Table 2.
Answers to the Antimicrobial Stewardship Program Self-Assessment by Hospital Type
| Item Evaluated | For-Profit Hospitals N = 8 (%) |
Not-for-Profit Hospitals N = 12 (%) |
|---|---|---|
| ASP structure and resources | ||
| There is an official document approving the ASP | 4 (50) | 6 (50) |
| The official document includes a designated individual responsible for the ASP | 4 (50) | 2 (17) |
| There is a specific budget for AS activities including salary support | 0 | 1 (8) |
| There are annual AS goals and a strategic plan to achieve the goals of the ASP | 8 (100) | 8 (66) |
| There is a specific AS committee | 5 (63) | 8 (66) |
| The AS committee has authority | 1 (13) | 3 (35) |
| The AS committee meets at least quarterly | 1 (13) | 1 (8) |
| The AS committee collaborates with other committees | 5 (63) | 6 (50) |
| Physicians have dedicated time for AS activities | 1 (13) | 3 (25) |
| Pharmacist have dedicated time for AS activities | 0 | 1 (8) |
| Physicians from other groups participate in AS meetings | 6 (75) | 4 (35) |
| Bedside nurses participate in AS meetings | 1 (13) | 6 (50) |
| IT resources | ||
| IT assists with data extraction and reporting (eg, antimicrobial consumption data, patient days) | 3 (38) | 3 (25) |
| The hospital has digitized medical records | 7 (88) | 7 (59) |
| Microbiology | ||
| The hospital has access to a microbiology laboratory | 8 (100) | 12 (100) |
| The microbiology laboratory has technology to identify the most relevant resistance mechanisms | 8 (100) | 11 (92) |
| The microbiology laboratory has implemented rapid diagnostic testing | 7 (88) | 10 (82) |
| The microbiology laboratory performs selective or cascading susceptibility reporting | 8 (100) | 10 (82) |
| The microbiology laboratory reports culture results in a timely manner | 8 (100) | 12 (100) |
| The microbiology laboratory disseminates annual antibiograms | 7 (88) | 8 (66) |
| Treatment guidelines | ||
| Guidelines are developed and adapted by consensus with multidisciplinary teams | 8 (100) | 10 (83) |
| Guidelines are adapted based on local epidemiology and sensitivity patterns | 8 (100) | 10 (83) |
| Treatment guidelines include recommendations on the duration of antimicrobial therapy | 8 (100) | 9 (75) |
| Treatment guidelines include therapeutic alternatives to allergy to beta-lactams | 8 (100) | 9 (75) |
| Community-acquired pneumonia | 7 (88) | 9 (75) |
| Hospital-acquired pneumonia including ventilation-associated pneumonia | 8 (100) | 9 (75) |
| Urinary tract infections | 8 (100) | 9 (75) |
| Skin and soft tissue infections | 6 (75) | 8 (66) |
| Intraabdominal infections | 5 (63) | 7 (58) |
| Sepsis of unknown source | 4 (50) | 4 (33) |
| Surgical prophylaxis | 8 (100) | 11 (92) |
| Infections in immunocompromised hosts | 7 (88) | 8 (66) |
| Multidrug-resistant organism infections | 7 (88) | 6 (50) |
| Pharmacy | ||
| ASP participates in decisions regarding inclusion/exclusion of antimicrobials in the hospital formulary | 7 (88) | 8 (66) |
| The hospital has regular access to new antimicrobials | 8 (100) | 10 (83) |
| AS interventions | ||
| ASP regularly performs post-prescription review and feedback at 48–72 h | 5 (63) | 4 (33) |
| Certain antimicrobials require preauthorization for at least certain areas | 6 (75) | 9 (75) |
| ASP conducts handshake stewardship | 7 (88) | 11 (92) |
| The hospital has a therapeutic drug monitoring program | 8 (100) | 9 (75) |
| The hospital has implemented “auto-stops” | 4 (50) | 4 (33) |
| There is a process in place to regularly alert of duplicate therapy (eg, duplicate anerobic coverage) | 0 | 0 |
| Pharmacists regularly participate in antimicrobial dose adjustments | 4 (50) | 2 (17) |
| Monitoring and reporting | ||
| There is an established system for routine and ad hoc data collection and analysis for AU/AMR data | 1 (13) | 4 (33) |
| The ASP monitors antimicrobial consumption data | 7 (88) | 10 (83) |
| ASP monitors adherence to clinical practice guidelines | 4 (50) | 9 (75) |
| ASP monitors the adherence to specific interventions implemented | 3 (38) | 5 (42) |
| The hospital monitors rates of multidrug-resistant organisms | 6 (75) | 5 (42) |
| The hospital monitors Clostridioides difficile infection rates | 6 (75) | 4 (50) |
| The hospital monitors clinical indicators such as mortality, length of stay, readmission | 7 (88) | 7 (58) |
| Education and training | ||
| The AS team has access to training on implementation and evaluation of ASPs | 8 (100) | 11 (92) |
| Healthcare workers receive education on AS principles upon hiring on AS principles | 3 (38) | 4 (33) |
| Healthcare workers receive education on AS principles | 4 (50) | 8 (66) |
| Nurses are trained on antimicrobial use such as drug stability | 7 (88) | 9 (75) |
| Patients and/or their families are educated on antimicrobials at discharge | 4 (50) | 4 (33) |
| The ASP conducts annual awareness campaigns on the responsible use of AU/AMR | 1 (13) | 4 (33) |
| Work climate | ||
| The hospital implements strategies to promote teamwork | 4 (50) | 3 (25) |
| 5 (63) | 2 (17) | |
| The hospital has an anonymous reporting system to report adverse events | 7 (88) | 6 (50) |
Abbreviations: AS, antimicrobial stewardship; ASP, antimicrobial stewardship program; AU, antibiotic use; IT, information technology.