Antimicrobial Stewardship

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.

• SIDP Certificate Program
• MAD-ID Certificate Program
• SIDP/ASCP Long-term Care Certificate Program

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.

• 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.

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

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

• University of Nebraska Medical Center Antimicrobial Stewardship Program
• University of Minnesota Center for Infectious Disease Research and Policy Antimicrobial Stewardship
• IDSA Guidelines
• HIV Guidelines

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.