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ABX: Antimicrobial Stewardship

Why We Want to Improve Antibiotic Stewardship

Antibiotics are some of the most widely prescribed drugs in medical practice, yet, according the Centers for Disease Control and Prevention (CDC), up to 50 percent of all antibiotics prescribed are either not necessary or are not effective as prescribed; this has become widely recognized as a top public health priority. Antibiotic stewardship initiatives are a crucial measure in preventing the overuse and misuse of antimicrobials.

Overuse of antibiotics can lead to C. difficile infection (C. diff), a dangerous infection that cause illness ranging from diarrhea to sepsis and even death. C. diff is estimated by the CDC to have caused almost half a million infections in the United States in 2011. Approximately 83,000 of the patients who developed the infection experienced at least one recurrence, and 29,000 people died within 30 days of the initial diagnosis. The economic impact of C. diff is similarly devastating; According to the CDC’s March 2012 Vital Signs report, C. diff alone cost at least $1 billion in extra healthcare costs annually.

Inappropriate antibiotic use can also lead to antibiotic-resistant (AR) organisms. Persons infected with AR organisms are more likely to require longer hospital stays, require combinations of antimicrobials and require the use of drugs considered second or third choice. These factors are often associated with greater toxicity and length of hospitalization, as well as higher cost of care. In addition to direct patient harm, AR in the United States costs an estimated $20 billion a year in healthcare costs, $35 billion in other societal costs and more than 8 million additional days spent by patients in the hospital.

Preventing AR and C. diff requires hospitals to use a proactive approach that includes antimicrobial stewardship, clinician education and patient and family engagement around proper use of antibiotics.

Success Within New Jersey Hospitals

NJHIIN is working with New Jersey hospitals to promote the use of the appropriate agent, dose, duration and route of administration of antimicrobial agents both in the acute care and post-acute care settings in order to improve quality of patient care and patient safety while reducing excessive costs attributable to inappropriate antimicrobial use.

This is being accomplished in part through hospital participation in the following collaborative efforts:

New Jersey Antimicrobial Stewardship Learning Action Collaborative

The collaborative is made up of acute care hospitals and post-acute care facilities from across New Jersey, all focusing on the goals of improving antibiotic use and reducing adverse outcomes including C. difficile infection and antibiotic resistance. To achieve the collaborative goals, an approach is being used that combines the clinical expertise of core faculty, experiences of best-practice healthcare organizations and the organizational strength and data capabilities of the NJHIIN.

Through this work, teams are expected to successfully implement the following seven CDC core elements of antimicrobial stewardship:

  • Leadership Commitment: Dedicating necessary human, financial and information technology resources;
  • Accountability: Appointing a single physician leader and a single nurse leader responsible for program outcomes;
  • Drug Expertise: Appointing a single pharmacist leader responsible for working to improve antimicrobial use;
  • Action: Implementing policies and interventions to improve antimicrobial use, such as systemic evaluation of ongoing treatment need after a set period of initial treatment (i.e. “antibiotic time out” after 48 hours);
  • Tracking: Monitoring antimicrobial prescribing and resistance patterns;
  • Reporting: Regular reporting information on antimicrobial use and resistance to doctors, nurses and relevant staff; and
  • Education: Educating clinicians about resistance and optimal prescribing.

Our Goals Moving Ahead

By September 2018, each participating NJHIIN hospital will demonstrate a 20 percent reduction in healthcare-associated C. difficile infections.

By September 2019, each participating NJHIIN hospital will demonstrate 100 percent implementation of all seven CDC core elements of antibiotic stewardship. The collaborative as a whole will establish a statewide baseline antimicrobial use rate from which future improvements will be benchmarked.


NJHIIN Webinars

NJHIIN Antimicrobial Stewardship Collaborative for Long Term Care Settings