Download ASP-Implementation-Guide-June-2016

Antibiotic Stewardship Program Implementation Guide
General Infrastructure – Leadership Support & Accountability
Resource
Website
https://www.whitehouse.gov/the-pressExecutive Order – Combating Antibiotic-Resistant Bacteria
office/2014/09/18/executive-orderThe White House outlines importance and need to take action released in September of
combating-antibiotic-resistant-bacteria
2014
https://www.whitehouse.gov/sites/defa
National Action Plan for Combating Antibiotic Resistant Bacteria
ult/files/docs/national_action_plan_for
Developed in response to Executive Order 13676: Combating Antibiotic-Resistant
_combating_antiboticBacteria—issued by President Barack Obama on September 18, 2014—the National Action
resistant_bacteria.pdf
Plan outlines steps for implementing the National Strategy for Combating AntibioticResistant Bacteria and addressing the policy recommendations of the President’s Council of
Advisors on Science and Technology (PCAST).
https://www.whitehouse.gov/sites/defa
The National Strategy for Combating Antibiotic Resistant Bacteria
ult/files/docs/carb_national_strategy.p
This document identifies priorities and coordinates investments: to prevent, detect, and
df
control outbreaks of resistant pathogens recognized by CDC as urgent or serious threats,
including carbapenem-resistant Enterobacteriaceae (CRE), methicillin-resistant
Staphylococcus aureus (MRSA), ceftriaxone resistant Neisseria gonorrhoeae, and
Clostridium difficile.
http://www.cdc.gov/getsmart/healthcar
Overview and Evidence to Support Stewardship
e/evidence.html
CDC Get Smart for Healthcare provides an overview, fast facts, antimicrobial stewardship
fact sheets, slide sets, and references.
Antibiotic Stewardship Driver Diagram and Change Package
http://www.cdc.gov/getsmart/healthcar
The Centers for Disease Control and Prevention (CDC) and the Institute for Healthcare
e/pdfs/antibiotic_stewardship_change_
Improvement (IHI) partnered in an effort to develop this conceptual model of key drivers
package.pdf
for reducing inappropriate antibiotic utilization.
Evidence on Impact of ASPs Current evidence on hospital antimicrobial stewardship
http://www.thelancet.com/journals/lani
objectives: a systematic review and meta-analysis.
nf/article/PIIS1473-3099(16)00065Lancet Infect Dis. 2016; S1473-3099(16):00065-7.
7/abstract
Antibiotic Stewardship Driver Diagram
http://www.cdc.gov/getsmart/healthcar
Assists in understanding primary and secondary drivers to timely and appropriate
e/pdfs/antibiotic_stewardship_driver_d
antibiotic utilization.
iagram.pdf
1
General Infrastructure – Leadership Support & Accountability
Resource
Website
Clinical and Economic Outcomes of a Prospective Antimicrobial Stewardship Program
http://www.ahaphysicianforum.org/res
In ASHP’s American Journal of Health-System Pharmacy, the authors found antimicrobial
ources/appropriateexpenditures, which had increased by an average of 14.4 percent annually in the years preceding
use/antimicrobial/content%20files%20
ASP implementation, decreased by 9.75 percent in the first year of the program and remained
pdf/ASHP-clinical-economicrelatively stable in subsequent years, with overall cumulative cost savings estimated at $1.7
outcomes.pdf
million. Rates of nosocomial infections involving Clostridium difficile, methicillin-resistant
Staphylococcus aureus and vancomycin-resistant enterococci all decreased after ASP
implementation.
Antibiotic Resistance - The Global Threat
http://www.cdc.gov/getsmart/week/do
wnloads/antibiotic-resistance-theglobal-threat.pdf
Antibiotic Rx in Hospitals: Proceed with Caution
http://www.ahaphysicianforum.org/res
This fact sheet from CDC illustrates how antibiotics save lives, but poor prescribing practices put ources/appropriatepatients at unnecessary risk for preventable allergic reactions, super-resistant infections and
use/antimicrobial/content%20files%20
deadly diarrhea. Errors in prescribing decisions also contribute to antibiotic resistance, making
pdf/CDC-Infographic.pdf
these drugs less likely to work in the future
http://www.whaqualitycenter.org/Porta
Top Ten Checklist
ls/0/Partners%20for%20Patients/C%2
Evidence based interventions provided by American Hospital Association (AHA),
0Difficile/CDIchecklist_2014.pdf
Partnership of Patients, and the Health Research and Educational Trust (HRET)
2013 Antibiotic Resistant Threat Report
http://www.cdc.gov/drugresistance/thr
Many of the most urgent and serious antibiotic-resistant bacteria CDC warned of in the threaten eat-report-2013/index.html
patients while they are being treated in healthcare facilities for other conditions. Four Core
Actions to Prevention Antibiotic Resistance is found on page 31.
http://www.ahrq.gov/professionals/edu
Engage the Senior Executive Module — Comprehensive Unit-based Safety Program
cation/curriculum(CUSP) Toolkit Tools focused on engaging and defining the roles and responsibilities of senior
tools/cusptoolkit/modules/engage/inde
executives in a quality improvement initiative, from the Agency for Healthcare Research and
x.html
Quality (AHRQ)
Stop the Line for Patient Safety Initiative
http://www.qualityandsafety.va.gov/St
Video describing an initiative that empowers staff to speak up if they see a risk to patient safety,
optheLine/StoptheLine. asp
from the U.S. Department of Veterans Affairs
2
General Infrastructure – Leadership Support & Accountability
Resource
Website
CDI NHSN Targeted Assessment for Prevention (TAP) Report Tool
https://www.lsqin.org/wpLSQIN step-by-step guide on how to run a TAP report in NHSN to determine how many less
content/uploads/2015/01/CDI-TAPinfections you need to reach your facilities goals.
Report-Tool.pdf
New societal approaches to empowering antibiotic stewardship
http://jama.jamanetwork.com/article.as
JAMA. 2016; 315(12):1229-1230.
px?articleid=2498636
Anthem Quality-In-Sights®: Hospital Incentive Program (Q-HIP)
https://www.anthem.com/provider/noa
pplication/f0/s0/t0/pw_b154968.pdf?re
fer=ahpprovider&state=nh
Seven ways to preserve the miracle of antibiotics
http://cid.oxfordjournals.org/content/56/10
Clin Infect Dis. 2013;56:(10)1445-1450
/1445
3
General Infrastructure – Supporting System
Resource
National Quality Forum Antibiotic Stewardship Playbook
The Playbook is designed to help hospitals and health systems strengthen existing
antibiotic stewardship initiatives or create antibiotic stewardship programs from the ground
up.
Antibiotic Stewardship Change Package
The Centers for Disease Control and Prevention (CDC) and the Institute for Healthcare
Improvement (IHI) partnered in an effort to develop this conceptual model of key drivers for
reducing inappropriate antibiotic utilization.
Antibiotic Stewardship Driver Diagram
Assists in understanding primary and secondary drivers to timely and appropriate antibiotic
utilization.
Antimicrobial Stewardship Toolkit
Best practices from an Antimicrobial Stewardship Collaborative, from the Greater New York
Hospital Association and the United Hospital Fund
Strategies to Assess Antibiotic use to Drive Improvements in Hospitals
Provided by the CDC and the PEW Charitable Trusts, the suggestions outlined in this document
are intended to help antibiotic stewardship programs in hospitals assess antibiotic use to see if
there are opportunities for improvement.
CDC Core Elements of Hospital Antibiotic Stewardship
Lists practical ways to initiate or expand antibiotic stewardship activities in hospitals.
Get Smart for Healthcare – Stewardship Program Examples
Links to hospital stewardship programs at various hospitals, success stories, and an interactive
collection of charts and maps summarizing national and subnational data on antimicrobial use
and resistance (Resistance Map), from CDC
Get Smart for Healthcare – Implementation Resources
Resources to assist in the implementation of hospital antibiotic stewardship programs, including
guidelines, assessment tools, conceptual models, and a sample inter-facility infection control
transfer form, from CDC
4
Website
http://www.qualityforum.org/Publicati
ons/2016/05/Antibiotic_Stewardship_
Playbook.aspx?utm_source=external&
utm_medium=link&utm_term=ABX&
utm_content=Playbook&utm_campaig
n=ABX
http://www.cdc.gov/getsmart/healthcar
e/pdfs/antibiotic_stewardship_change_
package.pdf
http://www.cdc.gov/getsmart/healthcar
e/pdfs/antibiotic_stewardship_driver_d
iagram.pdf
http://www.sheaonline.org/Portals/0/GNYHA_Antimic
robial_Stewardship_Toolk
it_FINALv2%20Dec2011.pdf
https://www.cdc.gov/getsmart/healthca
re/pdfs/strategies-to-assess-antibioticuse-in-hospitals-508.pdf
http://www.cdc.gov/getsmart/healthcar
e/implementation/core-elements.html
http://www.cdc.gov/getsmart/healthcar
e/programs.html
http://www.cdc.gov/getsmart/healthcar
e/implementation.htm l
General Infrastructure – Supporting System
Resource
Infectious Diseases Society of America and the Society for Healthcare Epidemiology of
America Antimicrobial Stewardship: Implementation Tools & Resources This section
provides additional resources for individuals interested in antimicrobial stewardship programs,
including Materials and Forms, US Academic Medical Centers Online Stewardship Resources,
International Online Stewardship Resources, and Other Resources.
Infectious Diseases Society of America and the Society for Healthcare Epidemiology of
America Guidelines for Developing an Institutional Program to Enhance Antimicrobial
Stewardship
This document presents guidelines for developing institutional programs to enhance
antimicrobial stewardship, an activity that includes appropriate selection, dosing, route, and
duration of antimicrobial therapy. 2007
Infectious Diseases Society of America and the Society for Healthcare Epidemiology of
America Antimicrobial Stewardship: Implementation Tools & Resources
This section provides additional resources for individuals interested in antimicrobial stewardship
programs, including Materials and Forms, US Academic Medical Centers Online Stewardship
Resources, International Online Stewardship Resources, and Other Resources.
Guidelines for Developing an Institutional Program to Enhance Antimicrobial
Stewardship
A joint SHEA/IDSA task force presents guidelines for developing institutional programs to
enhance antimicrobial stewardship, an activity that includes appropriate selection, dosing, route,
and duration of antimicrobial therapy. These guidelines, published in Clinical Infectious
Diseases focus on the development of effective hospital-based stewardship programs and do not
include specific outpatient recommendations.
Implementing an Antibiotic Stewardship Program: Guidelines by the Infectious Diseases
Society of America (IDSA) and Society for Healthcare Epidemiology of America (SHEA),
2016
Evidence-based guidelines for implementation and measurement of antibiotic stewardship
interventions in inpatient populations including long-term care were prepared by a
multidisciplinary expert panel
5
Website
http://www.sheaonline.org/PriorityTopics/Antimicrobia
lStewardship/ImplementationToolsRes
ources.aspx
http://cid.oxfordjournals.org/content/4
4/2/159.short
http://www.sheaonline.org/PriorityTopics/Antimicrobia
lStewardship/ImplementationToolsRes
ources.aspx
http://www.ahaphysicianforum.org/res
ources/appropriateuse/antimicrobial/content%20files%20
pdf/Guidelines-InstitutionalProgram.pdf
http://cid.oxfordjournals.org/content/ea
rly/2016/04/11/cid.ciw118.full
General Infrastructure – Supporting System
Resource
Starting and Growing Your Antimicrobial Stewardship Program (ASP)
Provided by Mount Sinai Hospital & University Health Network website and includes resources
for sense of urgency through gather and analyzing data, create the guiding coalition, create and
communicate the vision, empower & plan, and finally, consolidate and anchor.
Policy Statement on Antimicrobial Stewardship by SHEA, IDSA, and PIDS
This position statement recommends the mandatory implementation of antimicrobial stewardship
throughout the health care continuum suggests process and outcome measures to monitor these
interventions and addresses deficiencies in education and research in this field as well as the lack
of accurate data on antimicrobial use in the United States.
