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Antibiotic Stewardship Program

Improvement or Implementation Guide

Updated February 2018

MetaStar represents Wisconsin in the Lake Superior Quality Innovation Network. | 608-274-1940 | www.metastar.com

http://www.metastar.com/

Table of ContentsGeneral Infrastructure – Leadership Support, Accountability, Commitment.............................................................................................3

General Infrastructure – Supporting System.............................................................................................................................................8

Policy/Procedure/Protocol.......................................................................................................................................................................13

Education................................................................................................................................................................................................ 27

Tracking, Monitoring Antibiotic Use, and Process Measures..................................................................................................................41

Reporting Information to Staff on Improving Antibiotic Use and Resistance – Antibiotic Use and Outcome Measure...........................47

Antibiotic Stewardship – Pharmacy-Driven Interventions.......................................................................................................................50

Antibiotic Stewardship – Diagnosis and Infection Specific Interventions................................................................................................57

This material was prepared by the Lake Superior Quality Innovation Network, under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services. The materials do not necessarily reflect CMS policy. 11SOW-WI-C1-16-70 060116



General Infrastructure – Leadership Support, Accountability, CommitmentResource Website

Executive Order – Combating Antibiotic-Resistant BacteriaThe White House outlined the importance and need to take action. This order was released in September of 2014.

https://www.whitehouse.gov/the-press-office/2014/09/18/executive-order-combating-antibiotic-resistant-bacteria

National Action Plan for Combating Antibiotic Resistant BacteriaDeveloped in response to Executive Order 13676: Combating Antibiotic-Resistant Bacteria—issued by President Barack Obama on September 18, 2014—the National Action Plan outlines steps for implementing the National Strategy for Combating Antibiotic-Resistant Bacteria and addressing the policy recommendations of the President’s Council of Advisors on Science and Technology (PCAST).

https://www.cdc.gov/drugresistance/pdf/national_action_plan_for_combating_antibotic-resistant_bacteria.pdf

The National Strategy for Combating Antibiotic Resistant BacteriaThis document identifies priorities and coordinates investments: to prevent, detect, and control outbreaks of resistant pathogens recognized by CDC as urgent or serious threats, including carbapenem-resistant Enterobacteriaceae (CRE), methicillin-resistant Staphylococcus aureus (MRSA), ceftriaxone resistant Neisseria gonorrhoeae, and Clostridium difficile.

https://www.cdc.gov/drugresistance/pdf/carb_national_strategy.pdf

Antibiotic Resistance Threats in the United States, 2013This document prioritized bacteria in this report into one of three categories: urgent, serious, and concerning. The second section describes what can be done to combat this growing threat, including information on current Centers for Disease Control and Prevention (CDC) initiatives.

https://www.cdc.gov/drugresistance/pdf/ar-threats-2013-508.pdf

Overview and Evidence to Support StewardshipThe CDC provides an overview, fast facts, antimicrobial stewardship fact sheets, slide sets, and references.

http://www.cdc.gov/getsmart/healthcare/evidence.html

Antibiotic Stewardship Driver Diagram and Change Package http://



http://www.cdc.gov/getsmart/healthcare/pdfs/antibiotic_stewardship_change_package.pdf







The CDC and the Institute for Healthcare Improvement (IHI) partnered in an effort to develop this conceptual model of key drivers for reducing inappropriate antibiotic utilization.

www.cdc.gov/getsmart/healthcare/pdfs/antibiotic_stewardship_change_package.pdf

Evidence on Impact of Antibiotic Stewardship Programs (ASPs) – Current evidence on hospital antimicrobial stewardship objectives: A systematic review and meta-analysis. Lancet Infect Dis. 2016; S1473-3099(16):00065-7.

http://www.thelancet.com/journals/laninf/article/PIIS1473-3099(16)00065-7/abstract

Antibiotic Stewardship Driver DiagramAssists in understanding primary and secondary drivers to timely and appropriate antibiotic utilization.

