BACKGROUND: In 2015, CSTE released position statement 15-ID-02 recommending a collaborative One Health approach to address antimicrobial stewardship and a forum for sharing examples. Minnesota used a One Health approach to develop an inter-agency antimicrobial stewardship strategic plan.
METHODS: Beginning in 2015, we used a One Health approach to antimicrobial stewardship as follows: needs assessment to describe the problem; environmental scan to identify existing data, resources, and stakeholders; and strategic plan development including engaging stakeholders, analyzing data, reviewing and refining mission, vision, strategies, outcomes, and the evaluation plan.
RESULTS: For the needs assessment, we interviewed a range of human, animal, and environmental experts and evaluated existing stewardship guidelines through focus group discussions and a survey across the continuum of human healthcare. Major themes included the need to improve communication among human, animal, and environmental health practitioners; data collection and feedback mechanisms; and organizations connected with existing resources.
For the environmental scan, we conducted a literature review and identified One Health data sources for potential metrics including state surveillance of antimicrobial-resistant pathogens in humans and retail food, health care quality reports, surveys (e.g. National Healthcare Safety Network, FoodNet, Food and Drug Administration, US Department of Agriculture, US Geographical Survey, state sites from a national point-prevalence antimicrobial use survey), and academic research studies. We added measures to the Behavioral Risk Factor Surveillance System and pursued access to the state All Payers Claims Database for future data analyses. We identified stakeholders including Department of Health, Department of Agriculture, Board of Animal Health, Pollution Control Agency, and Department of Human Services; human and animal healthcare professional associations, licensing boards, leading clinicians from inpatient, outpatient, dentistry, long-term care, and veterinary medicine settings; representatives from livestock producers, food retail corporations, laboratory sciences, pharmaceuticals, and informatics; environmental scientists; and policy-makers.
For the strategic plan development, we planned a One Health antimicrobial stewardship summit to engage stakeholders and begin strategic plan development. In preparation, we compiled the aforementioned data to present. We formed a steering group, iteratively reviewed and revised our mission, vision, and strategic priorities, and provided participant homework beforehand. We planned facilitated summit group exercises to find common motivation among One Health groups and discuss desired outcomes, resources, and barriers for the strategic plan.
CONCLUSIONS: We hope our structured One Health approach and future strategic plan will allow a foundation for improved coordination of One Health activities and advocacy for evidence-based policy to address antimicrobial stewardship.