Toolkit for Reduction of Clostridium difficile Infections Through Antimicrobial
Stewardship: The Evaluation and Research on Antimicrobial Stewardship's Effect on
Clostridium difficile (ERASE C. difficile) Project
An antimicrobial stewardship program (ASP) is a systematic approach to developing coordinated
interventions to reduce overuse and inappropriate selection of antibiotics, and to achieve optimal
outcomes for patients in cost-efficient ways. This toolkit assists hospital staff and leadership in
developing an effective ASP with the potential to reduce C. difficile.
Get Smart for Healthcare – Stewardship Program Examples
Links to hospital stewardship programs at various hospitals, success stories, and an interactive
collection of charts and maps summarizing national and subnational data on antimicrobial use
and resistance (Resistance Map), from CDC
Infection Prevention + Antimicrobial Stewardship = Synergy
In the APIC quarterly member magazine, Prevention Strategist, Julia Moody, MS, SM (ASCP),
shares a case study and explains the infection perfectionist’s and health care epidemiologist’s
role in antimicrobial stewardship.
Antimicrobial Stewardship: A Collaborative Partnership between Infection Preventionist
and Health Care Epidemiologists
Infection preventionists and health care epidemiologists play key roles in promoting effective
antimicrobial stewardship in collaboration with other health professionals, according to a joint
position paper published by APIC and SHEA in their respective peer-review journals, the
American Journal of Infection Control and Infection Control and Hospital Epidemiology.
6
Website
http://www.antimicrobialstewardship.c
om/starting-and-growing-yourantimicrobial-stewardship-programasp
http://www.ahaphysicianforum.org/res
ources/appropriateuse/antimicrobial/content%20files%20
pdf/Policy%20Statement.pdf
http://www.ahrq.gov/professionals/qua
lity-patient-safety/patient-safetyresources/resources/cdifftoolkit/index.
html
http://www.cdc.gov/getsmart/healthcar
e/programs.html
http://www.ahaphysicianforum.org/res
ources/appropriateuse/antimicrobial/content%20files%20
pdf/APIC-synergy.pdf
http://www.ahaphysicianforum.org/res
ources/appropriateuse/antimicrobial/content%20files%20
pdf/APIC_SHEA_Antimicrobial_Stew
ardship_Position_Statement.pdf
General Infrastructure – Supporting System
Resource
Antimicrobial Stewardship and Clostridium difficile Infection: A Primer for the Infection
Preventionist
This chapter, in Guide to Preventing Clostridium difficile Infections (CDI), an APIC
Implementation Guide, discusses antimicrobial use and its impact on patients in all healthcare
settings and ASPs within the context of CDI.
Antimicrobials and Resistance
This chapter from the 4th edition of APIC Text of Infection Control and Epidemiology discusses
that although infection prevention traditionally has approached the problem of resistance
primarily from the aspect of preventing transmission, more needs to be done to control how
antimicrobials are commonly used. Click on the blue bar that reads, ‘Download a free chapter of
the APIC Text on “Antimicrobials and Resistance.’
CDC Core Elements of Outpatient Antibiotic Stewardship
Lists practical ways to initiate or expand antibiotic stewardship activities in the outpatient setting
based upon best practice.
A Path to Better Antibiotic Stewardship in Inpatient Settings
Provided by the Pew Charitable Trust, 10 case studies map how to improve antibiotic use in
acute and long-term care facilities
The Core Elements of Antibiotic Stewardship for Nursing Homes
Adapts the CDC Core Elements of Hospital Antibiotic Stewardship into practical ways to
initiate or expand antibiotic stewardship activities in nursing homes.
CDC Informatics: Antimitotic Stewardship in Nursing Homes
CDC Leading Antibiotic Stewardship in Nursing Homes
Creating a Culture to Improve Antibiotic Use in Nursing Homes
7
Website
http://www.ahaphysicianforum.org/res
ources/appropriateuse/antimicrobial/content%20files%20
pdf/APIC%20implementation%20guid
e%20chapter%20re%20ASP.pdf
http://apic.org/APICStore/Products/Pr
oduct?id=SLSTXT14
https://www.cdc.gov/mmwr/volumes/6
5/rr/rr6506a1.htm
http://www.pewtrusts.org/en/researchand-analysis/reports/2016/04/a-pathto-better-antibiotic-stewardship-ininpatient-settings
http://www.cdc.gov/longtermcare/prevent
ion/antibiotic-stewardship.html
http://www.cdc.gov/longtermcare/pdfs/inf
ographic-antibiotic-stewardship-nursinghomes.pdf
http://www.cdc.gov/longtermcare/pdfs/fa
ctsheet-core-elements-leading-antibioticstewardship.pdf
http://www.cdc.gov/longtermcare/pdfs/fac
tsheet-core-elements-creating-cultureimprove-use.pdf
General Infrastructure – Supporting System
Resource
Infections
Advancing Excellence in America’s Nursing Homes with identify baseline, examine process,
and monitor and sustain as three of the seven steps.
Nursing Home Antimicrobial Stewardship Modules
Includes four tested, evidence-based toolkits to help optimize antibiotic use in nursing homes.
The modules are intended to assist nursing homes develop antimicrobial programs.
8
Website
https://www.nhqualitycampaign.org/goal
Detail.aspx?g=inf#tab2
http://www.ahrq.gov/professionals/quality
-patient-safety/patient-safetyresources/resources/nhaspguide/index.html
Policy/Procedure/Protocol
Resource
Guidelines for the Prevention of Antimicrobial Resistance in Hospitals
This joint SHEA/IDSA task force publication details how antimicrobial resistance results in
increased morbidity, mortality and costs of health care. Prevention of the emergence of resistance
and the dissemination of resistant microorganisms will reduce these adverse effects and their
attendant costs. Appropriate antimicrobial stewardship that includes optimal selection, dose and
duration of treatment, as well as control of antibiotic use, will prevent or slow the emergence of
resistance among microorganisms. A comprehensively applied infection control program will
interdict the dissemination of resistant strains.
The California Public Health Antimicrobial Stewardship Program Initiative
Antimicrobial stewardship programs aim to promote and measure use of the appropriate agent,
dose, duration, and route of administration of antimicrobial agents, in order to improve patient
outcomes while minimizing adverse events including toxicity.
Get Smart for Healthcare – Stewardship Program Examples
Links to hospital stewardship programs at various hospitals, success stories, and an interactive
collection of charts and maps summarizing national and subnational data on antimicrobial use
and resistance (Resistance Map), from CDC
Get Smart for Healthcare – Implementation Resources
Resources to assist in the implementation of hospital antibiotic stewardship programs, including
guidelines, assessment tools, conceptual models, and a sample inter-facility infection control
transfer form, from CDC
Tools and Sample Forms
This resource, from SHEA's Antimicrobial Stewardship task force, includes tools such as an adult
inpatient antibiotic approval form, a blank order set for antifungal therapy, a sample checklist, a
drug use evaluation form and others.
The Tool Book
A handbook of drug dosing and usage guidelines that improve clinical care at Barnes-Jewish
Hospital (BJH), Washington University Medical Center in St. Louis, Missouri, USA. This site is
co-managed by the Department of Pharmacy at BJH and the Division of Infectious Diseases,
Washington University School of Medicine.
The Sanford Guide to Antimicrobial Therapy 2016
Perryville, VA: Sanford Guide
9
Website
http://www.ahaphysicianforum.org/resour
ces/appropriateuse/antimicrobial/content%20files%20pdf/
SHEA-Prevention-Guideline-1997.pdf
http://www.cdph.ca.gov/programs/hai/Pag
es/antimicrobialStewardshipProgramInitiat
ive.aspx
http://www.cdc.gov/getsmart/healthcare/pr
ograms.html
http://www.cdc.gov/getsmart/healthcare/i
mplementation.htm l
http://www.sheaonline.org/PriorityTopics/AntimicrobialSt
ewardship/ImplementationToolsResources
.aspx
http://bjhtoolbook.wustl.edu/
http://www.sanfordguide.com/
Policy/Procedure/Protocol
Resource
Infectious Diseases Society of America Infections by organism
Includes bacteria (Lyme Disease, Clostridium difficile, MRSA, NTM, & TB), fungi (Aspergillus,
Blastomycosis, Coccidioidomycosis, Cryptococcal Disease, Candidiasis, Histoplasmosis,
Sporotrichosis), HIV/AIDS, parasites (Leishmaniasis, Cysticercosis), and viruses (HCV, HBV,
Influenza).
University of California, San Francisco Medical Center Guidelines
Policies and guidelines include antimicrobial stewardship, diagnostic testing, and prevention and
treatment of infections.
Guidelines specific to each University of California, San Francisco-affiliated teaching
hospital
Includes UCSF Benioff Children’s Hospital, San Francisco General Hospital, and Veterans
Affairs Medical Center san Francisco.
Stanford Medicine Antimicrobial Guidebook
This guide provides information on antimicrobial lock therapy, intravenous to oral
therapeutic interchange protocol, five clinical pathway treatment guidelines, surgical
prophylaxis, and a Polymyxin B and Colistin tip sheet.
John Hopkins Antimicrobial Stewardship Program
This guide was first created in 2001 and is updated annually.
University of California, San Francisco Medical Center Guidelines for Empiric
Antimicrobial Therapy for Hospitalized Patients
Includes additional links to bone & joint infections, central nervous system infections,
endocarditis, gastrointestinal infections, gynecologic infections, head and heck infections,
intravascular catheter-related infections, respiratory tract infections, severe sepsis with unknown
source, skin & soft tissue infections, and urinary tract infections.
University of Kentucky Polices and Guidelines
Includes links for empiric treatment of adults with suspected bacterial meningitis, empiric use of
antifungal therapy in critically ill adults, measuring voriconazole concentrations, perioperative
antimicrobial prophylaxis, treatment of adults with complicated intra-abdominal infections,
treatment of patients with neutropenia and fever, and use of antifungal agents in adult
hematopoietic stem cell transplant and leukemia patients.
University of Wisconsin Health Antimicrobial Stewardship Drug Specific Information
Includes Amphotericin, Daptomycin, Linezolid, Vancomycin, Antibiotic Lock Solution
Guideline, Restricted Antimicrobial List, and Antiviral Drugs for Viruses other than HIV
10
Website
http://www.idsociety.org/Organism/
http://idmp.ucsf.edu/ucsf-medical-centerguidelines
http://idmp.ucsf.edu/hospital-specificguidelines
http://med.stanford.edu/bugsanddrugs/gui
debook.html
http://www.hopkinsmedicine.org/AMP
http://idmp.ucsf.edu/guidelines-empirictherapy-hospitalized-adults
http://www.hosp.uky.edu/pharmacy/amt/
UKGuide.html
http://www.uwhealth.org/antimicrobialstewardship/drug-specific/36432
Policy/Procedure/Protocol
Resource
Implementation resources Centers for Disease Control (CDC) Assessment tools for
antibiotic use
The critical role of the staff nurse in antimicrobial stewardship – Unrecognized, but
Already There
Clin Infect Dis. 2016;62(1):84-8
The 5Ds—Diagnosis/Indication; Drug; Dose; Duration; and De-escalation + Door for
Choosing the Best Setting of Care ASP documentation
Southwest Memorial Hospital Stewardship Committee Houston, TX: Southwest Memorial
Hospital; 2016.
Successful ASP Actions: Antibiotic Time-Out, Essential Elements and Development
webinar and slide deck by Partnership for Quality Care (PQC)
Taking an Antibiotic Timeout
This video highlights three steps to take towards Antibiotic Stewardship and is presented by Dr.
Arjun Srinivasan of the CDC.
Antibiotic self-stewardship: trainee-led structured antibiotic time-outs to improve
antimicrobial use Ann Intern Med. 2014; 161(10 Suppl): S53-S58.
