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The CDC’s Priorities for Hospital Core Element Implementation aim to expand the use of the Core Elements of Hospital Antibiotic Stewardship Programs.
“Hospital antibiotic stewardship programs are essential to optimize treatment of infections in patients and help combat antimicrobial resistance,” Melinda Neuhauser, PharmD, MPH, notes. “The Core Elements of Hospital Antibiotic Stewardship Programs (Core Elements) outline structural and procedural components that are associated with successful antibiotic stewardship programs.”
It is important to track the implementation of the Core Elements, Dr. Neuhauser notes, to assess the quality of practices implemented since the guidance was released in 2014.
For a study published in Open Forum Infectious Diseases, Dr. Neuhauser and colleagues utilized the National Healthcare Safety Network annual hospital survey to examine facility demographics, practices of antibiotic stewardship programs, and uptake of the Core Elements from 2014-2021. Facilities included only acute care hospitals.
Moving from Core to Priority Elements
Between 4,184 and 5,067 acute care hospitals completed the NHSN survey annually from 2014 to 2021. Facility types included critical access, general acute care, oncology, orthopedic, surgical, Veterans Affairs, and women’s hospitals.
Overall, uptake of all seven Core Elements increased from 41% in 2014 to 95% in 2021.
“Substantial progress was made in the implementation of CDC’s Core Elements between 2014 and 2021,” Dr. Neuhauser says. “Almost every hospital in America now has a stewardship program that implements all of CDC’s Core Elements, which is more than double what it was in 2014. Moreover, we’ve seen a lot of growth in specific areas that we think are especially important for the quality of the program, like having a physician and pharmacist lead the program together. This was only true in 23% of hospitals in 2014 but is now the case in 64%.”
Uptake of all six Priority Elements was 10% in 2021, though 46% of hospitals met most—four or five—of the possible six elements. The Priority Elements include hospital leadership commitment, accountability, pharmacy/stewardship expertise, action, tracking, and reporting (Figure).
“Now that so many hospitals have implemented the Core Elements, we want hospitals to focus on the specific implementation approaches that are most effective,” Dr. Neuhauser continues. “To that end, in 2022, CDC released Priorities for Hospital Core Element Implementation (Priorities), which highlights the most effective implementation approaches. We are encouraging hospital antibiotic stewardship programs to implement the Priorities and would like to stress the important partnership between stewardship program staff and clinicians in optimizing antibiotic use. The success of any antibiotic stewardship program depends upon clinician engagement.”
Facilitating Further Improvements in Antibiotic Stewardship
The findings indicate that “US hospitals have built a strong foundation for antibiotic stewardship,” Dr. Neuhauser notes.
She points to several interventions outlined in the Priorities regarding future actions: prospective audit, feedback, and preauthorization.
“Most hospitals in the US have these actions in place, and implementation of these actions is not limited to large hospitals,” Dr. Neuhauser says. “However, there is some opportunity for improvement, as we would like to see all hospitals using either prospective audit and/or preauthorization.”
Future research should focus on translating the infrastructure of antibiotic stewardship programs into even more effective interventions to improve antibiotic use, she continues. One example involves integrating tools and resources into EHRs to facilitate clinical decision-making for diagnosing and treating infections.
“The field of antibiotic stewardship and healthcare IT is rapidly evolving, and stewardship programs need to leverage the most effective and efficient methods to support clinician decision-making,” Dr. Neuhauser says.
