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Antimicrobial Stewardship
Antimicrobial Stewardship refers to a coordinated effort within healthcare settings to ensure that antibiotics and other antimicrobial medications (including antibiotics) are prescribed appropriately, only when needed, in the correct dose, and for the right duration. These programs aim to optimize patient care, prevent avoidable side effects, slow the development of antimicrobial resistance, and limit the spread of multidrug-resistant organisms (MDROs).
Improper or excessive use of antimicrobials is a major global public health threat. When antimicrobials are used unnecessarily or incorrectly, microorganisms such as bacteria, viruses, and fungi can evolve and develop resistance to the drugs meant to eliminate them. As resistance grows, infections become more complex and more expensive to treat. Individuals with antimicrobial-resistant infections often experience longer hospitalizations, more complications, and increased healthcare costs.
The following resources relate to APIC’s advocacy position on Antimicrobial Stewardship.
APIC Statements and Position Papers
The APIC Policy Agenda: Antibiotic Stewardship
APIC believes that successful efforts to combat antibiotic resistant bacteria must recognize the collective responsibility
to protect the effectiveness of all antibiotics – those we have today, and those yet to be developed.
Antimicrobial stewardship and infection prevention—leveraging the synergy: A position paper update
During 2012, the Association for Professionals in Infection Control and Epidemiology (APIC) and the Society for Healthcare Epidemiology of America (SHEA) published a position paper highlighting the critical importance of infection preventionists (IPs) and health care epidemiologists (HEs) in effective antimicrobial stewardship (AS) programs.
APIC Statement in Support of National Action Plan for Combating Antibiotic-Resistant Bacteria
APIC Statement in Support of National Action Plan for Combating Antibiotic-Resistant Bacteria can be found here.
Antimicrobial stewardship: A collaborative partnership between infection preventionists and health care epidemiologists
Misuse and overuse of antimicrobials, primarily involving therapeutic agents used to treat infection in humans, is considered one of the world’s most pressing public health problems
APIC Implementation Guides relevant to Antimicrobial Stewardship.
Available Guides
Guide to Preventing Clostridium difficile Infections (2013)
Best practices for IPs and anyone who cares for patients with C. difficile or in facilities with patients who are being treated for C. difficile infections (CDI).
Guide to the Elimination of Methicillin-Resistant Staphylococcus aureus (MRSA) Transmission in Hospital Settings, 2nd Edition, 2010
Practice guidance for the elimination of methicillin-resistant Staphylococcus aureus (MRSA) transmission in hospital settings.
Guide to the Elimination of Multidrug-resistant Acinetobacter baumannii Transmission in Healthcare Settings, 2010
Summary of the latest studies, outbreak experiences, applicable guidelines, and tools to manage and eliminate transmission of multidrug-resistant Acinetobacter baumannii (MDR Ab) in healthcare settings.
Guide to the Elimination of Methicillin-Resistant Staphylococcus aureus (MRSA) in the Long-Term Care Facility, 2009
Comprehensive strategies for eliminating MRSA across the entire spectrum of long-term care (LTC) facilities.
The Following chapter from the APIC Text is relevant to the topic (subscription is required).
APIC Text Chapter
The following resources originate from organizations outside of APIC.
View External Resources
Be Antibiotics Aware Partner Toolkit
CDC’s educational effort, Be Antibiotics Aware, aims to improve antibiotic prescribing and use among consumer and healthcare professional audiences to protect patient safety and combat drug resistance.
Antimicrobial Stewardship in Non-Traditional Settings
In 2014, the US Centers for Disease Control and Prevention launched a new set of core elements for acute-care hospitals to implement key strategies in antimicrobial stewardship (AS).
Core Elements of Antibiotic Stewardship
CDC’s Core Elements of Antibiotic Stewardship offer providers and facilities a set of key principles to guide efforts to improve antibiotic use and, therefore, advance patient safety and improve outcomes.
CDC Antibiotic Stewardship Trainings
Healthcare professionals can earn continuing education (CE) through these antimicrobial resistance and antibiotic stewardship trainings.