Wake Forest Baptist Medical Center Disease State Treatment Guidelines for Adults
Provides antimicrobial treatment guidelines for adults with various infectious diseases including
Community Acquired Pneumonia Guidelines, Hospital Acquired Pneumonia Guidelines,
Emergency Department Healthcare Associated Pneumonia (HCAP) Guide, Empiric Antibiotics for
Sepsis, Guidelines for Interpreting Procalcitonin, Empiric Antibiotics for Infections (not sepsis),
Neutropenic Fever Guidelines, Clostridium difficile-Associated Colitis Diagnosis and
Management, C diffcile Testing Algorithm, Treatment of Pyelonephritis for Patients with Severe
Penicillin Allergy, and Procalcitonin to Guide Antibiotics - Cardiology Patients
Pediatric Stewardship Resources
Resources are available from SHEA that are specific to pediatric antimicrobial stewardship.
11
Website
http://www.cdc.gov/getsmart/healthcare/i
mplementation.html
http://cid.oxfordjournals.org/content/62/1/
84
http://www.qualityforum.org/WorkArea/li
nkit.aspx?LinkIdentifier=id&ItemID=824
02
http://pqc-usa.org/timeout/
http://www.medscape.com/viewarticle/73
1784
http://annals.org/article.aspx?articleid=193
5743
http://www.wakehealth.edu/School/CAUS
E/Disease-State-TreatmentGuidelines.htm
http://www.sheaonline.org/PriorityTopics/AntimicrobialSt
ewardship/PediatricStewardshipResources
.aspx
Policy/Procedure/Protocol
Resource
UCSF Benioff Children’s Hospital San Francisco: 2016 Empiric Antimicrobial Therapy
Guidelines
These guidelines were developed to inform initial selection of empiric antimicrobial therapy for
children at UCSF Benioff Children's Hospital San Francisco and affiliated outpatient sites. The
guidelines were developed by the Pediatric Antimicrobial Stewardship Program in collaboration
with multiple clinical groups. They represent consensus based on evidence-based guidelines and
local microbiology and susceptibility patterns.
Clinical practice guidelines for Clostridium difficile infection in adults: 2010 update by the
society for healthcare epidemiology of America (SHEA) and the infectious diseases society of
America (IDSA).
Multidrug-Resistant Organism & Clostridium difficile Infection module
Centers for Disease Control and Prevention (CDC) Atlanta, GA: 2016
Website
http://idmp.ucsf.edu/ucsf-benioffchildrens-hospital-san-francisco-empiricantimicrobial-therapy-guidelines
https://www.ncbi.nlm.nih.gov/pubmed/20
307191
http://www.cdc.gov/nhsn/PDFs/pscManua
l/12pscMDRO_CDADcurrent.pdf
Practice guidelines for the management of infectious diarrhea
Clin Infect Dis. 2001 Feb 1; 32(3):331-51. Epub 2001 Jan 30.
Clinical Practice Guideline for the Management of Candidiasis: 2016 Update by the
Infectious Diseases Society of America
Clin Infect Dis. 2016;62(4): e1-e50
International clinical practice guidelines for the treatment of acute uncomplicated cystitis
and pyelonephritis in women: A 2010 update by the Infectious Diseases Society of America
and the European Society for Microbiology and Infectious Diseases.
Clin Infect Dis. 2011 Mar 1; 52(5):e103-20. Doi: 10.1093/cid/ciq257.
Infective endocarditis: diagnosis, antimicrobial therapy, and management of complications:
a statement for healthcare professionals from the Committee on Rheumatic Fever,
Endocarditis, and Kawasaki Disease, Council on Cardiovascular Disease in the Young, and
the Councils on Clinical Cardiology, Stroke, and Cardiovascular Surgery and Anesthesia,
American Heart Association: endorsed by the Infectious Diseases Society of America.
https://www.ncbi.nlm.nih.gov/pubmed/11
170940
http://cid.oxfordjournals.org/content/62/4/
e1
Clinical practice guideline for the use of antimicrobial agents in neutropenic patients with
cancer: 2010 update by the Infectious Diseases Society of America.
https://www.ncbi.nlm.nih.gov/pubmed/21
258094
Guidelines for evaluation of new fever in critically ill adult patients: 2008 update from the
American College of Critical Care Medicine and the Infectious Diseases Society of America.
Crit Care Med. 2008 Apr; 36(4):1330-49. doi: 10.1097/CCM.0b013e318169eda9
https://www.ncbi.nlm.nih.gov/pubmed/18
379262
12
https://www.ncbi.nlm.nih.gov/pubmed/21
292654
https://www.ncbi.nlm.nih.gov/pubmed/15
956145
Policy/Procedure/Protocol
Resource
Clinical practice guidelines by the Infectious Diseases Society of America for the treatment
of methicillin-resistant Staphylococcus aureus infections in adults and children.
Clin Infect Dis. 2011 Feb 1; 52(3):e18-55. doi: 10.1093/cid/ciq146. Epub 2011 Jan 4
Treatment of complicated skin and soft tissue infections.
Surg Infect (Larchmt). 2009 Oct; 10(5):467-99. doi: 10.1089/sur.2009.012.
Practice guidelines for the diagnosis and management of skin and soft-tissue infections.
Clin Infect Dis. 2005 Nov 15; 41(10):1373-406. Epub 2005 Oct 14.
Diagnosis and treatment of diabetic foot infections.
Clin Infect Dis. 2004 Oct 1; 39(7):885-910. Epub 2004 Sep 10.
Infectious Diseases Society of America guidelines for the diagnosis and treatment of
asymptomatic bacteriuria in adults.
Clin Infect Dis. 2005 Mar 1; 40(5):643-54. Epub 2005 Feb 4.
Appropriate Antibiotic Use for Acute Respiratory Tract Infection in Adults: Advice for
High-Value Care From the American College of Physicians and the Centers for Disease
Control and Prevention
Acute respiratory tract infection (ARTI) is the most common reason for antibiotic prescription in
adults. Antibiotics are often inappropriately prescribed for patients with ARTI. This article
presents best practices for antibiotic use in healthy adults (those without chronic lung disease or
immunocompromising conditions) presenting with ARTI.
Guidelines for the management of adults with hospital-acquired, ventilator-associated, and
healthcare-associated pneumonia.
Am J Respir Crit Care Med. 2005 Feb 15; 171(4):388-416.
Surviving Sepsis Campaign Resources
Website
https://www.ncbi.nlm.nih.gov/pubmed/21
208910
https://www.ncbi.nlm.nih.gov/pubmed/19
860574
https://www.ncbi.nlm.nih.gov/pubmed/16
231249
https://www.ncbi.nlm.nih.gov/pubmed/15
472838
https://www.ncbi.nlm.nih.gov/pubmed/15
714408
http://annals.org/aim/article/2481815/appr
opriate-antibiotic-use-acute-respiratorytract-infection-adults-advice-high
https://www.ncbi.nlm.nih.gov/pubmed/15
699079
http://www.survivingsepsis.org/guidelines/
Pages/default.aspx
https://www.ncbi.nlm.nih.gov/pubmed/20
175247
Diagnosis, prevention, and treatment of catheter-associated urinary tract infection in adults:
2009 International Clinical Practice Guidelines from the Infectious Diseases Society of
America.
Clin Infect Dis. 2010 Mar 1; 50(5):625-63.
Model Stop the Line Policy
http://www.mnhospitals.org/Portals/0/d
Sample policy giving all hospital personnel the responsibility and authority to intervene to prevent ocuments/ptsafety/timeout/stop-thea patient safety event, from the Minnesota Hospital Association.
line-policy.doc
13
Policy/Procedure/Protocol
Resource
Clinical practice guidelines for the diagnosis and management of intravascular catheterrelated infection: 2009 Update by the Infectious Diseases Society of America.
Antimicrobial Prophylaxis for Surgery (IDSA/SCIP guidelines) Clin Infect Dis 1994; 18:422427
Clinical Practice Guidelines for Antimicrobial Prophylaxis in Surgery
Authored by ASHP, IDSA, the Surgical Infection Society (SIS) and SHEA these guidelines are
intended to provide practitioners with a standardized approach to the rational, safe and effective
use of antimicrobial agents for the prevention of surgical-site infections based on currently
available clinical evidence and emerging issues.
American Society of Health-System Pharmacists ASHP therapeutic guidelines on
antimicrobial prophylaxis in surgery Am J Health-Syst Pharm 1999;56:1839-88
University of Wisconsin Health Surgical Prophylaxis Guidelines - Appendix B of
Antimicrobial Use Guidelines
University of Miami Health System Antimicrobial Surgical Prophylaxis Protocols
Antimicrobial surgical prophylaxis general and solid organ transplant and LVADs is shared.
Diagnosis and management of complicated intra-abdominal infection in adults and
children: guidelines by the Surgical Infection Society and the Infectious Diseases Society of
America
Clin Infect Dis. 2010;50(2):133-16
Infectious Diseases Society of America Infections by Antimicrobial Agent Use
Includes antimicrobial prophylaxis for surgery, antimicrobial stewardship, combat-related
infections, neutropenic patients with cancer, outpatient parenteral anti-infective therapy (OPAT),
and vancomycin.
Cleveland Clinic Guidelines for Antimicrobial Usage
This pdf file has bookmarks for gram stain morphology of selected organisms, key
characteristics of selected organisms, usual acid-fast bacillus characteristics, mechanism of
action of common antibacterial agents, nine different treatment guidelines, guide to dosing
adults, antivirals, dosing guidelines, antimicrobial interactions, and five prophylactic dosing
recommendations.
14
Website
https://www.ncbi.nlm.nih.gov/pubmed/19
489710
https://www.ncbi.nlm.nih.gov/pubmed/80
11827
http://www.ahaphysicianforum.org/resour
ces/appropriateuse/antimicrobial/content%20files%20pdf/
SHEA-Clinical-Guidelines.pdf
https://www.ncbi.nlm.nih.gov/pubmed/10
511234
http://www.uwhealth.org/files/uwhealth/d
ocs/antimicrobial/Appx_B_Surgical_Prophylaxis_Guidelines_.pdf
http://www.ugotabug.med.miami.edu/jmh
-antimicrobial-stewardshipprogram/antimicrobial-surgicalprophylaxis
http://cid.oxfordjournals.org/content/50/2/
133
https://www.idsociety.org/Antimicrobial_
Agents/
http://www.clevelandclinicmeded.com/me
dicalpubs/antimicrobial-guidelines/
Policy/Procedure/Protocol
Resource
University of California, San Francisco Medical Center Guidelines for Dosing
Includes access to adults not receiving hemodialysis, adults receiving hemodialysis,
aminoglycoside dosing and monitoring recommendations for adults, dosing in pediatric patients,
and dosing in neonates.
Antibiotic dosing in critical illness
J Antimicrob Chemother. 2011 Apr; 66 Suppl 2:ii25-31. doi: 10.1093/jac/dkq516.
Wake Forest Baptist Medical Center Antimicrobial Dosing Guidelines
Provide antimicrobial dosing recommendations for adults in the areas of Antimicrobial,
Vancomycin, Gentamicin and Tobramycin, Amikacin dosing as well as Monitoring Guideline for
Adults being treated with Aminoglycoside or Vancomycin.
Stanford Medicine Dosing Guides
This webpage provides information on dosing guides including renal, vancomycin (including
loading dose), and aminoglycoside. In addition, extended infusion protocols are included for
piperacillin-tazobactam, cefepime, meropenem, and extended infusion beta-lactam dosing
timetables.
Nebraska Dosing Protocols
Links include alternative dosing protocol justification and education, antimicrobial
desensitization, Colistin, dosing rounding policy, and renal dosing adjustment protocol for
antimicrobials.