http://www.cdc.gov/getsmart/healthcare/pdfs/antibiotic_stewardship_driver_diagram.pdf

Clinical and Economic Outcomes of a Prospective Antimicrobial Stewardship ProgramIn ASHP’s American Journal of Health-System Pharmacy, the authors found antimicrobial expenditures, which had increased by an average of 14.4 percent annually in the years preceding ASP implementation, decreased by 9.75 percent in the first year of the program and remained relatively stable in subsequent years, with overall cumulative cost savings estimated at $1.7 million. Rates of nosocomial infections involving Clostridium difficile, methicillin-resistant Staphylococcus aureus and vancomycin-resistant enterococci (VRE) all decreased after ASP implementation.

http://www.ahaphysicianforum.org/resources/appropriate-use/antimicrobial/content%20files%20pdf/ASHP-clinical-economic-outcomes.pdf

Antibiotic Resistance – The Global Threat http://www.cdc.gov/getsmart/week/downloads/antibiotic-resistance-the-global-threat.pdf

Antibiotic Rx in Hospitals: Proceed with CautionThis fact sheet from CDC illustrates how antibiotics save lives, but poor prescribing practices put patients at unnecessary risk for preventable allergic reactions, super-resistant infections and deadly diarrhea. Errors in prescribing decisions also contribute to antibiotic resistance, making these drugs less likely to work in the future.

http://www.ahaphysicianforum.org/resources/appropriate-use/antimicrobial/content%20files%20pdf/CDC-Infographic.pdf






http://www.cdc.gov/getsmart/week/downloads/antibiotic-resistance-the-global-threat.pdf














Preventing Unnecessary Harm From Antibiotics Change PacketThis change package is intended for hospitals participating in the Hospital Improvement Innovation Network (HIIN) project led by the Centers for Medicare and Medicaid Services (CMS) and Partnership for Patients (PFP). It is meant to be a tool to help you make patient care safer and improve care transitions.

http://www.hret-hiin.org/Resources/asp/17/antibiotic-stewardship-program-change-package.PDF

2013 Antibiotic Resistant Threat Report Many of the most urgent and serious antibiotic-resistant bacteria CDC warned of threaten patients while they are being treated in healthcare facilities for other conditions. Four Core Actions to Prevention Antibiotic Resistance is found on page 31.

http://www.cdc.gov/drugresistance/threat-report-2013/index.html

Engage the Senior Executive Module — Comprehensive Unit-based Safety Program (CUSP) Toolkit Tools focused on engaging and defining the roles and responsibilities of senior executives in a quality improvement initiative, from the Agency for Healthcare Research and Quality (AHRQ)

http://www.ahrq.gov/professionals/education/curriculum- tools/cusptoolkit/modules/engage/index.html

Stop the Line for Patient Safety InitiativeVideo describing an initiative that empowers staff to speak up if they see a risk to patient safety, from the U.S. Department of Veterans Affairs

http://www.qualityandsafety.va.gov/StoptheLine/StoptheLine. asp

CDI NHSN Targeted Assessment for Prevention (TAP) Report ToolLake Superior QIN step-by-step guide on how to run a TAP report in NHSN to determine how many less infections you need to reach your facilities goals.

https://www.lsqin.org/wp-content/uploads/2015/01/CDI-TAP-Report-Tool.pdf

New societal approaches to empowering antibiotic stewardshipJAMA. 2016; 315(12):1229-1230.

http://jama.jamanetwork.com/article.aspx?articleid=2498636

Anthem Quality-In-Sights®: Hospital Incentive Program (Q-HIP) https://www.anthem.com/provider/noapplication/f0/s0/t0/pw_b154968.pdf?refer=ahpprovider&state=nh

