Despite widespread efforts to control the spread of multidrug-resistant organisms (MDROs), the incidence of infections attributed to MDROs among hospital patients continues to rise. Infections caused by MDROs are associated with a significant deterioration in clinical outcomes, including an increased risk of death and significantly increased costs, mostly attributable to increased lengths of stay.
Consequently, unnecessary or inappropriate use of antibiotics has increased rates of serious diseases or complications such as Clostridium difficile–associated diseases. To address these issues, health care institutions are beginning to rely on stewardship programs to manage antimicrobial usage with the goal of reducing the incidence of MDRO infections, improving patient outcomes, and reducing costs.
Antimicrobial stewardship is a rational, systematic approach to the use of antimicrobial agents in order to achieve optimal outcomes—those of the patient (achievement of cure, avoidance of toxicity, and other adverse effects) and of the larger population (avoidance of emergence or propagation of antimicrobial resistance). Through ongoing monitoring and, when necessary, a change in antimicrobial prescribing practices, successful stewardship programs have improved patient care, decreased antimicrobial use and resistance, and reduced unnecessary pharmacy expenditures, in addition to other direct and indirect hospital costs.
Funded by the New York State Department of Health (DOH), from October 2009 to April 2010 the Greater New York Hospital Association (GNYHA), in partnership with UHF, assisted a small group of acute care and long-term care facilities in establishing antimicrobial stewardship programs within their institutions. Guided by a Steering Committee comprising expert infectious disease–trained physicians, clinical pharmacists, hospital epidemiologists, senior leadership, and representatives from DOH, as well as GNYHA affiliates the Continuing Care Leadership Coalition and The Health Economics and Outcomes Research Institute, GNYHA/UHF developed this evidence-based toolkit to assist other health care facilities with implementing an effective and sustainable antimicrobial stewardship program.
This toolkit is based on published guidelines and the experiences of the facilities that participated in the GNYHA/UHF Antimicrobial Stewardship Project. The resources included are intended to provide a basic framework that can be tailored to suit other institutions irrespective of the facility’s size, academic teaching status, staffing model, formulary, prescribing practices, patient population, level of implementation, or available resources.