Wake Forest Baptist Medical Center Prior Authorization of Restricted Antimicrobials
Describes process for obtaining authorization by one of two methods as well as lists medication
which require authorization including Acyclovir Intravenous (Zovirax),
Amphotericin B Lipid Complex (ABLC, Abelcet), Aztreonam (Azactam), Ceftaroline (Teflaro),
Ceftazidime (Fortaz), Ceftazidime/avibactam (Avycaz), Ceftolozane/tazobactam (Zerbaxa),
Colistin, Colistimethate (Colymycin), Dalbavancin (Dalvance), Daptomycin (Cubicin), Ertapenem
(Invanz), Fidaxomicin (Dificid), Imipenem (Primaxin), Isavuconazonium (Cresemba), Linezolid
(Zyvox), Meropenem (Merrem), Micafungin (Mycamine), Peramivir (Rapivab), Posaconazole
(Noxafil), Ribavirin inhaled, Quinupristin/Dalfopristin (Synercid), Tigecycline (Tygacil), and
Voriconazole (Vfend).
Notable drugs not on formulary include: Tedizolid (Sivextro), Doripenem (Doribax), Telavancin
(Vibativ), Oritavancin (Orbactiv), Liposomal Amphotericin B (Ambisome), Amphotericin B
Colloidal Dispersion (Amphotec).
15
Website
http://idmp.ucsf.edu/antimicrobial-dosingguidelines
https://www.ncbi.nlm.nih.gov/pubmed/21
398304
http://www.wakehealth.edu/School/CAUS
E/Antimicrobial-Dosing-Guidelines.htm
http://med.stanford.edu/bugsanddrugs/dosi
ng-protocols.html
http://www.nebraskamed.com/careers/edu
cation-programs/asp/dosing-protocols
http://www.wakehealth.edu/School/CAUS
E/Prior-Authorization.htm
Policy/Procedure/Protocol
Resource
Nebraska Medicine Antimicrobial Restrictions
Anti-infective restriction process and use criteria summary for Ceftolozane/tazobactam, Colistin,
Cytomegalovirus immune globulin, Daptomycin, Fosfomycin, Peramivir, Posaconazole,
Tigecycline, and Oral Ribavirin for RSV
University of Kentucky Restricted Antimicrobial Agents
Includes links to Amphotericin B Lipid Complex (Abelcet®), Itraconazole IV Daptomycin
(Cubicin®), Itraconazole IV (Sporanox®), Linezolid (Zyvox®), Meropenem (Merrem®),
Meropenem (Mycamine®), Quinupristin/Dalfopristin (Synercid®), Valganciclovir
Ticarcillin/Clavulanate (Timentin®), Valganciclovir Tigecycline (Tygacil®), Valganciclovir
(Valcyte®), Vancomycin, Voriconazole (VFend®), and Restricted Antimicrobial Ordering
Process
University of Miami Health System Antibiotic Desensitization Protocols
Includes following antibiotics: Ampicillin IV, Ampicillin Oral, Cephalosporins IV,
Ciprofloxacin IV and oral, Imipenem, Meropenem, Penicillin IV and oral
Piperacillin/Tazobactam, Rifampin Oral, and Trim/Sulfa IV and oral.
University of Miami Health System Adult Ethanol lock orders
Written in checklist format, includes indication, catheter type, number of lumens, compatibility
check, flush with normal saline prior to instillation, frequency, label, and dwell time.
Telemedicine based antimicrobial stewardship program improves prescribing, reduces
bacterial Resistance at a Rural Hospital
Agency for Healthcare Research and Quality (AHRQ) Innovations Exchange
University of Miami Health System Suggested Weekly Lab Parameters for Outpatient
Parenteral and Oral Antimicrobial Therapy
Based upon the clinical Infectious Disease 2004; 38:1661
Outpatient Adult Treatment Recommendations
A table summarizes the most recent recommendations including epidemiology, diagnosis and
management including appropriate antibiotic prescribing for adults seeking care in an outpatient
setting for acute rhinosinusitis, acute uncomplicated bronchitis, common cold or non-specific
upper respiratory tract infection, pharyngitis, and acute uncomplicated cystitis.
16
Website
http://www.nebraskamed.com/careers/edu
cation-programs/asp/restrictions
http://www.hosp.uky.edu/pharmacy/amt/R
estrictedAgents.html
http://www.ugotabug.med.miami.edu/jmh
-antimicrobial-stewardshipprogram/antibiotic-desensitizationprotocols
http://www.ugotabug.med.miami.edu/doc
uments/C290ZjEthanolLockOrders2012.pdf
https://innovations.ahrq.gov/profiles/telem
edicine-based-antimicrobial-stewardshipprogram-improves-prescribing-reducesbacterial
http://www.ugotabug.med.miami.edu/doc
uments/OPATmonitoring.pdf
https://www.cdc.gov/getsmart/community
/for-hcp/outpatient-hcp/adult-treatmentrec.html
Policy/Procedure/Protocol
Resource
University of California, San Francisco Guideline for Empiric Therapy: Adult Outpatients
Includes guidelines for gastrointestinal infections, head and neck infections, respiratory tract
infections, respiratory tract infections, skin and soft-tissue infections, urinary tract infections,
and urogenital infections.
GetSmart Viral Prescription Pad
Allows providers to check off diagnosis, explains why an antibiotic is not useful, general
instruction to release signs and symptoms, and area to add OTC medications, and follow up
plan.
Not Just A Maid Service
Video describing how two hospitals engaged their environmental service workers to decrease
transmission of CDI, from the Illinois Department of Public Health
CDC Options for Evaluating Environmental Cleaning
All hospitals that have successfully achieved a Level I program should advance to Level II if
continued high rates.
The Guidelines for Environmental Infection Control in Health-Care Facilities, 2003
This guideline is a compilation of recommendations for the prevention and control of infectious
diseases that are associated with healthcare environments.
Inter-facility Infection Prevention Transfer Tool
Sample form for communication of infectious disease status, including CDI, during transitions
of care, from the Arizona Department of Health Services
17
Website
http://idmp.ucsf.edu/guidelines-empirictherapy-adult-outpatients
English:
https://www.cdc.gov/getsmart/community
/materials-references/printmaterials/hcp/viral-rx-pad-color.pdf
Spanish:
https://www.cdc.gov/getsmart/community/
materials-references/printmaterials/hcp/viral-rx-pad-color-sp.pdf
http://www.notjustamaidservice.com/
http://www.cdc.gov/HAI/pdfs/toolkits/Env
iron-Cleaning-Eval-Toolkit12-2-2010.pdf
http://www.cdc.gov/hicpac/pdf/guidelines/
eic_in_HCF_03.pdf
http://www.google.com/url?sa=t&rct=j&q
=&esrc=s&frm=1&source=web&cd=13&
cad=rja&uact=8&ved=0CCkQFjACOAo
&url=
http%3A%2F%2Fwww.health.wyo.gov%
2FMedia.aspx%3Fmedi
aId%3D15582&ei=JPBAVeefLYelgwSno
YCYAQ&usg=AFQjCNFjL
Dseb0nYOAFvnEufjJ1vzEPlw&sig2=9COUg7myzJuq2qI1Q
dT51Q
Policy/Procedure/Protocol
Resource
Inter-facility Infection Control Transfer Form
Sample form to assist in fostering communication of infectious disease status during transitions
of care, from CDC and the Utah Department of Health.
Inter-facility Infection Prevention Transfer Form
Sample form for communication of infectious disease status, including CDI, during transitions
of care, from the Cook County (IL) Department of Public Health
Nebraska Medicine Mobile App
The Antimicrobial Stewardship Program at Nebraska Medicine has created a mobile app that
puts the program’s clinical guidelines, protocols, and dosing adjustments for antimicrobial use
into a clinician's hands.
18
Website
http://www.cdc.gov/hai/pdfs/toolkits/Infec
tionControlTransfe rFormExample1.pdf
http://www.cookcountypublichealth.org/fi
les/pdf/facility- transfer-form.pdf
http://www.nebraskamed.com/careers/educ
ation-programs/asp/asp-app
Education
Resource
Stanford Medicine Educational Center
The subjects include antimicrobial stewardship: optimization of antibiotic practices (6 hours
course) and optimizing antimicrobial therapy with timeouts (2 hour course).
Website
http://med.stanford.edu/bugsanddrugs/ed
ucation.html
Center for Infectious Disease Research and Policy Antibiotic Stewardship Program
Listen to Dr. Fleming-Dutra on this Podcast (21.36 minutes) discuss her work to improve
antimicrobial prescribing practices within the ambulatory care setting.
Antimicrobial stewardship: optimization of antibiotic practices
Stanford Medicine Online Continuing Medical Education (CME) Online CME Course
American Society of Health-System Pharmacists (ASHP)
Resources and virtual posters (on line videos)
Get Smart: Know When Antibiotics Work
Here is an introductory slide set that lays out the case for antibiotic stewardship interventions.
CDC Commentary: Three Steps to Antibiotic Stewardship
Watch this video (4.56 minutes) which Arjun Srinivasan describe 3 simple things you can do to
improve antibiotic use in hospitals and long-term care facilities.
http://www.cidrap.umn.edu/asp/meetthe-experts/asp-podcast-dec-19-2016
The Evolution of Bacteria on a “Mega-Plate” Petri Dish (Kishony Lab)
In this video (1.54 minutes) scientists from the Kishony Lab at HMS and Technion have designed
a simple way to observe how bacteria move as they become impervious to drugs. It allows the
viewer to see how bacteria which develops resistance appears even when they encounter higher
doses of antibiotic and still survive and thrive.
Antimicrobial Stewardship Training Programs
Basic Program: Designed to teach the basic skills and provide an overview of Antimicrobial
Stewardship practice needed to develop an Antimicrobial Stewardship Program.
Advanced Program: Designed to meet the needs of pharmacists, physicians and other providers
that have some antimicrobial stewardship experience and/or basic skills in this area. CPE and
CME credit for didactic portion provided by MAD-ID and NFID, respectively.
Pediatric Infectious Diseases Society. Annual International Pediatric Antimicrobial
Stewardship Conference website
Society of Infectious Disease Pharmacists (SIDP)
Antimicrobial stewardship - A certificate program for pharmacists
https://youtu.be/plVk4NVIUh8
19
https://med.stanford.edu/cme/courses/onl
ine/antimicrobial.html
http://www.leadstewardship.org/vp
https://www.cdc.gov/getsmart/healthcare
/pdfs/getsmart-healthcare.pdf
http://www.medscape.com/viewarticle/7
31784?src=par_cdc_stm_mscpedt&faf=1
http://mad-id.org/antimicrobialstewardship-programs/
http://www.pids.org/meetings-andevents/asp-conference.html
http://www.sidp.org/page-1442823
Education
Resource
Guidance for the knowledge and skills required for antimicrobial stewardship leaders
Infect Control Hosp Epidemiol. 2014;35(12):1444-1451
Get smart about antibiotics: an antibiotic stewardship curriculum for medical students
Wake Forest School of Medicine
Save Money with Antibiotic Stewardship
Resistance Anywhere is Resistance Everywhere
Educating Patients About Antibiotic Use
This video (7.17 minutes) provided by New York State Department of Health and features
discussions between health care providers and patients on antibiotic resistance and the prudent
use of antibiotics. For more information on Antibiotic Resistance
Nebraska Medicine: Five part series on Antimicrobial Stewardship in Long-term Care
Facilities
•Antimicrobial Stewardship and Long-term Care Facilities: Introduction - Video 1 (11 min.)
•What is Antimicrobial Stewardship - Video 2 (10 minutes)
•Antimicrobial Stewardship in Long-term Care Facilities - Video 3 (10 min.)
•Stewardship Interventions in Long-term Care Facilities - Video 4 (16 min.)
•Interpreting Clinical Microbiology Reports - Video 5 (15 min.)
Get Smart for Healthcare – Stewardship Program Examples
Links to hospital stewardship programs at various hospitals, success stories, and an interactive
collection of charts and maps summarizing national and subnational data on antimicrobial use
and resistance (Resistance Map), from CDC
Preserve the Power of Antibiotics – For Providers
Antibiotics: Pharmacists Can Make the Difference
In this podcast, a pharmacist counsels a frustrated father about appropriate antibiotic use and
symptomatic relief options for his son's cold.
