Use of leading practices in US hospital antimicrobial stewardship programs.
Edward A Stenehjem, Barbara I Braun, Salome O Chitavi, David Y Hyun, Stephen P Schmaltz, Mohamad G Fakih, Melinda M Neuhauser, Lisa E Davidson, Marc J Meyer, Pranita D Tamma, Elizabeth S Dodds-Ashley, David W Baker
Author Information
Edward A Stenehjem: Division of Infectious Diseases and Epidemiology, Intermountain Healthcare, Salt Lake City, Utah.
Barbara I Braun: Division of Healthcare Quality Evaluation, The Joint Commission, Oakbrook Terrace, Illinois. ORCID
Salome O Chitavi: Division of Healthcare Quality Evaluation, The Joint Commission, Oakbrook Terrace, Illinois. ORCID
David Y Hyun: The Pew Charitable Trust, Washington, DC. ORCID
Stephen P Schmaltz: Division of Healthcare Quality Evaluation, The Joint Commission, Oakbrook Terrace, Illinois. ORCID
Mohamad G Fakih: Ascension Healthcare, St. Louis, Missouri. ORCID
Melinda M Neuhauser: Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia.
Lisa E Davidson: Division of Infectious Diseases, Department of Medicine, Atrium Health, Charlotte, North Carolina. ORCID
Marc J Meyer: Infection Prevention and Clinical Pharmacy, Southwest Health System, Cortez, Colorado. ORCID
Pranita D Tamma: Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland. ORCID
Elizabeth S Dodds-Ashley: Division of Infectious Diseases and International Health, Duke University Medical Center, Durham, North Carolina.
David W Baker: Division of Healthcare Quality Evaluation, The Joint Commission, Oakbrook Terrace, Illinois. ORCID
OBJECTIVE: To determine the proportion of hospitals that implemented 6 leading practices in their antimicrobial stewardship programs (ASPs). Design: Cross-sectional observational survey. SETTING: Acute-care hospitals. PARTICIPANTS: ASP leaders. METHODS: Advance letters and electronic questionnaires were initiated February 2020. Primary outcomes were percentage of hospitals that (1) implemented facility-specific treatment guidelines (FSTG); (2) performed interactive prospective audit and feedback (PAF) either face-to-face or by telephone; (3) optimized diagnostic testing; (4) measured antibiotic utilization; (5) measured C. difficile infection (CDI); and (6) measured adherence to FSTGs. RESULTS: Of 948 hospitals invited, 288 (30.4%) completed the questionnaire. Among them, 82 (28.5%) had <99 beds, 162 (56.3%) had 100-399 beds, and 44 (15.2%) had ≥400+ beds. Also, 230 (79.9%) were healthcare system members. Moreover, 161 hospitals (54.8%) reported implementing FSTGs; 214 (72.4%) performed interactive PAF; 105 (34.9%) implemented procedures to optimize diagnostic testing; 235 (79.8%) measured antibiotic utilization; 258 (88.2%) measured CDI; and 110 (37.1%) measured FSTG adherence. Small hospitals performed less interactive PAF (61.0%; P = .0018). Small and nonsystem hospitals were less likely to optimize diagnostic testing: 25.2% (P = .030) and 21.0% (P = .0077), respectively. Small hospitals were less likely to measure antibiotic utilization (67.8%; P = .0010) and CDI (80.3%; P = .0038). Nonsystem hospitals were less likely to implement FSTGs (34.3%; P < .001). CONCLUSIONS: Significant variation exists in the adoption of ASP leading practices. A minority of hospitals have taken action to optimize diagnostic testing and measure adherence to FSTGs. Additional efforts are needed to expand adoption of leading practices across all acute-care hospitals with the greatest need in smaller hospitals.
