Characteristics of Antimicrobial Stewardship Programs at Veterans Affairs Hospitals: Results of a Nationwide Survey. (24th February 2016)

• Record Type: Journal Article
• Authors: Chou, Ann F.; Graber, Christopher J.; Jones, Makoto; Zhang, Yue; Goetz, Matthew Bidwell; Madaras-Kelly, Karl; Samore, Matthew; Kelly, Allison; Glassman, Peter A.
• Is Part Of: Infection control and hospital epidemiology. Volume 37:Number 6(2016)
• Page Start: 647
• Page End: 654
• Publication Date: 2016-02-24
• Subjects: Nosocomial infections -- Epidemiology -- Periodicals; Health facilities -- Sanitation -- Periodicals; Hospital buildings -- Sanitation -- Periodicals; Cross Infection -- Periodicals; Epidemiology -- Periodicals; Hospitals -- Periodicals; Infection Control -- Periodicals; 614.44
• DOI: 10.1017/ice.2016.26
• Languages: English
• ISSNs: 0899-823X

Abstract

Abstract : BACKGROUND: Antimicrobial stewardship programs (ASPs) are variably implemented. OBJECTIVE: To characterize variations of antimicrobial stewardship structure and practices across all inpatient Veterans Affairs facilities in 2012 and correlate key characteristics with antimicrobial usage. DESIGN: A web-based survey regarding stewardship activities was administered to each facility's designated contact. Bivariate associations between facility characteristics and inpatient antimicrobial use during 2012 were determined. SETTING: Total of 130 Veterans Affairs facilities with inpatient services. RESULTS: Of 130 responding facilities, 29 (22%) had a formal policy establishing an ASP, and 12 (9%) had an approved ASP business plan. Antimicrobial stewardship teams were present in 49 facilities (38%); 34 teams included a clinical pharmacist with formal infectious diseases (ID) training. Stewardship activities varied across facilities, including development of yearly antibiograms (122 [94%]), formulary restrictions (120 [92%]), stop orders for antimicrobial duration (98 [75%]), and written clinical pathways for specific conditions (96 [74%]). Decreased antimicrobial usage was associated with having at least 1 full-time ID physician ( P= .03), an ID fellowship program ( P= .003), and a clinical pharmacist with formal ID training ( P= .006) as well as frequency of systematic patient-level reviews of antimicrobial use ( P= .01) and having a policy to address antimicrobial use in the context of Clostridium difficile infection ( P= .01). Stop orders for antimicrobial duration were associated with increased use ( P= .03). CONCLUSIONS: ASP-related activities varied considerably. Decreased antibiotic use appeared related to ID presence and certain select practices. Further statistical assessments may help optimize antimicrobial practices. Infect Control Hosp Epidemiol 2016;37:647–654