Developing Technical Guidance for State and Local Health Departments Implementing Antibiotic Stewardship

BACKGROUND: Antibiotic resistance (AR) is an urgent health problem that is responsible for over two million illnesses and 23,000 deaths annually in the United States. The misuse of antibiotics has contributed to the growing problem of AR and avoidable adverse events, such as Clostridium difficile infection. Because antibiotics are a shared resource, the potential for spread of resistant organisms means that the misuse of antibiotics can adversely impact the health of patients who are not even exposed to them. Improving the use of antibiotics in healthcare to protect patients and reduce the threat of antibiotic resistance is a national priority.

Antibiotic stewardship (AS) refers to coordinated interventions designed to improve the use of antibiotics. State and local health departments (SHD) play critical roles as partners and conveners to establish regional collaboratives to promote AS. In 2014, CSTE submitted a policy position statement recommending that all SHDs evaluate and incorporate AS activities across healthcare settings into their healthcare associated infections (HAI) programs. The Centers for Disease Control and Prevention (CDC) partnered with the Public Health Foundation (PHF) to assess SHD needs and collect tools, success stories and strategies from SHDs implementing AS activities as part of a coordinated approach to prevent and reduce antibiotic resistance.

METHODS: Core components of AS programs include leadership, surveillance, AS activity coordination, education, communication strategy and AS policy. These core components were used to develop a standardized tool to guide a one-hour in-depth interview with HAI coordinators conducted by an experienced facilitator. The discussion will focus on stewardship activities occurring in each jurisdiction, including how the SHD coordinates and convenes partners to promote stewardship across the healthcare continuum. SHD selection was based on the National Healthcare Safety Network (NHSN) annual facility survey (NHSN is the CDC surveillance system for HAIs; the survey contained questions about inpatient stewardship programs), CDC subject matter expert input, and took into account geographic representation and activities reflecting the full healthcare continuum. Twenty SHDs were contacted for participation in the structured in-depth interview; consent was obtained to share identified tools and strategies for national distribution.

RESULTS: AND CONCLUSIONS: This project is ongoing and we anticipate completion in spring 2016. CDC and PHF plan to release technical guidance for SHDs, including a catalogue of tools and strategies, to facilitate local implementation of AS activities.