20
Website
http://www.jstor.org/stable/10.1086/678
592
http://www.wakehealth.edu/ASCurriculum/
http://www.cdc.gov/getsmart/week/dow
nloads/gsw-factsheet-cost.pdf
http://www.cdc.gov/getsmart/week/dow
nloads/gsw-factsheet-global.pdf
https://youtu.be/YHYmb2OKoMU
http://www.nebraskamed.com/careers/ed
ucation-programs/asp
http://www.cdc.gov/getsmart/healthcare/
programs.html
http://www.cdc.gov/getsmart/week/down
loads/gsw-factsheet-providers.pdf
https://www2c.cdc.gov/podcasts/player.a
sp?f=14198
Education
Resource
ASHP Guidelines on Pharmacist-Conducted Patient Education and Counseling
A coordinated effort among health care team members will enhance patients’ adherence to
pharmacotherapeutic regimens, monitoring of drug effects, and feedback to the health system.
ASHP believes this patient education and counseling guidelines are applicable in all practice
settings—including acute inpatient care, ambulatory care, home care and long-term care—whether
these settings are associated with integrated health systems, managed care organizations or are
freestanding.
Get Smart: Know When Antibiotics Work – Print Materials for Healthcare Professionals
These print materials focus on when it is and is not appropriate to prescribe antibiotics and explain
why antibiotic resistance is one of the world's most pressing public health problems.
 Antibiotic Stewardship Commitment posters as written public commitments in support of
antibiotic stewardship that are placed in examination rooms have been shown to reduce
inappropriate antibiotic prescriptions. These posters can also facilitate patient
communication about appropriate antibiotic use. We encourage you to add your healthcare
facility logo, healthcare professional photo or signature to any of these posters. Print the
posters via your office printers, or send to a professional printer, and post in patient
examination rooms. Posters can be printed in color or black and white.
 Checklist for Antibiotic Prescribing in Dentistry,
 Is it Really a Penicillin Allergy,
 Save Money with Antibiotic Stewardship,
 Preserve the Power of Antibiotics- For Providers,
 Antibiotics Aren’t Always the Answer – For Parents,
 Antibiotic Resistance – The Global Threat,
 Resistance Anywhere is Resistance Everywhere,
 Prescription Pads include:
o Taking Your Antibiotics Appropriately,
o Symptomatic Relief for Viral Illness,
o What is Delayed Prescribing?
o What is Watchful Waiting?
 Return to Day Care sample letter
21
Website
http://www.ahaphysicianforum.org/resou
rces/appropriateuse/antimicrobial/content%20files%20p
df/ASHP-pharmacist-patienteducation.pdf
https://www.cdc.gov/getsmart/communit
y/materials-references/printmaterials/hcp/index.html
Education
Resource
Bob Has a Respiratory Infection Video
Target Audience: Clinicians This video (2:15 minutes) posted by Global Respiratory Infection
Partnership demonstrates how clinicians can work with patients when they request antibiotics.
CDC Commentary: Antibiotic Stewardship in the Outpatient Setting
Target Audience: Clinicians
This video (5:54 minutes) provides an overview of CDC’s latest resource to support antibiotic
stewardship in the outpatient setting: the Core Elements of Outpatient Antibiotic Stewardship.
CDC Commentary: Antibiotics for Acute Otitis Media in Children
Target Audience: Pediatricians and clinicians who care for children
This video (5:35 minutes) shared the principles of judicious antibiotic prescribing related to
AAP’s clinical practice guidelines for the diagnosis and management of acute otitis media.
CDC Commentary: Don’t Give In and Give Those Antibiotics!
Target Audience: Clinicians This video (3:45 minutes) provides tips on how to communicate
with patients about appropriate antibiotic prescribing for upper respiratory infections.
Get Smart: Know When Antibiotics Work
These print materials focus on the issue of antibiotic resistance, as well as the importance of
prescribing and using antibiotics wisely.
Choosing Wisely. Antibiotics: Will They Help or Hurt You?
New York NY: Consumer Reports; 2015
Choosing Wisely. Antibiotics: When you need them – and when you don’t.
New York, NY: Consumer Reports Health; 2014
Choosing Wisely. Antibiotic treatment in the hospital: sometimes it can be stopped.
New York, NY: Consumer Reports Health; 2016
Speak Up: Antibiotics - Know the Facts
Taking an antibiotic when you shouldn’t kills good bacteria in your body, which can cause you
more problems, and your body can become resistant to antibiotics. This short video highlights
why and antibiotic is not always needed.
Antibiotics Aren’t Always the Answer
This fact sheet from the CDC briefly explains six simple facts about antibiotic use and
when they can help treat your child’s illness.
22
Website
https://youtu.be/72jPQhoQ05Y
http://www.medscape.com/viewarticle/8
71205?src=par_cdc_stm_mscpedt&faf=1
http://www.medscape.com/viewarticle/8
14301?src=par_cdc_stm_mscpedt&faf=1
http://www.medscape.com/viewarticle/7
30224?src=par_cdc_stm_mscpedt&faf=1
http://www.cdc.gov/getsmart/community
/materials-references/printmaterials/index.html
http://consumerhealthchoices.org/wpcontent/uploads/2015/02/3AntibioticsTriFold_DownloadGenericFINAL.pdf
http://consumerhealthchoices.org/wpcontent/uploads/2014/02/ChoosingWisel
yAntibioticsRoundup.pdf
http://consumerhealthchoices.org/wpcontent/uploads/2016/02/ChoosingWisel
yAntibioticsHospitalSHEA-ER.pdf
https://www.jointcommission.org/topics/
speakup_antibiotics.aspx
http://www.ahaphysicianforum.org/resou
rces/appropriateuse/antimicrobial/content%20files%20pd
f/CDC-Fact-Sheet.pdf
Education
Resource
Cold or Flu. Antibiotics Don’t Work For You.
This tri-fold brochure from the CDC briefly explains the difference between bacteria and
viruses and how bacteria become resistant. It also answers some common questions about
when it is and is not appropriate to use an antibiotic
Ask Questions about Your Medicines
This guide from APIC explains to patients when antibiotics work, when they don’t and when
prescribed why it’s important to finish the course of antibiotics as the prescriber recommends
ABC’s of Antibiotics
This infographic from APIC helps patients and families better understand their role in preventing
infections and includes a list of questions to ask their healthcare provider about antibiotics.
Antibiotics: Miracle Drugs
Podcast (2:18 minutes)Target Audience: General public
The overuse of antibiotics has led to the development of resistance among bacteria, making
antibiotics ineffective in treating certain conditions. This podcast discusses the importance of
talking to your healthcare professional about whether or not antibiotics will be beneficial if
you’ve been diagnosed with an infectious disease.
Get Smart: Know When Antibiotics Work – For Everyone
These print materials focus on the issue of antibiotic resistance, as well as the importance of
prescribing and using antibiotics wisely. All materials are provided in low-resolution for office
printers. Includes chart on Viruses or Bacteria – What’s Got You Sick, Preventing and Treating
Ear Infections, Antibiotic Safety: Do’s and Don’ts at the Dentist, Antibiotic Resistance – The
Global Threat, Resistance Anywhere is Resistance Everywhere.
Get Smart: Know When Antibiotics Work – Print Materials for Adults
These print materials focus on the issue of antibiotic resistance, as well as the importance of
prescribing and using antibiotics wisely. All materials are provided in low-resolution for office
printers. Includes Cold or Flu – Antibiotics Don’t Work for You and Warning: Antibiotics Don’t
Work for Viruses Like Colds and the Flu.
Antibiotics Aren’t Always the Answer - For Parents
23
Website
http://www.ahaphysicianforum.org/resou
rces/appropriateuse/antimicrobial/content%20files%20pd
f/CDC-Cold-or-Flu.pdf
http://apic.org/For-Consumers/Monthlyalerts-for-consumers/Article?id=getsmart-about-antibiotics-and-antibiotic-re
http://www.ahaphysicianforum.org/resou
rces/appropriateuse/antimicrobial/content%20files%20pd
f/APIC-ABCsAntibiotic.pdf
https://www2c.cdc.gov/podcasts/player.a
sp?f=10055
https://www.cdc.gov/getsmart/communit
y/materials-references/printmaterials/everyone/index.html
https://www.cdc.gov/getsmart/communit
y/materials-references/printmaterials/adults/index.html
http://www.cdc.gov/getsmart/week/down
loads/antibiotics-arent-always-theanswer-for-parents.pdf
Education
Resource
Get Smart: Know When Antibiotics Work – Print Materials for Parents of Young Children
These print materials focus on the issue of antibiotic resistance, as well as the importance of
prescribing and using antibiotics wisely. All materials are provided in low-resolution for office
printers. Includes Antibiotics Aren’t Always the Answer, Snort. Sniffle. Sneeze. No Antibiotics
Please, Preventing and Treating Ear Infections, Antibiotics Aren’t Always the Answer – For
Parents, Six Smart Facts About Antibiotic Use, Fluid in the Middle Ear Q&A, Runny Nose Q&A,
and Return to Day Care Letter.
Know When Antibiotics Work
Podcast (1:12 minutes) Target Audience: General public, particularly parents of young children.
This podcast provides a brief background about antibiotics and quick tips to help prevent
antibiotic resistance.
Snort. Sniffle. Sneeze. No Antibiotics Please!
Target Audience: Parents of young children
This video (3:47 minutes) features a doctor, who's also a concerned mom, and a humorous turn
on a possible doctor's visit.
Preventing and Treating Ear Infections Fact Sheet
Target Audience: Parents of young children
This CDC fact sheet provides information on what is an ear infection, common causes,
prevention, and how it is treated.
Get Smart: Know When Antibiotics Work – Print Materials for Spanish Speakers
Same material as posted on the CDC but in Spanish.
WI Healthcare-associated infection (HAIs) website
Tutorials are designed to help with some of the more common NHSN functions in real-time, short
segments related to NHSN.
IP Collaboration Project
This Educational Toolkit has been developed by the Association for Professionals in Infection
Control and Epidemiology (APIC) and the American Society for Microbiology (ASM).
Antimicrobial Stewardship: A Collaborative Partnership between Infection Preventionists
and Health Care Epidemiologists
American Journal of Infection Control 40 (2012) 94-5
24
Website
https://www.cdc.gov/getsmart/communit
y/materials-references/printmaterials/parents-youngchildren/index.html
https://www2c.cdc.gov/podcasts/player.a
sp?f=8636412
https://youtu.be/e5qP891fy9E
https://www.cdc.gov/getsmart/communit
y/downloads/270227a_koneil_factsheet508_final.pdf
https://www.cdc.gov/getsmart/communit
y/sp/materials/index.html
https://www.dhs.wisconsin.gov/hai/tutoria
ls.htm
http://labproject.site.apic.org/files/2012/
11/Final-Draft-of-Lab-Toolkit-v21.pdf
http://www.ahaphysicianforum.org/resou
rces/appropriateuse/antimicrobial/content%20files%20pd
f/APIC_SHEA_Antimicrobial_Stewards
hip_Position_Statement.pdf
Education
Resource
How to be a good Visitor!