CDC Antibiotic Stewardship Resource Bundles
Healthcare professionals and partner organizations—including health departments and professional societies — can review and share the Antibiotic Stewardship Resource Bundles as part of their organization’s U.S. Antibiotic Awareness Week promotion efforts.
WHO policy guidance on integrated antimicrobial stewardship activities
Member States have requested WHO policy guidance on how to facilitate the implementation of national AMS activities in an integrated and programmatic approach. This policy guidance responds to that demand from Member States and is anchored in public health guiding principles in the human health sector.
Catheter-associated urinary tract infection (CAUTI)
Catheter-associated urinary tract infections (CAUTI) develop either during or after placement of a urinary catheter. CAUTI has been shown to increase patient morbidity and mortality, increase length of stay, and add to the cost of care. This page contains CAUTI prevention resources and education for both healthcare professionals and consumers.
The following links are APIC resources on CAUTI prevention for healthcare professionals.
Implementation guides and tools
Strategies to Prevent Catheter-Associated Urinary Tract Infections in Acute Care Hospitals: 2014 Update
Society for Healthcare Epidemiology of America (APIC collaborated with SHEA and other organizations on development of this resource)
On the CUSP: Stop CAUTI
APIC’s role in the national implementation of CUSP to eliminate HAIs
The Importance of Surveillance Technologies in the Prevention of Healthcare-Associated Infections (HAIs)
APIC Position paper
The following links are APIC resources on CAUTI prevention for healthcare professionals.
Implementation guides and tools
Strategies to Prevent Catheter-Associated Urinary Tract Infections in Acute Care Hospitals: 2014 Update
Society for Healthcare Epidemiology of America (APIC collaborated with SHEA and other organizations on development of this resource)
CLABSI
Clostridioides difficile
CRE
Disinfection and Sterilization
Environmental Services
Environmental Services (EVS) play a critical role in preventing the spread of germs that can cause illness in both patients and healthcare personnel. Effective EVS practices are essential to reduce healthcare-associated infections and support overall infection prevention and control efforts
The following links are APIC resources on Environmental Services for healthcare professionals.
APIC Tools
Environmental Rounds Checklist
Useful checklist for infection preventionists on environmental rounds.
The following link provides relevant chapter information from the APIC Text. These resources for available to members only.
APIC Text Chapters
Chapter 32: Cleaning, Disinfection, and Sterilization
Environmental cleaning and disinfection are essential for maintaining a safe patient environment.
Chapter 106: Environmental Services
There is an increased awareness of the relationship between effective environmental hygiene programs and infection prevention, patient harm reduction, and HCP safety.
Chapter 111: Waste Management
Infection preventionists have varying levels of involvement with healthcare waste management and are often focused on regulated medical waste. The categories of regulated medical waste streams of particular interest to infection preventionists include infectious waste, pathological waste, and sharps waste.
APIC has compiled useful links to external sources about Environmental Services.
External Resources
CDC – Environmental Services
Environmental services guidelines from the Guidelines for Environmental Infection Control in Health-Care Facilities (2003).
CDC – EVS and the Battle Against Infection
Environmental services (EVS) personnel have the shared responsibility to help stop healthcare-associated infections (HAIs) from spreading by working with colleagues, prioritizing areas that pose immediate safety risks, and following guidelines for cleaning and disinfecting. This interactive training illustrates the important role EVS personnel have in the prevention of HAIs.
CDC – Considerations for Reducing Risk: Surfaces in Healthcare Facilities
Hospitals must maintain a clean environment and reduce germ exposure to keep patients, visitors and healthcare personnel safe.
CDC – Environmental Cleaning Procedures
This chapter provides the current best practices for environmental cleaning procedures in patient care areas, as well as cleaning for specific situations (e.g., blood spills) and for noncritical patient care equipment.
Association for the Health Care Environment (AHE) – Project Firstline EVS Cleaning
As part of the Project Firstline initiative, the AHA and AHE have released two cleaning and disinfecting job aids for frontline EVS professionals and their supervisors to use in their efforts to practice proper cleaning and disinfection in a variety of health care settings.
WHO – Environmental Cleaning and Infection Prevention and Control in Healthcare Facilities in low-and middle-income countries
Environmental cleaning and infection prevention and control in health care facilities in low- and middle-income countries