Seven ways to preserve the miracle of antibiotics Clin Infect Dis. 2013;56:(10)1445-1450

http://cid.oxfordjournals.org/content/56/10/1445





https://www.anthem.com/provider/noapplication/f0/s0/t0/pw_b154968.pdf?refer=ahpprovider&state=nh








http://www.qualityandsafety.va.gov/StoptheLine/StoptheLine.asp



http://www.ahrq.gov/professionals/education/curriculum-tools/cusptoolkit/modules/engage/index.html






Antibiotic Resistance Patient Safety Atlas – data on Antibiotic-Resistant Healthcare-Associated InfectionsThis Atlas presents antimicrobial resistance testing data from select healthcare-associated infections (CLABSI, CAUTI, and SSI) in U.S. hospitals. Data can be selected by state or region, phenotype, infection type, or year.

https://gis.cdc.gov/grasp/PSA/index.html

A Path to Better Antibiotic Stewardship in Inpatient Settings -10 case studies map how to improve antibiotic use in acute and long-term care facilitiesProvided by the PEW Charitable Trusts, this report highlights key findings.

http://www.pewtrusts.org/~/media/assets/2016/04/apathtobetterantibioticstewardshipininpatientsettings.pdf

Antimicrobial Stewardship StandardThe Joint Commission’s Medication Management (MM) standard applies to hospitals, critical access hospitals, and nursing care centers. Standard MM.09.01.01 addresses antimicrobial stewardship and became effective January 1, 2017.

https://www.jointcommission.org/assets/1/6/New_Antimicrobial_Stewardship_Standard.pdf

2017 Antibiotic Use In The United States Progress And OpportunitiesThe United States has made progress in understanding antibiotic prescribing and use in healthcare and in the community. But there are many opportunities to improve.

https://www.cdc.gov/antibiotic-use/stewardship-report/pdf/stewardship-report.pdf

Key Investments to Combat Antibiotic ResistanceCDC's strategic investments empower the nation to combat antibiotic resistance (AR), the global threat jeopardizing modern medicine. The Fiscal Year 2016 investments support comprehensive, coordinated, and ambitious public health action to meet national goals to prevent drug-resistant infections.

https://wwwn.cdc.gov/arinvestments/

30, 60, 90 Day Action Plan to Implement Antibiotic Stewardship in HospitalsProvided by Lake Superior Quality Innovation Network (Lake Superior QIN) and Wisconsin Hospital Association (WHA), this excel document provides a step-by-step activity by month to achieve all seven core elements and the Joint Commission Standard.

http://bit.ly/2aVkNTC

Hospital Documentation of Leadership SupportProvided by Lake Superior QIN and WHA, this word document can be used to document leadership support in the basic, intermediate, or advance levels.

http://bit.ly/2a2H5hX



Community Poster to Show Leadership Support Provided by Lake Superior QIN, this document can be downloaded in a variety of file types as needed, but indicates support by the system to use antibiotic only when necessary.

Word: http://bit.ly/2l8LfLxPDF: http://bit.ly/2lQ3MfmPowerPoint: https://www.lsqin.org/wp-content/uploads/2017/08/LakeSuperiorQIN_poster.pptx

Community Pharmacy Poster to Show Leadership Support Provided by Lake Superior QIN, this document indicates pharmacy support to use antibiotic only when necessary.

Word: https://www.lsqin.org/wp-content/uploads/2016/08/C310_poster_pharmacy_health_photo_smpix.docxPDF: https://www.lsqin.org/wp-content/uploads/2017/10/C310_poster_health_pharm_photo.pdf



General Infrastructure – Supporting SystemResource Website

National Quality Forum Antibiotic Stewardship PlaybookThe Playbook is designed to help hospitals and health systems strengthen existing antibiotic stewardship initiatives or create antibiotic stewardship programs from the ground up. This resource focuses on acute care.

http://www.qualityforum.org/WorkArea/linkit.aspx?LinkIdentifier=id&ItemID=82501

Antibiotic Stewardship Change PackageThe Centers for Disease Control and Prevention (CDC) and the Institute for Healthcare Improvement (IHI) partnered in an effort to develop this conceptual model of key drivers for reducing inappropriate antibiotic utilization.


