Antimicrobial stewardship, a program designed to guide appropriate selection and use of antimicrobial agents, is one strategy for preventing an outbreak of multidrug-resistant organisms in a healthcare facility, according to a report in the New England Journal of Medicine.
The report describes seven interventions to reduce antibiotic exposure in hospitals as part of an antimicrobial stewardship program:
1. Promote clear, accessible decision support for appropriate duration of antibiotic therapy. Decision support should target common diagnoses and provide links to evidence.
2. Use standardized order sets that clearly define the appropriate antimicrobial agent, dose and duration of treatment.
3. Make the antibiotic indication visible at the point of care. Healthcare providers can require the indication to be specified when the order set is written or highlight the indication on the medication administration.
4. Document the start day, day of treatment and expected duration.
5. Implement an antibiotic "time out" after 72 hours of treatment to determine as a team whether to continue or de-escalate antibiotic therapy.
6. Send appropriate cultures before starting antibiotics. Positive cultures help narrow regimens' spectrum as appropriate, and negative cultures provide evidence to discontinue unnecessary therapy.
7. Implement prospective-audit-with-feedback strategies and build an organizational culture that values feedback. This culture engages frontline clinicians and enables providers to track progress in reducing antibiotic exposure.
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The report describes seven interventions to reduce antibiotic exposure in hospitals as part of an antimicrobial stewardship program:
1. Promote clear, accessible decision support for appropriate duration of antibiotic therapy. Decision support should target common diagnoses and provide links to evidence.
2. Use standardized order sets that clearly define the appropriate antimicrobial agent, dose and duration of treatment.
3. Make the antibiotic indication visible at the point of care. Healthcare providers can require the indication to be specified when the order set is written or highlight the indication on the medication administration.
4. Document the start day, day of treatment and expected duration.
5. Implement an antibiotic "time out" after 72 hours of treatment to determine as a team whether to continue or de-escalate antibiotic therapy.
6. Send appropriate cultures before starting antibiotics. Positive cultures help narrow regimens' spectrum as appropriate, and negative cultures provide evidence to discontinue unnecessary therapy.
7. Implement prospective-audit-with-feedback strategies and build an organizational culture that values feedback. This culture engages frontline clinicians and enables providers to track progress in reducing antibiotic exposure.
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