Evaluating the State of Antimicrobial Stewardship Programs in Acute Care and Critical Access Hospitals in Hawaii

BACKGROUND:   Antibiotic resistance is ever increasing, with more than two million people in the United States acquiring infections resistant to antibiotics each year and at least 23,000 people dying as a result.  Up to 50% of all antibiotics prescribed are unnecessary or inappropriately prescribed. An antibiotic stewardship program (ASP) is one method that has been shown to curtail the rising antibiotic resistance. ASP implementation in healthcare facilities has not been measured in Hawaii. Our objective was to evaluate the status of ASPs in Hawaii acute care and critical access hospitals.

METHODS:   A web-based survey was adapted from the California Department of Health’s ASP needs assessment (2010) and distributed to all 24 acute care and critical access hospitals in Hawaii. The assessment included questions on antibiogram use, electronic medical systems, availability of dedicated staff, ASP interventions in place, barriers to initiating an ASP, and desired areas of further training. We defined ASP as follows: coordinated interventions designed to improve and measure the appropriate use of antimicrobial agents by promoting the selection of the optimal antimicrobial drug use. We asked facilities to complete the survey as a multi-disciplinary team.  

RESULTS:   Responses from 83% (n=20) of facilities were obtained.  Forty-five percent (n=9) of these reported having ASP strategies and dedicated staff (n=4) or at least a partial ASP program in place (n=5).  Additionally, 35% (n=7) reported not having an ASP but planned on initiating one; only 20% (n=4) reported not having any ASP activities planned or in place. For facilities with no ASP (n=11), the primary barriers to ASP implementation were staffing constraints (55%, n=6) and ASP not being a high priority (28%, n=3). Of all facilities surveyed; facilities indicated that they would like further training in de-escalation of antibiotics (65%, n=13) and establishing clinical pathways and guidelines (60%, n=12).

CONCLUSIONS:   We found through our assessment that while very few (n=4) facilities in Hawaii have an established ASP, most are in various stages of implementing one. However, some have yet to prioritize this critical issue. Additionally, we have identified challenges to implementing an ASP as well as specific facility interests that have contributed to our developing actionable steps forward, including targeted trainings, consultations, and facility-tailored strategies to move forward most effectively. Conducting an assessment before initiating ASP activities or an ASP collaborative may be very helpful for states, territories, and local health departments to facilitate targeting the limited resources and personnel available.