Successful Antimicrobial Stewardship Takes Team Approach

As antimicrobial resistance and the risk of so-called “superbugs” have become major issues in the health care industry, some organizations have raced to develop internal processes to mitigate resistance, usually under the banner of an “antimicrobial stewardship program.”

That’s good news, insofar as it suggests hospitals are working hard to actively reduce the risks inherent to treatment at hospitals. In a new article published in Clinical Microbiology and Infection, an international team of infectious disease specialists lay out the bad news: most of these programs are being developed without clear guidance on which processes, guidelines, and structures are most effective at achieving the goals of antimicrobial stewardship.

The paper aims to change that, laying out an evidence-based “how-to” guide to help health care organizations optimize their antimicrobial stewardship programs (ASPs) based on the latest scientific evidence.

Successful ASPs begin with careful planning, the authors write. Prior to beginning an ASP, organizations need to put in place the proper structures, including creating guidelines for the ASP, choosing the antimicrobial stewardship (AMS) team, and setting aside sufficient resources to fund the program. Organizations should clearly define which processes need to be targeted by the program, and then move on to develop strategies to improve those processes.

Corresponding author Celine Pulcini, MD, PhD, of the University of Lorraine, in France, told Contagion® that health care leaders need to understand that the process won’t happen overnight. Full implementation of a successful program is likely to take at least a couple of years, and sometimes as many as 5 years.

Celine Pulcini, MD, PhD

“Most hospital executives (and clinicians) probably do not realize that the process takes such a long time to become an optimal full-scale program,” she said. “...As an example, decreasing antimicrobial use can usually be achieved quite quickly (within 1 year or 2), whereas significantly improving compliance with guidelines may take more time,” she said.

Compliance is an essential part of the process, but achieving a high level of compliance can be tricky with so many stakeholders involved. Pulcini and colleagues recommend that ASP teams proactively meet with stakeholders, listen to their thoughts, and explain the evidentiary basis for their AMS guidelines.

“An AMS program relies a lot on persuasive measures, even though some restrictive measures are usually associated,” she said. “It is therefore essential to build trust and empower people, so everyone is on board to bring about significant changes.”

Having the support of stakeholders—at all levels—is also important because swift responses to infections are a key part of a successful ASP.

Pulcini said some of the most challenging elements are securing the support of hospital management and sufficient personnel and information technology resources.

“Access to laboratory/imaging services and to timely results to be able to support the diagnosis of the most common infections at your hospital can also be a limiting factor in low resource settings,” she said. “Monitoring/surveillance, as well as reporting and feedback can be sometimes overlooked, especially at the start of the program, or when the program is understaffed.”

Pulcini and colleagues said it’s also important to keep staff informed of the progress you are making. By giving regular updates and using benchmarks health care organizations can improve their results by leveraging the power of healthy competition between units or wards.

The full how-to guide can be accessed for free in the article.