BACKGROUND: Antimicrobial stewardship programs (ASP) promote and support the judicious use of antibiotics within healthcare facilities in order to curb the evolution of antimicrobial resistant (AR) organisms. The Centers for Disease Control and Prevention found that coordinated prevention approaches have more potential to prevent the emergence and spread of AR organisms, within and between healthcare facilities, than when working alone. In January 2017, skilled nursing facilities (SNFs) were required by California law to implement specific ASP elements. However, many do not have the capacity and/or resources to comply. The Los Angeles County Department of Public Health (LACDPH) conducted a survey to assess the status of hospital ASPs, in part to better understand what level of support they can provide to SNFs with which they share patients (network SNFs).
METHODS: An online questionnaire was sent out to all 93 LAC acute care hospitals in November 2015. Student volunteers conducted follow-up calls to obtain responses. Results were collected via Google Docs, and summarized in Excel. ASP tiers were defined using the California Department of Public Health ASP Initiative.
RESULTS: Overall fifty-one hospitals responded (55%): twenty (39%) reported having an advanced ASP and thirty-one (61%) an intermediate or basic ASP. Of those with an intermediate or basic ASP, 11/18 (61%) and 10/13 (77%), respectively, cited ‘insufficient protected time for ASP activities’ as a major or moderate challenge in implementing more advanced strategies. Thirty-one (63%) hospitals reported knowing the facility had a network of SNFs, but only five (11%) knew whether these SNFs have any AS activities. Thirty hospitals (59%) reported they would be likely or extremely likely to provide educational materials and treatment guidelines for stewardship activities at their network SNFs; twenty (39%) to provide infectious disease consultation; and nineteen (37%) to provide pharmacy support. Facilities with advanced ASPs were more likely to offer assistance in one or more of these areas but differences were not statistically significant.
CONCLUSIONS: Results show that many hospitals are willing to support ASPs of networked SNFs. More advanced programs appear more likely to provide this support. For hospitals with basic or intermediate ASPs, having more dedicated time and resources to advance their own hospital’s program may be needed before they can begin assisting others. As part of its ongoing efforts to combat the spread of AR in LAC, LACDPH is working with hospitals to develop a coordinated approach for AS activities with their network SNFs.