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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 39