NQF, CDC Unveil "Playbook" to Help Hospitals Control Use of Antibiotics

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The practical document will be of greatest use to smaller hospitals still building antibiotic stewardship programs from scratch. CDC estimates that drug-resistant bacteria infect 2 million people a year and cause 23,000 deaths.

A practical, 36-page “how to” document is the latest tool for hospitals looking for ways to use the right amount of antibiotics without adding to the growth antimicrobial resistance.

The guide from the National Quality Forum (NQF) is based on CDC’s 2014 Core Elements of Hospital Antibiotic Stewardship Programs, which followed a recommendation that every hospital develop a game plan to avoid overuse of antibiotics so that the nation can collectively slow the march of superbugs that are difficult or impossible to treat.

According to CDC, misuse of antibiotics has led to the emergence of drug-resistant bacteria that each year cause 2 million illnesses and 23,000 deaths. In response, NQF convened 25 national experts and stakeholders to develop a short-form tool to assist hospitals that might lack resources to develop a stewardship program.


The result, presented yesterday in a webinar for the media, is Antibiotic Stewardship in Acute Care: A Practical Playbook. While some health systems will use the tool to strengthen existing programs, the playbook’s greatest value will be for those hospitals that are still building stewardship programs from scratch, according to experts from CDC, the Hospital Corporation of America (HCA), and HHS.

While stewardship programs do not need to look exactly alike, “there are certain features that are associated with success,” said CDC’s Capt. Arjun Srinivasan, MD, of the US Public Health Service. These features, contained in the Core Elements, are finding their way into hospitals, but not evenly.

“One thing to recognize is that small hospitals are having a harder time than large hospitals” in meeting CDC’s Core Elements, Srinivasan said. By smaller, he referenced hospitals with fewer than 50 beds.

Ed Septimus, MD, medical director of infection prevention and epidemiology, HCA, said the playbook’s examples cover a range of topics under the Core Elements in a way that will allow implementation of a stewardship program, “regardless of size and regardless of resources.” Later, he said there has been some progress in slowing drug-resistant infection, but the playbook addresses a key need—tools for implementation of stewardship programs at the local level.

The playbook’s simplicity is its strength, said Sara Cosgrove, MD, a member of a presidential advisory council on combating anti-biotic resistant bacteria, and director of the stewardship program at Johns Hopkins. “There’s no really no document out there that is this practical,” she said. It will be of use at institutions where the concept of stewardship is still being resisted by those trying to implement it.

The need for the playbook emerged in 2010 when HCA launched its own antimicrobial management program, said Septimus, co-chair of the NQF effort. The document features team-wide, systematic approaches to assessing when patients need antibiotics and when treatment should be adjusted, instructions on educating staff family and patients on appropriate use, and information on tracking, reporting and prescribing.

“The playbook provides practical strategies to guide the implementation of antibiotic stewardship programs in US hospitals,” said Kathleen Giblin, RN, senior vice president of Quality Innovation at NQF. “State and local health departments, as well as other key sectors, need to implement effective stewardship programs across healthcare settings. The strategies outlined in the playbook serve as a model.”