Infection Prevention and You Patient and families provided by APIC
Guidance on Contact Precautions for Hospital Visitors
Society for Healthcare Epidemiology of America (SHEA) 2015
Isolation Precautions for Visitors
Society for Healthcare Epidemiology of America (SHEA) 2015
Peggy Lillis Foundation
C. difficile education and patient advocacy
The Story of Peggy Lillis: The Other Side of Antibiotics
In this video, Christian Lillis, son of Peggy Lillis, shares his personal story of losing his mother to
a Clostridium difficile infection (C. difficile) caused by antibiotic use. YouTube (2:39 minutes)
Patient Voice Institute
Quinolone Vigilance Foundation
Consumer Union Safe Patient Project
Fecal Transplant Foundation
Rory Staunton Foundation
Sepsis prevention
25
Website
http://consumers.site.apic.org/infectionprevention-basics/how-to-be-a-goodvisitor/
http://www.sheaonline.org/View/ArticleId/353/NewGuidance-on-Contact-Precautions-forHospital-Visitors.aspx
http://www.sheaonline.org/View/smid/428/ArticleID/354
.aspx
http://peggyfoundation.org/
https://youtu.be/ggl7Qgx-VeY
http://gopvi.org/
http://www.saferpills.org/
http://safepatientproject.org/
http://thefecaltransplantfoundation.org/
https://rorystauntonfoundationforsepsis.o
rg/
Tracking, Monitoring Antibiotic Use, and Process Measures
Resource
Website
Antibiotic Stewardship Measurement Framework
http://www.cdc.gov/getsmart/hea
This document describes selected measures that could be used to measure the change
lthcare/pdfs/antibiotic_stewardshi
concepts summarized in the Antibiotic Stewardship Drivers and Change Package.
p_measurement_framework.pdf
Clinical and Economic Outcomes of a Prospective Antimicrobial Stewardship Program
http://www.ahaphysicianforum.org/reso
In ASHP’s American Journal of Health-System Pharmacy, the authors found antimicrobial
urces/appropriateexpenditures, which had increased by an average of 14.4 percent annually in the years preceding
use/antimicrobial/content%20files%20p
ASP implementation, decreased by 9.75 percent in the first year of the program and remained
df/ASHP-clinical-economicrelatively stable in subsequent years, with overall cumulative cost savings estimated at $1.7
outcomes.pdf
million. Rates of nosocomial infections involving Clostridium difficile, methicillin-resistant
Staphylococcus aureus and vancomycin-resistant enterococci all decreased after ASP
implementation.
http://www.cdc.gov/drugresistance/pdf/
Antibiotic Resistance Solutions Initiative Infographic
Centers for Disease Control and Prevention (CDC) Atlanta, GA: CDC; 201
ar-nhsn.pdf
Antimicrobial Management Program Gap Analysis Checklist
http://www.cdc.gov/getsmart/healthcare
Provided by CDC Get Smart for Healthcare, this document includes aspects which should be
/improve-efforts/resources/doc/AMPincluded in policy, procedures, and monitoring.
GapAssessment.doc
https://www.advisory.com/technology/cr
The Current State of Hospital Antibiotic Stewardship: Findings from our Antibiotic
imson-continuum-ofStewardship Program Survey
Washington, DC: The Advisory Board; 2015
care/members/expert-insights/thecurrent-state-of-hospital-antibioticstewardship
Optimizing Antimicrobial Therapy with Timeouts
https://med.stanford.edu/cme/courses/o
National organizations, including the CDC and the Joint Commission, advocate for a formal
nline/optimizing-antimicrobial“Antibiotic Timeout” to reassess empiric antibiotics 48-72 hours after their initiation.
therapy.html
Facilitators and barriers to implementing antimicrobial stewardship strategies: Results from http://www.ajicjournal.org/article/S019
6-6553(14)00734-2/abstract
a qualitative study
Published in 2014 by the American Journal of Infection Control provides several factors that
may influence ASP success in the implementation of strategies.
Antimicrobial Management Program Gap Analysis Checklist
http://www.cdc.gov/getsmart/healthcare
Provided by CDC Get Smart for Healthcare, this document includes aspects which should be
/improve-efforts/resources/doc/AMPincluded in policy, procedures, and monitoring.
GapAssessment.doc
26
Tracking, Monitoring Antibiotic Use, and Process Measures
Resource
Website
http://www.antimicrobialstewardship.co
Starting and Growing Your Antimicrobial Stewardship Program (ASP)
Provided by Mount Sinai Hospital & University Health Network website and includes resources
m/starting-and-growing-yourfor sense of urgency through gather and analyzing data, create the guiding coalition, create and
antimicrobial-stewardship-program-asp
communicate the vision, empower & plan, and finally, consolidate and anchor.
http://www.ahaphysicianforum.org/reso
CDC Vital Signs: Improving Antibiotic Use among Hospitalized Patients
Antibiotic prescribing for inpatients is common, and there is ample opportunity to improve use
urces/appropriateand patient safety by reducing incorrect antibiotic prescribing. Hospital administrators and health
use/antimicrobial/content%20files%20p
care providers can reduce potential harm and risk for antibiotic resistance by implementing
df/CDC-MMWR-Vital-Signsformal programs to improve antibiotic prescribing in hospitals.
Improving-Antibiotic-Use.pdf
Antibiotic Stewardship Driver Diagram and Change Package
http://www.cdc.gov/getsmart/healthcare
The Centers for Disease Control and Prevention (CDC) and the Institute for Healthcare
/pdfs/antibiotic_stewardship_measurem
Improvement (IHI) partnered in an effort to develop this conceptual model of key drivers
ent_framework.pdf
for reducing inappropriate antibiotic utilization.
http://link.springer.com/article/10.1007
Antimicrobial stewardship— qualitative and quantitative outcomes: the role of
%2Fs11908-014-0433-x
measurement
Curr Infect Dis Rep. 2014;16(11):43
http://www.tandfonline.com/doi/full/10.
Benchmarking antimicrobial drug use in hospitals
Expert Rev Anti Infect Ther. 2012;10(4):445–457
1586/eri.12.18#.V1AcQrsg-jc
http://www.cdc.gov/getsmart/healthcare
Assessment for the Appropriateness of Antibiotic
CDC offers access to assessment tools which can downloaded.
/pdfs/gen-assessment.docx
http://www.ahrq.gov/professionals/qual
Toolkit for Reduction of Clostridium difficile Infections Through Antimicrobial
ity-patient- safety/patient-safetyStewardship: Medication Use Evaluation Template
Sample template for reviewing antibiotic use patterns, including graphic comparisons over time,
resources/resources/cdifftoolkit/cdiffl2t
from the Agency for Healthcare Research and Quality (AHRQ)
ools4d.html
Clostridium diffcile Infection Awareness Campaign Challenge #2: Antibiotic Stewardship
http://www.ohiokepro.com/cdi/pdfs/CD
Self-assessment to help facilities assess their current state of antibiotic stewardship and choose
I_change2_508.pdf
action oriented challenges to address from Kepro Ohio Quality Improvement Organization.
Assessment for the Appropriateness of Antibiotic for Urinary Tract Infections (UTIs)
CDC offers access to assessment tools which can downloaded.
27
http://www.cdc.gov/getsmart/healthcare
/pdfs/uti-assessment.docx
Tracking, Monitoring Antibiotic Use, and Process Measures
Resource
Website
http://www.cdc.gov/getsmart/healthcare
Assessment for the Appropriateness of Antibiotic for Community-Acquired Pneumonia
/pdfs/cap-assessment.docx
(CAP)
CDC offers access to assessment tools which can downloaded.
http://www.cdc.gov/getsmart/healthcare
Assessment for the Appropriateness of Antibiotic Use for Resistant Gram-Positive
/pdfs/gram-pos-assessment.docx
Infections
CDC offers access to assessment tools which can downloaded.
Measure #407: Appropriate treatment of methicillin-sensitive staphylococcus aureus (MSSA) https://pqrs.cms.gov/dataset/2016PQRS-Measure-407-11-17-2015/m66sbacteremia – National Quality Strategy
Domain: effective clinical car CMS. gov. Physician Quality Reporting System
yxfb
http://www.cdc.gov/nhsn/PDFs/pscMan
Antimicrobial Use and Resistance (AUR) Module
Centers for Disease Control and Prevention (CDC). Atlanta, GA:2016
ual/11pscAURcurrent.pdf
http://www.qualityforum.org/QPS/QPS
NQF-endorsed Standardized Antibiotic Administration Ratio
National Quality Forum (NQF). Quality Positioning System
Tool.aspx?m=2720&e=1
Arizona Antibiogram Toolkit
http://www.azdhs.gov/phs/oids/hai/advis
Guidance on preparing an antibiogram and ideas for educating providers about reading and
oryinterpreting the antibiogram, from the Arizona Department of Health Services
committee/documents/antimicrobialstewardship/antibiogram-toolkit.pdf
Concise Antibiogram Toolkit
http://www.ahrq.gov/sites/default/files/
Guidance for facilities on creating and interpreting an antibiogram, from the Agency for
wysiwyg/professional s/quality-patientHealthcare Research and Quality (AHRQ)
safety/patient-safetyresources/resources/nhaspguide/module2/toolkit1/cat_sources.
pdf
Antibiograms: developing cumulative reports for your clinicians’ quick guide Clinical and
http://shop.clsi.org/microbiologyLaboratory Standards Institute. M39-A4 QG.
companion-products/M39-A4_3.html
http://www.cdc.gov/nhsn/PDFs/demo/2Antibiogram demo exercise: advanced line list
Centers for Disease Control and Prevention (CDC); National Healthcare Safety network (NHSN). AdvancedLineList.pdf
Atlanta, GA: CDC; 201
Arizona Antibiogram Toolkit
http://www.azdhs.gov/phs/oids/hai/advis
Guidance on preparing an antibiogram and ideas for educating providers about reading and
oryinterpreting the antibiogram, from the Arizona Department of Health Services.
committee/documents/antimicrobialstewardship/antibiogram-toolkit.pdf
28
Tracking, Monitoring Antibiotic Use, and Process Measures
Resource
Website
Concise Antibiogram Toolkit
http://www.ahrq.gov/sites/default/files/
Guidance for facilities on creating and interpreting an antibiogram, from the Agency for
wysiwyg/professional s/quality-patientHealthcare Research and Quality (AHRQ)
safety/patient-safetyresources/resources/nhaspguide/module2/toolkit1/cat_sources.
pdf
The Antimicrobial Resistance Management (ARM) Program is a project run by the
http://www.armprogram.com/Default.ht
University of Florida and is an ongoing project designed to:
ml
•Document trends in antimicrobial susceptibility patterns
•Identify relationships between antibiotic use and resistance rates
Qualifying hospitals or systems may participate in the ARM program at no cost to them.
Participants receive a customized analysis of antimicrobial susceptibility trends within their
hospital/system. The trends are benchmarked against national, regional, and state comparators.
Infections
https://www.nhqualitycampaign.org/goa
Advancing Excellence in America’s Nursing Homes with identify baseline, examine process, and lDetail.aspx?g=inf#tab2
monitor and sustain as three of the seven steps.
The Development of Minimum Criteria for the Initiation of Antibiotics in Residents of Long- http://www.jstor.org/stable/10.1086/501
Term-Care Facilities: Results of a Consensus Conference (aka Loeb criteria).
875?seq=1#page_scan_tab_contents
Deciding when to initiate antibiotics can be particularly challenging but this article guides when
antibiotic use is appropriate.
Options for Evaluating Environmental Cleaning
http://www.cdc.gov/hai/toolkits/Evaluati
Elements of programs to assess environmental cleaning processes for HAI prevention, including
ng-Environmental- Cleaning.html
CDC Environmental Checklist for Monitoring Terminal Cleaning and spreadsheet for data entry
and scoring, from CDC
29
Reporting Information to Staff on Improving Antibiotic Use and Resistance – Antibiotic Use and Outcome Measure
Resource
Website
https://www.cdc.gov/getsmart/healthcar
Antibiotic Stewardship Driver Diagram and Change Package
A Framework to Reduce Inappropriate Antibiotic Utilization in Hospitals
e/pdfs/antibiotic_stewardship_change_p
The Centers for Disease Control and Prevention (CDC) and the Institute for Healthcare
ackage.pdf
Improvement (IHI) partnered in an effort to develop this conceptual model of key drivers for
reducing inappropriate antibiotic utilization.
https://www.cdc.gov/getsmart/healthcar
Antibiotic Stewardship Driver Diagram
The Centers for Disease Control and Prevention (CDC) and the Institute for Healthcare
e/pdfs/antibiotic_stewardship_driver_di
Improvement (IHI) partnered in an effort to develop this conceptual model of key drivers for
agram.pdf
reducing inappropriate antibiotic utilization.
