BACKGROUND: The promotion of antibiotic stewardship programs (ASPs) in healthcare facilities is a federal priority with the goal to have ASPs in 100 percent of hospitals by 2020. Guidelines have been published by the Centers for Disease Control and Prevention (CDC) outlining seven core elements of a successful hospital ASP. Elements include: leadership support, accountability, drug expertise, measurable actions, antibiotic tracking, reporting, and education. Facility capacity is evaluated through the Annual Hospital Survey completed within the National Healthcare Safety Network.
METHODS: A comparative analysis of 2014 and 2015 survey data was conducted to evaluate progress and identify remaining gaps in Virginia ASPs across two survey years. Hospitals were stratified based on Virginia region, bedsize (≤100, 101-200, >200), and medical school affiliation. Statistical significance was analyzed using Fisher’s exact test. Analyses were conducted using SAS 8.3.
RESULTS: A total of 81 and 82 Virginia hospitals responded to the 2014 and 2015 surveys, respectively. Forty hospitals (50%) met all seven core elements in 2014, and 50 hospitals (61%) reported meeting them in 2015 (p < 0.01). Statistically significant improvement was seen in 2015 in the leadership (p <0.001), accountability (p <0.001), and reporting (p=0.03) core elements. Of the hospitals that met all 7 core elements in 2015, 48% were affiliated with a medical school, and 42% were in hospitals with >200 beds.
CONCLUSIONS: Improvement was seen in Virginia hospital ASPs in 2015 compared to 2014. Despite overall improvement, gaps remain within each individual core element, including implementing antibiotic time out, tracking days of antibiotic therapy and defined daily dose, and developing staff stewardship education programs. Virginia stakeholders plan to use these data to create targeted education and resources to strengthen hospital ASPs across the state. The Virginia Department of Health’s recent receipt of federal funds to build capacity to enhance hospital ASPs will further augment these endeavors, with the aim to improve appropriate antibiotic prescribing and decrease antibiotic resistance.