Antibiotic Stewardship Driver DiagramAssists in understanding primary and secondary drivers to timely and appropriate antibiotic utilization.


Antibiotic Stewardship Statement for Antibiotic Guidelines – Recommendations of the Healthcare Infection Control Practices Advisory Committee (HICPAC)HICPAC is a federal advisory committee chartered to provide advice and guidance to the CDC and the Secretary of the Department of Health and Human Services (HHS) regarding the practice of infection control and strategies for surveillance, prevention and control of healthcare-associated infections, antimicrobial resistance and related events in United States healthcare settings. Dated September 21, 2017

https://www.cdc.gov/hicpac/pdf/Antibiotic-Stewardship-Statement.pdf

Antimicrobial Stewardship ToolkitBest practices from an Antimicrobial Stewardship Collaborative, from the Greater New York Hospital Association and the United Hospital Fund.

https://uhfnyc.org/assets/1042

Strategies to Assess Antibiotic use to Drive Improvements in HospitalsProvided by the CDC and the Pew Charitable Trusts, the suggestions outlined in this document are intended to help antibiotic stewardship programs in hospitals assess antibiotic use to see if there are opportunities for improvement.

https://www.cdc.gov/getsmart/healthcare/pdfs/strategies-to-assess-antibiotic-use-in-hospitals-508.pdf












CDC Core Elements of Hospital Antibiotic StewardshipLists practical ways to initiate or expand antibiotic stewardship activities in hospitals.

https://www.cdc.gov/antibiotic-use/healthcare/pdfs/core-elements.pdf

Implementation of Antibiotic Stewardship Core Elements at Small and Critical Access HospitalsLists practical ways to initiate or expand antibiotic stewardship activities in Critical Access hospitals.

https://www.cdc.gov/antibiotic-use/healthcare/pdfs/core-elements.pdf

Antimicrobial Stewardship Programs a Toolkit for Critical Access Hospitals in KansasThis toolkit follows the CDC’s Core Elements of Antimicrobial Stewardship and adapts these core elements to facilities in the state of Kansas, in particular the critical access hospitals and provides specific examples in order to better aid hospitals in the development and implementation of effective antimicrobial stewardship programs (ASP).

http://www.kdheks.gov/epi/download/KS_ABX_Stewardship_CAHs_Toolkit.pdf

Get Smart for Healthcare – Stewardship Program ExamplesLinks to hospital stewardship programs at various hospitals, success stories, and an interactive collection of charts and maps summarizing national and subnational data on antimicrobial use and resistance (Resistance Map), from CDC.

http://www.cdc.gov/getsmart/healthcare/programs.html

Get Smart for Healthcare – Implementation ResourcesResources to assist in the implementation of hospital antibiotic stewardship programs, including guidelines, assessment tools, conceptual models, and a sample inter-facility infection control transfer form, from CDC.

http://www.cdc.gov/getsmart/healthcare/implementation.htm l

Infectious Diseases Society of America and the Society for Healthcare Epidemiology of America Antimicrobial Stewardship: Implementation Tools & ResourcesThis section provides additional resources for individuals interested in antimicrobial stewardship programs, including materials and forms, U.S. academic medical centers online stewardship resources, international online stewardship resources and other resources.

http://www.shea-online.org/PriorityTopics/AntimicrobialStewardship/ImplementationToolsResources.aspx






http://www.cdc.gov/getsmart/healthcare/implementation.html





Infectious Diseases Society of America and the Society for Healthcare Epidemiology of America (SHEA) Guidelines for Developing an Institutional Program to Enhance Antimicrobial StewardshipThis document presents guidelines for developing institutional programs to enhance antimicrobial stewardship, an activity that includes appropriate selection, dosing, route, and duration of antimicrobial therapy. 2007

http://cid.oxfordjournals.org/content/44/2/159.short

Guidelines for Developing an Institutional Program to Enhance Antimicrobial StewardshipA joint SHEA/Infectious Diseases Society of America (IDSA) task force presents guidelines for developing institutional programs to enhance antimicrobial stewardship, an activity that includes appropriate selection, dosing, route, and duration of antimicrobial therapy. These guidelines, published in Clinical Infectious Diseases focus on the development of effective hospital-based stewardship programs and do not include specific outpatient recommendations.