Antibiotic Stewardship Measurement Framework
This document describes selected measures that could be used to measure the change concepts
summarized in the Antibiotic Stewardship Drivers and Change Package.
https://www.cdc.gov/getsmart/healthcar
e/pdfs/antibiotic_stewardship_measure
ment_framework.pdf
Antimicrobial stewardship— qualitative and quantitative outcomes: The Role of
Measurement
Curr Infect Dis Rep. 2014;16(11):433
Toolkit for Reduction of Clostridium difficile Infections Through Antimicrobial
Stewardship: Possible Methods for Evaluating Antibiotic Use
Table of possible metrics to use for measurement and evaluation of antibiotic use, from the
Agency for Healthcare Research and Quality (AHRQ)
Starting and Growing Your Antimicrobial Stewardship Program (ASP)
Provided by Mount Sinai Hospital & University Health Network website and includes resources
for sense of urgency through gather and analyzing data, create the guiding coalition, create and
communicate the vision, empower & plan, and finally, consolidate and anchor.
Software vendors who support the CDC antimicrobial use and resistance initiative
Society for Infectious Diseases Pharmacists (SIDP)
Strategies To Assess Antibiotic Use To Drive Improvements In Hospitals
The suggestions outlined in this document are intended to help antibiotic stewardship programs in
hospitals assess antibiotic use to see if there are opportunities for improvement.
http://dx.doi.org/10.1007/s11908-0140433-x
30
http://www.ahrq.gov/professionals/quali
ty-patient- safety/patient-safetyresources/resources/cdifftoolkit/cdiffl2to
ols2c.html
http://www.antimicrobialstewardship.co
m/starting-and-growing-yourantimicrobial-stewardship-program-asp
http://www.sidp.org/aurvendors
https://www.cdc.gov/getsmart/healthcar
e/pdfs/strategies-to-assess-antibioticuse-in-hospitals-508.pdf
Reporting Information to Staff on Improving Antibiotic Use and Resistance – Antibiotic Use and Outcome Measure
Resource
Website
Assessment of Appropriateness of Antibiotics for Urinary Tract Infections (UTIs)
https://www.cdc.gov/getsmart/healthcar
e/pdfs/uti-assessment.docx
Assessment of Appropriateness of Antibiotics for Community-Acquired Pneumonia (CAP)
https://www.cdc.gov/getsmart/healthcar
e/pdfs/cap-assessment.docx
Assessment of Appropriateness of Antibiotic Use for Resistant Gram-Positive Infections
https://www.cdc.gov/getsmart/healthcar
e/pdfs/gram-pos-assessment.docx
Assessment of Appropriateness of Inpatient Antibiotics
https://www.cdc.gov/getsmart/healthcar
e/pdfs/gen-assessment.docx
The Development of Minimum Criteria for the Initiation of Antibiotics in Residents of LongTerm-Care Facilities: Results of a Consensus Conference (aka Loeb criteria).
Deciding when to initiate antibiotics can be particularly challenging but this article guides when
antibiotic use is appropriate.
http://www.jstor.org/stable/10.1086/501
875?seq=1#page_scan_tab_contents
31
Antibiotic Stewardship – Pharmacy-Driven Interventions
Resource
Website
Antibiotic Streamlining – Sample Pharmacist’s Daily Routine
http://www.sheaSample pharmacist’s daily routine for reviewing and streamlining antibiotic use, from the
online.org/Assets/files/kuper/Sample_Dai
Society for Healthcare Epidemiology of America (SHEA)
ly_Routine_Checklist_K__Kuper.pdf
http://cid.oxfordjournals.org/content/42/S
The Role of Antimicrobial Management Programs in Optimizing Antibiotic Prescribing
upplement_2/S90.full.pdf+html
within Hospitals
Managing serious infections is a balance between providing timely and appropriate broadspectrum empirical therapy for individual patients, which has been consistently shown to
improve outcomes, and reducing unnecessary use of antimicrobial agents, which may contribute
to the development of antimicrobial resistance. 2006
http://www.ahaphysicianforum.org/resou
ASHP Statement on the Pharmacist’s Role in Antimicrobial Stewardship and Infection
rces/appropriatePrevention and Control
use/antimicrobial/content%20files%20pd
Pharmacists have a responsibility to take prominent roles in ASPs and participate in the
infection prevention and control programs of hospitals and health systems. Pharmacists’
f/ASHP-statement.pdf
responsibilities for antimicrobial stewardship and infection prevention and control include
promoting the optimal use of antimicrobial agents, reducing the transmission of infections and
educating health professionals, patients and the public.
http://www.ashp.org/DocLibrary/BestPra
American Society Of Health-System Pharmacists (ASHP)
ctices/SpecificStAntimicrob.aspx
ASHP statement on the pharmacist's role in antimicrobial stewardship and infection
prevention and control.
http://journals.cambridge.org/action/displ
The essential role of pharmacists in antimicrobial stewardship
ayAbstract?fromPage=online&aid=1028
Infect Control Hosp Epidemiol. 2016; April 13:1-2
0244&fileId=S0899823X16000829
Antibiotics: Pharmacists Can Make the Difference
https://www2c.cdc.gov/podcasts/player.a
In this podcast, a pharmacist counsels a frustrated father about appropriate antibiotic use and
sp?f=14198
symptomatic relief options for his son's cold.
Successful ASP Actions: Antibiotic Time-Out, Essential Elements and Development
http://pqc-usa.org/timeout/
webinar and slide deck by Partnership for Quality Care (PQC)
Taking an Antibiotic Timeout
http://www.medscape.com/viewarticle/73
This video highlights three steps to take towards Antibiotic Stewardship and is presented by Dr.
1784
Arjun Srinivasan of the CDC.
Antibiotic self-stewardship: trainee-led structured antibiotic time-outs to improve
http://annals.org/article.aspx?articleid=19
antimicrobial use Ann Intern Med. 2014; 161(10 Suppl): S53-S58.
35743
32
Antibiotic Stewardship – Pharmacy-Driven Interventions
Resource
Website
Wake Forest Baptist Medical Center Disease State Treatment Guidelines for Adults
http://www.wakehealth.edu/School/CAU
Provides antimicrobial treatment guidelines for adults with various infectious diseases including
SE/Disease-State-TreatmentCommunity Acquired Pneumonia Guidelines, Hospital Acquired Pneumonia Guidelines,
Guidelines.htm
Emergency Department Healthcare Associated Pneumonia (HCAP) Guide, Empiric Antibiotics for
Sepsis, Guidelines for Interpreting Procalcitonin, Empiric Antibiotics for Infections (not sepsis),
Neutropenic Fever Guidelines, Clostridium difficile-Associated Colitis Diagnosis and
Management, C diffcile Testing Algorithm, Treatment of Pyelonephritis for Patients with Severe
Penicillin Allergy, and Procalcitonin to Guide Antibiotics - Cardiology Patients
Pediatric Stewardship Resources
http://www.sheaResources are available from SHEA that are specific to pediatric antimicrobial stewardship.
online.org/PriorityTopics/AntimicrobialS
tewardship/PediatricStewardshipResourc
es.aspx
UCSF Benioff Children’s Hospital San Francisco: 2016 Empiric Antimicrobial Therapy
http://idmp.ucsf.edu/ucsf-benioffGuidelines
childrens-hospital-san-francisco-empiricThese guidelines were developed to inform initial selection of empiric antimicrobial therapy for
antimicrobial-therapy-guidelines
children at UCSF Benioff Children's Hospital San Francisco and affiliated outpatient sites. The
guidelines were developed by the Pediatric Antimicrobial Stewardship Program in collaboration
with multiple clinical groups. They represent consensus based on evidence-based guidelines and
local microbiology and susceptibility patterns.
Clinical practice guidelines for Clostridium difficile infection in adults: 2010 update by the
https://www.ncbi.nlm.nih.gov/pubmed/2
society for healthcare epidemiology of America (SHEA) and the infectious diseases society of 0307191
America (IDSA).
Multidrug-Resistant Organism & Clostridium difficile Infection module
http://www.cdc.gov/nhsn/PDFs/pscManu
Centers for Disease Control and Prevention (CDC) Atlanta, GA: 2016
al/12pscMDRO_CDADcurrent.pdf
Practice guidelines for the management of infectious diarrhea
Clin Infect Dis. 2001 Feb 1; 32(3):331-51. Epub 2001 Jan 30.
Clinical Practice Guideline for the Management of Candidiasis: 2016 Update by the
Infectious Diseases Society of America
Clin Infect Dis. 2016;62(4): e1-e50
International clinical practice guidelines for the treatment of acute uncomplicated cystitis
and pyelonephritis in women: A 2010 update by the Infectious Diseases Society of America
and the European Society for Microbiology and Infectious Diseases.
Clin Infect Dis. 2011 Mar 1; 52(5):e103-20. Doi: 10.1093/cid/ciq257.
33
https://www.ncbi.nlm.nih.gov/pubmed/1
1170940
http://cid.oxfordjournals.org/content/62/4
/e1
https://www.ncbi.nlm.nih.gov/pubmed/2
1292654
Antibiotic Stewardship – Pharmacy-Driven Interventions
Resource
Website
Infective endocarditis: diagnosis, antimicrobial therapy, and management of complications: https://www.ncbi.nlm.nih.gov/pubmed/15
a statement for healthcare professionals from the Committee on Rheumatic Fever,
956145
Endocarditis, and Kawasaki Disease, Council on Cardiovascular Disease in the Young, and
the Councils on Clinical Cardiology, Stroke, and Cardiovascular Surgery and Anesthesia,
American Heart Association: endorsed by the Infectious Diseases Society of America.
Clinical practice guideline for the use of antimicrobial agents in neutropenic patients with
https://www.ncbi.nlm.nih.gov/pubmed/21
cancer: 2010 update by the Infectious Diseases Society of America.
258094
Guidelines for evaluation of new fever in critically ill adult patients: 2008 update from the
https://www.ncbi.nlm.nih.gov/pubmed/18
American College of Critical Care Medicine and the Infectious Diseases Society of America. 379262
Crit Care Med. 2008 Apr; 36(4):1330-49. doi: 10.1097/CCM.0b013e318169eda9
Clinical practice guidelines by the Infectious Diseases Society of America for the treatment
https://www.ncbi.nlm.nih.gov/pubmed/21
of methicillin-resistant Staphylococcus aureus infections in adults and children.
208910
Clin Infect Dis. 2011 Feb 1; 52(3):e18-55. doi: 10.1093/cid/ciq146. Epub 2011 Jan 4
Treatment of complicated skin and soft tissue infections.
https://www.ncbi.nlm.nih.gov/pubmed/19
Surg Infect (Larchmt). 2009 Oct; 10(5):467-99. doi: 10.1089/sur.2009.012.
860574
Practice guidelines for the diagnosis and management of skin and soft-tissue infections.
https://www.ncbi.nlm.nih.gov/pubmed/16
Clin Infect Dis. 2005 Nov 15; 41(10):1373-406. Epub 2005 Oct 14.
231249
Diagnosis and treatment of diabetic foot infections.
https://www.ncbi.nlm.nih.gov/pubmed/15
Clin Infect Dis. 2004 Oct 1; 39(7):885-910. Epub 2004 Sep 10.
472838
Infectious Diseases Society of America guidelines for the diagnosis and treatment of
https://www.ncbi.nlm.nih.gov/pubmed/15
asymptomatic bacteriuria in adults.
714408
Clin Infect Dis. 2005 Mar 1; 40(5):643-54. Epub 2005 Feb 4.
Appropriate Antibiotic Use for Acute Respiratory Tract Infection in Adults: Advice for
http://annals.org/aim/article/2481815/appr
High-Value Care From the American College of Physicians and the Centers for Disease
opriate-antibiotic-use-acute-respiratoryControl and Prevention
tract-infection-adults-advice-high
Acute respiratory tract infection (ARTI) is the most common reason for antibiotic prescription in
adults. Antibiotics are often inappropriately prescribed for patients with ARTI. This article
presents best practices for antibiotic use in healthy adults (those without chronic lung disease or
immunocompromising conditions) presenting with ARTI.
