Priorities for Hospital Core Element Implementation
Opportunities to Enhance Hospital Antibiotic Stewardship Programs
Hospital antibiotic stewardship programs are essential to optimize patient care and help combat antimicrobial resistance. In 2021, nearly 95% of U.S. hospitals had antibiotic stewardship programs that met all seven of the Core Elements of Hospital Antibiotic Stewardship Programs (Hospital Core Elements).
To continue enhancing hospital antibiotic stewardship programs, CDC has released Priorities for Hospital Core Element Implementation (Priorities) that can help enhance the quality and impact of existing antibiotic stewardship programs. The Priorities (Table) highlight highly effective implementation approaches and are supported by evidence and stewardship experts. Like the Hospital Core Elements, the uptake of the Priorities is tracked and reported through CDC’s National Healthcare Safety Network and can be viewed on the Antibiotic Resistance & Patient Safety Portal.
Table. The Core Elements of Hospital Antibiotic Stewardship Programs and the Priorities for Hospital Core Element Implementation.
Hospitals that have implemented the Hospital Core Elements of Antibiotic Stewardship can implement the Priorities for Hospital Core Element Implementation to further enhance their stewardship program.
Hospital Core Elements
Hospital Core Elements
Priorities for Hospital Core Element Implementation
Priorities for Hospital Core Element Implementation
Hospital Leadership Commitment
Hospital Leadership Commitment
Dedicate necessary human, financial, and information technology resources.
Dedicate necessary human, financial, and information technology resources.
Antibiotic stewardship physician and/or pharmacist leader(s) have antibiotic stewardship responsibilities in their contract, job description, or performance review.
Antibiotic stewardship physician and/or pharmacist leader(s) have antibiotic stewardship responsibilities in their contract, job description, or performance review.
Accountability
Accountability
Appoint leader or co-leaders, such as a physician and pharmacist, responsible for program management and outcomes.
Appoint leader or co-leaders, such as a physician and pharmacist, responsible for program management and outcomes.
Antibiotic stewardship program is co-led by a physician and a pharmacist.*
Antibiotic stewardship program is co-led by a physician and a pharmacist.*
Pharmacy/Stewardship Expertise
Pharmacy/Stewardship Expertise
Appoint a pharmacist, ideally as the co-leader of the stewardship program, to help lead implementation efforts to improve antibiotic use.
Appoint a pharmacist, ideally as the co-leader of the stewardship program, to help lead implementation efforts to improve antibiotic use.
Antibiotic stewardship physician and/or pharmacist leader(s) have completed infectious diseases specialty training, a certificate program, or other training on antibiotic stewardship.
Antibiotic stewardship physician and/or pharmacist leader(s) have completed infectious diseases specialty training, a certificate program, or other training on antibiotic stewardship.
Action
Action
Implement interventions, such as prospective audit and feedback or preauthorization, to improve antibiotic use.
Implement interventions, such as prospective audit and feedback or preauthorization, to improve antibiotic use.
Antibiotic stewardship program has facility-specific treatment recommendations for common clinical condition(s) and performs prospective audit/feedback or preauthorization.
Antibiotic stewardship program has facility-specific treatment recommendations for common clinical condition(s) and performs prospective audit/feedback or preauthorization.
Tracking
Tracking
Monitor antibiotic prescribing, impact of interventions, and other important outcomes, like C. difficile infections and resistance patterns.
Monitor antibiotic prescribing, impact of interventions, and other important outcomes, like C. difficile infections and resistance patterns.
Hospital submits antibiotic use data to the NHSN Antimicrobial Use Option.
Hospital submits antibiotic use data to the NHSN Antimicrobial Use Option.
Reporting
Reporting
Regularly report information on antibiotic use and resistance to prescribers, pharmacists, nurses, and hospital leadership.
Regularly report information on antibiotic use and resistance to prescribers, pharmacists, nurses, and hospital leadership.
Antibiotic use reports are provided at least annually to target feedback to prescribers. In addition, the antibiotic stewardship program monitors adherence to facility-specific treatment recommendations for at least one common clinical condition.
Antibiotic use reports are provided at least annually to target feedback to prescribers. In addition, the antibiotic stewardship program monitors adherence to facility-specific treatment recommendations for at least one common clinical condition.
Education
Education
Educate prescribers, pharmacists, nurses, and patients about adverse reactions from antibiotics, antibiotic resistance, and optimal prescribing.
Educate prescribers, pharmacists, nurses, and patients about adverse reactions from antibiotics, antibiotic resistance, and optimal prescribing.
No implementation priority identified.
No implementation priority identified.
Hospital Core Elements
Hospital Leadership Commitment
Dedicate necessary human, financial, and information technology resources.
Accountability
Appoint leader or co-leaders, such as a physician and pharmacist, responsible for program management and outcomes.
Pharmacy/Stewardship Expertise
Appoint a pharmacist, ideally as the co-leader of the stewardship program, to help lead implementation efforts to improve antibiotic use.
Action
Implement interventions, such as prospective audit and feedback or preauthorization, to improve antibiotic use.
Tracking
Monitor antibiotic prescribing, impact of interventions, and other important outcomes, like C. difficile infections and resistance patterns.
Reporting
Regularly report information on antibiotic use and resistance to prescribers, pharmacists, nurses, and hospital leadership.
Education
Educate prescribers, pharmacists, nurses, and patients about adverse reactions from antibiotics, antibiotic resistance, and optimal prescribing.
Priorities for Hospital Core Element Implementation
Antibiotic stewardship physician and/or pharmacist leader(s) have antibiotic stewardship responsibilities in their contract, job description, or performance review.
Antibiotic stewardship program is co-led by a physician and a pharmacist.*
Antibiotic stewardship physician and/or pharmacist leader(s) have completed infectious diseases specialty training, a certificate program, or other training on antibiotic stewardship.
Antibiotic stewardship program has facility-specific treatment recommendations for common clinical condition(s) and performs prospective audit/feedback or preauthorization.
Hospital submits antibiotic use data to the NHSN Antimicrobial Use Option.
Antibiotic use reports are provided at least annually to target feedback to prescribers. In addition, the antibiotic stewardship program monitors adherence to facility-specific treatment recommendations for at least one common clinical condition.
No implementation priority identified.
* For critical access hospitals (CAHs), this criterion can be met if the hospital has a physician leader with a pharmacist involved in stewardship (recognizing that some CAHs do not have pharmacists on staff, so co-leadership is not possible).
The Hospital Core Elements outline structural and procedural components that are associated with successful antibiotic stewardship programs, which was updated in 2019 to reflect new evidence and lessons learned from implementing programs. Suggestions specific to small and critical access hospitals can be found in Implementation of Antibiotic Stewardship Core Elements at Small and Critical Access Hospitals (Figure).
Figure Text Alternative:
Blue arrows show a timeline of Core Elements of Hospital Antibiotic Stewardship Programs
Timeline shows important events for Hospital Antibiotic Stewardship Programs in 2014, 2017, 2019, and 2022.
2014: Core Elements of Hospital Antibiotic Stewardship Programs
2017: Implementation of Antibiotic Stewardship Core Elements of Small and Critical Access Hospitals Supplemental Guidance
2019: Core Elements of Hospital Antibiotic Stewardship Programs Update
2022: Priorities for Hospital Core Element Implementation Supplemental Guidance