Priorities for Hospital Core Element Implementation
Opportunities to Enhance Hospital Antibiotic Stewardship Programs
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. 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) in 2022 to 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.
Priorities for Hospital Core Element Implementation
Hospitals that have implemented the Hospital Core Elements can implement the Priorities to further enhance their stewardship program. The Priorities have been identified for six of the seven Core Elements and provide hospital leadership and antibiotic stewards opportunities to expand their antibiotic stewardship programs.
Dedicate the necessary human, financial, and information technology resources.
The Priority specifies that antibiotic stewardship physician and/or pharmacist leader(s) have antibiotic stewardship responsibilities in their contract, job description, or performance review. This ensures sustainable staffing resources needed to operate the antibiotic stewardship program effectively.
Appoint a leader or co-leaders, such as a physician and pharmacist, responsible for program management and outcomes.
The Priority specifies that an antibiotic stewardship program is co-led by a physician and pharmacist. Most hospitals have found a co-leadership model to be effective, and according to the 2021 National Healthcare Safety Network (NHSN) Annual Hospital Survey, 64% of hospitals in the United States have stewardship programs that are co-led by a physician and pharmacist. For critical access hospitals (CAHs), accountability 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).
Appoint a pharmacist, ideally as the co-leader of the stewardship program, to help lead implementation efforts to improve antibiotic use.
The Priority specifies that antibiotic stewardship physician and/or pharmacist leader(s) have completed infectious diseases specialty training, a certificate program, or other training on antibiotic stewardship. Highly effective hospital antibiotic stewardship programs have strong engagement of pharmacists and physicians with stewardship training and expertise.
Implement interventions, such as prospective audit and feedback or preauthorization, to improve antibiotic use.
The Priority specifies antibiotic stewardship program has facility-specific treatment recommendations for common clinical condition(s) and performs prospective audit and feedback or preauthorization for specific antibiotic agents. Facility-specific treatment guidelines establish clear recommendations for optimal antibiotic use. As outlined by the Hospital Core Elements, prospective audit/feedback and preauthorization are the two most effective antibiotic stewardship interventions in hospitals and can be greatly enhanced by facility-specific treatment guidelines.
Monitor antibiotic prescribing, the impact of interventions, and other important outcomes, like Clostridioides difficile infections and resistance patterns.
The Priority specifies that a hospital submits antibiotic use data to the NHSN Antimicrobial Use (AU) Option. Monitoring and benchmarking antimicrobial use data is important to inform and assess stewardship interventions.
Regularly report information on antibiotic use and resistance to prescribers, pharmacists, nurses, and hospital leadership.
The Priority specifies that prescriber, unit or service-level 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. This ensures that the priority actions, tracking, and reporting are integrated in the quality improvement pathway.
Educate prescribers, pharmacists, nurses, and patients about adverse reactions from antibiotics, antibiotic resistance, and optimal prescribing.
No implementation Priority was identified for education.
Mapping of the Patient Safety Component – Annual Hospital Survey
Questions from the Annual Hospital Survey are mapped to Hospital Core Elements and Priorities.
Antibiotic Resistance & Patient Safety Portal
The uptake of the Priorities can be viewed on the Antibiotic Resistance & Patient Safety Portal.
How to Run the Priorities Line List in NHSN
The uptake of the Priorities can be found when running the Priorities for Hospital Core Element Implementation line list within National Healthcare Safety network.