BACKGROUND: The promotion of antibiotic stewardship programs in healthcare facilities to prevent the increase of antibiotic-resistant organisms is a priority of the nation and the Virginia Department of Health healthcare-associated infections advisory group. Guidelines based on best practices have been published by the Centers for Disease Control and Prevention (CDC) outlining 7 core elements of hospital antibiotic stewardship programs. Core elements include: leadership support, accountability, pharmacy expertise, measurable actions, tracking, reporting, and education. To evaluate facility capacity, the CDC developed a survey instrument; a version of which was included in the National Healthcare Safety Network (NHSN), Annual Hospital Survey. In an effort to reduce inappropriate use of antibiotics in Maryland and Virginia hospitals, an affinity group was formed comprised of stakeholders from public health, quality improvement, and clinical communities.
METHODS: In October 2015, the Virginia/Maryland Antibiotic Stewardship Affinity Group developed an online assessment characterizing current hospital stewardship programs in the two states according to the seven CDC Core Elements. A comparative analysis evaluating the differences in results between the NHSN Annual Hospital Survey and the VA/MD Assessment was conducted, adjusting for differences in questions and facility respondents. Only Virginia hospitals were compared across assessments. Statistical significance of percentages was analyzed using chi-square tests using SAS version 8.3.
RESULTS: A total of 86 hospitals (52 in Virginia) responded to the VA/MD assessment (response rate=64%) and 82 Virginia hospitals responded to the 2014 NHSN annual survey. A total of 49 Virginia hospitals responded to both assessments. Approximately half of VA hospitals met all 7 core elements (52% VA/MD assessment, 49% NHSN annual survey). Both assessments identified leadership, accountability, reporting, and education as opportunities for greatest improvement. Statistically significant differences were observed for the leadership element (VA/MD: 65.3%, NHSN: 71.4%; p value: <0.001) and education element (VA/MD: 86.0%, NHSN: 65.3%; p value: 0.002) when assessing only the 49 facilities that completed both assessments.
CONCLUSIONS: Overall, these findings identified gaps in Virginia hospital antibiotic stewardship programs and suggest that there is variability in stewardship responses based on assessment type. Differences regarding survey completion date and respondent may help explain some of the discrepancies that were seen in the results. However, these findings stress the importance of standardized definitions and questions when evaluating hospital stewardship programs and activities within and across states. Virginia stakeholders plan to use this information to create targeted education and resources to strengthen hospital stewardship programs in the state.