with available resources for clinicians and patients alike.
    • The MDHHS Surveillance for Healthcare Associated & Resistant Pathogens (SHARP) Unit also offers both onsite and remote infection control consultations for a variety of different types of facilities. Information on setting up an Infection Control Assessment and Response (ICAR) visit is available here.
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. ASHP has updated their Core Quality Measures for Pharmacy Accountability to include antimicrobial stewardship; more information is available here. A more detailed overview of the ASHP Pharmacy Accountability Measures can be found here after logging in with your ASHP account.

NHSN Antimicrobial Use and Resistance Module

  • Many institutions have begun to focus on enrolling and reporting to the National Healthcare Safety Network’s (NHSN) Antimicrobial Use and Resistance (AUR) Module. Information on the background, implementation process, and use of the NHSN AUR module can be found here.
  • A list of vendors that participate with the NHSN AUR module can be found on the SIDP website.
  • For specific details regarding the NSHN AUR module, we encourage you to reach out to one of the Michigan antimicrobial stewardship experts listed below.

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.

Pharmacy Representative

Institution

Reporting to NHSN AUR?

Adam Utley

McLaren Northern Michigan

No

Curtis Collins

St. Joseph Mercy Health System

Yes

Derek VanderHorst

Spectrum Health

Yes

Greg Eschenauer

University of Michigan

Yes

Nicholas Torney

Munson Medical Center

No

Rachel Kenny

Henry Ford Hospital

No –Likely by end of 2019

Sara Ogrin

Helen DeVos Children’s Hospital

Yes

Rand Sulaiman

Ascension Genesys Health System

Yes

Lama Hsaiky

Beaumont Hospital, Dearborn

No


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.