34
Antibiotic Stewardship – Pharmacy-Driven Interventions
Resource
Website
Guidelines for the management of adults with hospital-acquired, ventilator-associated, and
https://www.ncbi.nlm.nih.gov/pubmed/1
healthcare-associated pneumonia.
5699079
Am J Respir Crit Care Med. 2005 Feb 15; 171(4):388-416.
Surviving Sepsis Campaign Resources
http://www.survivingsepsis.org/guideline
s/Pages/default.aspx
Diagnosis, prevention, and treatment of catheter-associated urinary tract infection in adults: https://www.ncbi.nlm.nih.gov/pubmed/2
2009 International Clinical Practice Guidelines from the Infectious Diseases Society of
0175247
America.
Clin Infect Dis. 2010 Mar 1; 50(5):625-63.
Model Stop the Line Policy
http://www.mnhospitals.org/Portals/0/
Sample policy giving all hospital personnel the responsibility and authority to intervene to prevent documents/ptsafety/timeout/stop-thea patient safety event, from the Minnesota Hospital Association.
line-policy.doc
Clinical practice guidelines for the diagnosis and management of intravascular catheterhttps://www.ncbi.nlm.nih.gov/pubmed/1
related infection: 2009 Update by the Infectious Diseases Society of America.
9489710
Antimicrobial Prophylaxis for Surgery (IDSA/SCIP guidelines) Clin Infect Dis 1994; 18:422427
Clinical Practice Guidelines for Antimicrobial Prophylaxis in Surgery
Authored by ASHP, IDSA, the Surgical Infection Society (SIS) and SHEA these guidelines are
intended to provide practitioners with a standardized approach to the rational, safe and effective
use of antimicrobial agents for the prevention of surgical-site infections based on currently
available clinical evidence and emerging issues.
American Society of Health-System Pharmacists ASHP therapeutic guidelines on
antimicrobial prophylaxis in surgery Am J Health-Syst Pharm 1999;56:1839-88
https://www.ncbi.nlm.nih.gov/pubmed/8
011827
http://www.ahaphysicianforum.org/resou
rces/appropriateuse/antimicrobial/content%20files%20pd
f/SHEA-Clinical-Guidelines.pdf
University of Wisconsin Health Surgical Prophylaxis Guidelines - Appendix B of
Antimicrobial Use Guidelines
http://www.uwhealth.org/files/uwhealth/
docs/antimicrobial/Appx_B_Surgical_Prophylaxis_Guidelines_.pdf
35
https://www.ncbi.nlm.nih.gov/pubmed/1
0511234
Antibiotic Stewardship – Pharmacy-Driven Interventions
Resource
Website
University of Miami Health System Antimicrobial Surgical Prophylaxis Protocols
http://www.ugotabug.med.miami.edu/jmh
Antimicrobial surgical prophylaxis general and solid organ transplant and LVADs is shared.
-antimicrobial-stewardshipprogram/antimicrobial-surgicalprophylaxis
Diagnosis and management of complicated intra-abdominal infection in adults and
http://cid.oxfordjournals.org/content/50/2/
children: guidelines by the Surgical Infection Society and the Infectious Diseases Society of 133
America
Clin Infect Dis. 2010;50(2):133-16
Infectious Diseases Society of America Infections by Antimicrobial Agent Use
https://www.idsociety.org/Antimicrobial_
Includes antimicrobial prophylaxis for surgery, antimicrobial stewardship, combat-related
Agents/
infections, neutropenic patients with cancer, outpatient parenteral anti-infective therapy (OPAT),
and vancomycin.
Cleveland Clinic Guidelines for Antimicrobial Usage
http://www.clevelandclinicmeded.com/me
This pdf file has bookmarks for gram stain morphology of selected organisms, key
dicalpubs/antimicrobial-guidelines/
characteristics of selected organisms, usual acid-fast bacillus characteristics, mechanism of
action of common antibacterial agents, nine different treatment guidelines, guide to dosing
adults, antivirals, dosing guidelines, antimicrobial interactions, and five prophylactic dosing
recommendations.
University of California, San Francisco Medical Center Guidelines for Dosing
http://idmp.ucsf.edu/antimicrobial-dosingIncludes access to adults not receiving hemodialysis, adults receiving hemodialysis,
guidelines
aminoglycoside dosing and monitoring recommendations for adults, dosing in pediatric patients,
and dosing in neonates.
University of Kentucky Restricted Antimicrobial Agents
http://www.hosp.uky.edu/pharmacy/amt/R
Includes links to Amphotericin B Lipid Complex (Abelcet®), Itraconazole IV Daptomycin
estrictedAgents.html
(Cubicin®), Itraconazole IV (Sporanox®), Linezolid (Zyvox®), Meropenem (Merrem®),
Meropenem (Mycamine®), Quinupristin/Dalfopristin (Synercid®), Valganciclovir
Ticarcillin/Clavulanate (Timentin®), Valganciclovir Tigecycline (Tygacil®), Valganciclovir
(Valcyte®), Vancomycin, Voriconazole (VFend®), and Restricted Antimicrobial Ordering
Process
University of Miami Health System Antibiotic Desensitization Protocols
http://www.ugotabug.med.miami.edu/jmh
Includes following antibiotics: Ampicillin IV, Ampicillin Oral, Cephalosporins IV,
-antimicrobial-stewardshipCiprofloxacin IV and oral, Imipenem, Meropenem, Penicillin IV and oral
program/antibiotic-desensitizationPiperacillin/Tazobactam, Rifampin Oral, and Trim/Sulfa IV and oral.
protocols
36
Antibiotic Stewardship – Pharmacy-Driven Interventions
Resource
Website
Guidance to Providers: Testing for C. difficile Infection
http://www.mc.vanderbilt.edu/documents/infectio
Recommendations for CDI testing, including a sample diagnostic algorithm (pg. 2),
ncontrol/files/Guidance%20for%20Providers%20
from Vanderbilt University Medical Center
FINAL%202011.pdf
Stanford Medicine Criteria for C. difficile Testing
http://med.stanford.edu/bugsanddrugs/clinicalThis document defines when to test, prerequisite and exemptions based upon the Society microbiology/_jcr_content/main/panel_builder/pa
for Healthcare Epidemiology of America, Infectious Diseases Society of America. 2010. nel_0/download_696064726/file.res/C.diff%20P
Clinical practice guidelines for Clostridium difficile infection in adults: 2010 update by CR%20rejection%20criteria%206-9-15.pdf
the society for healthcare epidemiology of America (SHEA) and the infectious diseases
society of America (IDSA).
http://www.ugotabug.med.miami.edu/documents/
University of Miami Health System Clostridium difficile Testing Algorithm and
CdiffMD.pdf
Treatment
http://www.apic.org/Resource_/TinyMceFileMan
Sample Clostridium difficile Infection (CDI) Orders
ager/Practice_Guidance/cdiff/CDifficileInfection
CDIOrdersandCDifficileToxinScreeningandOrde
rs.pdf
http://www.fadona.org/CDILabTestInfoSheet122
Clostridium difficile Infection (CDI) Prevention Collaborative Laboratory
210.pdf
Testing Information Overview of C. difficile laboratory tests with table comparing
tests on pg. 2, from the Florida Department of Health
http://www.asm.org/images/pdf/Clinical/clostridi
A Practical Guidance Document for the Laboratory Detection of Toxigenic
umdifficile9- 21.pdf
Clostridium difficile Recommended practices and sample algorithms for C. difficile
laboratory testing, from the American Society for Microbiology (ASM)
http://www.mc.vanderbilt.edu/documents/infection
Guidance to Providers: Testing for C. difficile Infection
Recommendations for CDI testing, including a sample diagnostic algorithm (pg. 2), from control/fil
es/Guidance%20for%20Providers%20FINAL%20
Vanderbilt University Medical Center
2011.pdf
http://www.apic.org/Resource_/TinyMceFileMana
FAQ on Testing Asymptomatic Patients for C. difficile
ger/FAQ_on_Testing_Asymptomatic_Patients_for
An article out of the American Journal of Infection Control, said that testing patients
_Cdiff_04262013.pdf
with three risk factors upon hospital admission has potential to identify nearly three out
of four asymptomatic carriers of C. difficile at their institution. Given that CDC does not
currently recommend testing of asymptomatic patients for C. difficile, FAQs on this
issue was created.
37
Antibiotic Stewardship – Diagnosis and Infection Specific Interventions
Resource
Website
http://www.nebraskamed.com/app_files/pdf/career
Nebraska Gastrointestinal Pathogen Panel Guidance
s/education-programs/asp/gi-panel-guidance-12-3To improve the detection of intestinal pathogens, the microbiology lab introduced
14.pdf
multiplex PCR testing using the FilmArray Gastrointestinal (GI) panel, which detects 22
common viruses, bacteria, and parasites that cause infectious diarrhea.
http://www.nebraskamed.com/app_files/pdf/career
Nebraska Misinterpretation of Results from Rapid Blood Culture Identification
s/education-programs/asp/bcidPanel
misinterpretation.pdf
PCR-based blood culture identification (BCID) system confusion has been reported
particularly with interpretation of genus-level analytes and markers of antimicrobial
resistance thus this guide addresses knowledge which is necessary to interpret a report.
http://www.nebraskamed.com/app_files/pdf/career
Nebraska Rapid Blood Pathogen Identification Panel
s/education-programs/asp/biofire-recs.pdf
This document provides support for the Blood Pathogen Panel (performed on the
BioFire BCID instrument) which uses a PCR-based approach to amplify DNA targets
directly from positive blood cultures.
http://journals.cambridge.org/action/displayAbstrac
A randomized clinical trial comparing use of rapid molecular testing for
t?fromPage=online&aid=10039398&fileId=S0899
Staphylococcus aureus for patients with cutaneous abscesses in the emergency
823X15002020
department with standard of care
Infect Control Hosp Epidemiol
http://jid.oxfordjournals.org/content/212/11/1692
Serum procalcitonin measurement and viral testing to guide antibiotic use for
respiratory infections in hospitalized adults: a randomized controlled trial
J Infect Dis. 2015;212(11):1692-1700
University of Pennsylvania Medical Center Clinical Microbiology Laboratory
http://www.uphs.upenn.edu/bugdrug/antibiotic_
Information and Non-UPHS Guidelines for Antimicrobial Therapy
manual/table%20of%20contents.htm
Table of contents includes Endocarditis and Endovascular Infections, Fungal Infections,
Gastrointestinal Tract Infections, Intraabdominal Infections, Hepatitis, Urinary Tract
Infections, Sexually Transmitted Diseases, IDSA and BSAC Guidelines, Pneumonia and
Upper Respiratory Tract Infections, Tuberculosis, Parasitic, Tick-borne, Travel-related
Infections, and HIV.
http://www.cdc.gov/getsmart/healthcare/implemen
Clinician guide for collecting cultures
tation/clinicianguide.html
Centers for Disease Control and Prevention (CDC)
Johns Hopkins Specimen Guidelines
The proper collection of a specimen for culture is the most important step in the
recovery of pathogenic organisms responsible for infectious disease. A poorly collected
specimen may lead to failure in isolating the causative organism(s) and/or result in the
recovery of contaminating organisms.
38
http://www.hopkinsmedicine.org/microbiology/sp
ecimen/index.html
Antibiotic Stewardship – Diagnosis and Infection Specific Interventions
Resource
Website
Clinical and Laboratory Standards Institute
www.clsi.org
Provides multiple resources including developing cumulative reports for your Clinicians
Quick Guide, performance Standards for Antimicrobial Susceptibility Testing,
performance Standards for Antimicrobial Disk Susceptibility Tests, & Methods for
Dilution Antimicrobial Susceptibility Tests for Bacteria That Grow Aerobically.
CDC Clinician Guide for Collecting Cultures
http://www.cdc.gov/getsmart/healthcare/impleme
ntation/clinicianguide.html
This material was prepared in part by the Lake Superior Quality Innovation Network, under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department
of Health and Human Services. The materials do not necessarily reflect CMS policy. 11SOW-WI-C1-16-70 060116
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