The inappropriate and unnecessary overuse of antibiotics within hospital and outpatient settings has led to the rise of drug-resistant strains of bacteria over the past several decades. These “super” bugs cause 2 million illnesses and over 23,000 deaths in the U.S. alone, according to the Centers for Disease Control and Prevention (CDC)¹. In March of 2015, the White House issued a National Action Plan for Combating Antibiotic-Resistant Bacteria. The goals of the plan include¹:

1. Slow the emergence of resistant bacteria and prevent the spread of resistant infections.
2. Strengthen national one-health surveillance efforts to combat resistance.
3. Advance development and use of rapid and innovative diagnostic tests for identification and characterization of resistant bacteria.
4. Accelerate basic and applied research and development for new antibiotics, therapeutics, and vaccines.
5. Improve international collaboration and capacities for antibiotic-resistance prevention, surveillance, control, and antibiotic research and development.

By 2020, a primary outcome of Goal 1 will be the establishment of antibiotic stewardship programs in all acute care hospitals and across all healthcare settings². The core elements of hospital antibiotic stewardship programs will include^1,2:

• Establishing leadership commitment by dedicating necessary human, financial and information technology resources.
• Appointing a single physician leader, ideally formally trained in infectious diseases, responsible for program outcomes.
• Appointing a single pharmacist leader with drug expertise, responsible for working to improve antibiotic use.
• Securing support from the multidisciplinary team, including infection prevention control, nursing, information technology, laboratory and quality improvement.
• Implementing policies and interventions to improve antibiotic use, ensuring that patients receive the right antibiotic at the right time at the right dose for the right duration.
• Implementing at least one recommended action, such as systemic evaluation of ongoing treatment after a set period of initial treatment (i.e. “antibiotic time out” after 48 hours).
• Monitoring antibiotic prescribing and resistance programs.
• Educating clinicians about resistance and optimal prescribing.

Healthcare leaders and clinicians in all settings should focus efforts on implementing these recommendations in order to decrease antibiotic resistant bacteria.

References
Centers for Disease Control and Prevention: Get Smart for Healthcare. Checklist for Core Elements of Hospital Antibiotic Stewardship Programs. 
The White House: National Action Plan for Combating Antibiotic-resistant Bacteria. Washington, D.C.

Myrna B. Schnur, RN, MSN