Survey of Antimicrobial Stewardship Activities in Connecticut Acute Care Hospitals

BACKGROUND:  Prevention of antimicrobial resistance through the promotion of antimicrobial stewardship (AMS) programs in healthcare facilities is a national priority, and the subject of a recent Presidential Executive Order.  The Centers for Disease Control and Prevention (CDC) developed a set of core elements that summarizes evidence-based practices for antibiotic stewardship programs.  It includes seven key elements: leadership commitment, accountability, pharmacy expertise, measurable actions and objectives, tracking of progress, reporting, and education of staff and patients. Based on this, CDC developed a model survey instrument to assess facility capacity and antibiotic stewardship activities in acute care hospitals (ACHs) that can be used for facility-level, regional, or state assessments for planning, resource development, technical assistance, and public awareness.  CDC has posted this survey on their website, and developed a briefer version for the National Healthcare Safety Network (NHSN) annual survey. 

METHODS:  In September 2014, the Connecticut Department of Public Health (CT DPH) emailed the CDC survey to all 29 ACH in the state; all responded.    The responses to the CDC survey were also mapped to the version that has been incorporated into the NHSN annual facility survey.  Descriptive statistics were generated using Microsoft Excel.

RESULTS:  All ACH had physician and 90% had pharmacist AMS leaders.  Only 46% gave financial support.  All facilities prepare and distribute annual antibiograms and have protocols for treatment of frequently overprescribed clinical conditions.  However, only 28% document antibiotic indications, and only 38% require an “antibiotic time out” to reassess the initial regimen.  Two-thirds track consumption metrics, but only ½ of these communicate consumption data to clinical unit staff, and only 59% educate clinicians and staff annually on AMS.  Mapping the responses to the NHSN version of the annual facility survey, only seven (24%) of facilities were following 80% or more of the CDC core AMS elements.

CONCLUSIONS: AMS vary considerably between facilities, and most facilities lack key evidence-based elements for an effective AMS.  Using CDC’s technical assistance tools, Connecticut quickly developed a baseline dataset to inform future collaboration with facilities and pharmacists.  Because this survey is now incorporated into NHSN, tracking trends in AMS capacity and activities in facilities throughout the state will be facilitated.  These data are useful for ongoing prevention planning and evaluation.   AMS surveys could be useful for assessment in other facility types across the spectrum of healthcare that also are important sources of antimicrobial resistance (e.g., long term acute care hospitals, long term care facilities).