http://www.ahaphysicianforum.org/resources/appropriate-use/antimicrobial/content%20files%20pdf/Guidelines-Institutional-Program.pdf

Implementing an Antibiotic Stewardship Program: Guidelines by the IDSA and SHEA, 2016Evidence-based guidelines for implementation and measurement of antibiotic stewardship interventions in inpatient populations including long-term care were prepared by a multidisciplinary expert panel.

http://cid.oxfordjournals.org/content/early/2016/04/11/cid.ciw118.full

Starting and Growing Your Antimicrobial Stewardship Program (ASP)Provided by Mount Sinai Hospital and University Health Network website and includes resources for sense of urgency through gather and analyzing data, create the guiding coalition, create and communicate the vision, empower and plan, and finally, consolidate and anchor.

http://www.antimicrobialstewardship.com/starting-and-growing-your-antimicrobial-stewardship-program-asp













Policy Statement on Antimicrobial Stewardship by SHEA, IDSA, and PIDSThis position statement recommends the mandatory implementation of antimicrobial stewardship throughout the health care continuum suggests process and outcome measures to monitor these interventions and addresses deficiencies in education and research in this field as well as the lack of accurate data on antimicrobial use in the United States.

http://www.ahaphysicianforum.org/resources/appropriate-use/antimicrobial/content%20files%20pdf/Policy%20Statement.pdf

Toolkit for Reduction of Clostridium difficile Infections Through Antimicrobial Stewardship: The Evaluation and Research on Antimicrobial Stewardship's Effect on Clostridium difficile (ERASE C. difficile) ProjectAn antimicrobial stewardship program (ASP) is a systematic approach to developing coordinated interventions to reduce overuse and inappropriate selection of antibiotics, and to achieve optimal outcomes for patients in cost-efficient ways. This toolkit assists hospital staff and leadership in developing an effective ASP with the potential to reduce C. difficile.

http://www.ahrq.gov/professionals/quality-patient-safety/patient-safety-resources/resources/cdifftoolkit/index.html



Infection Prevention + Antimicrobial Stewardship = SynergyIn the APIC quarterly member magazine, Prevention Strategist, Julia Moody, MS, SM (ASCP), shares a case study and explains the infection perfectionist’s and health care epidemiologist’s role in antimicrobial stewardship.

http://www.ahaphysicianforum.org/resources/appropriate-use/antimicrobial/content%20files%20pdf/APIC-synergy.pdf














Antimicrobial Stewardship: A Collaborative Partnership between Infection Preventionist and Health Care EpidemiologistsInfection preventionists and health care epidemiologists play key roles in promoting effective antimicrobial stewardship in collaboration with other health professionals, according to a joint position paper published by APIC and SHEA in their respective peer-review journals, the American Journal of Infection Control and Infection Control and Hospital Epidemiology.

http://www.ahaphysicianforum.org/resources/appropriate-use/antimicrobial/content%20files%20pdf/APIC_SHEA_Antimicrobial_Stewardship_Position_Statement.pdf

Antimicrobial Stewardship and Clostridium difficile Infection: A Primer for the Infection PreventionistThis chapter, in Guide to Preventing Clostridium difficile Infections (CDI), an APIC Implementation Guide, discusses antimicrobial use and its impact on patients in all healthcare settings and ASPs within the context of CDI.

http://www.ahaphysicianforum.org/resources/appropriate-use/antimicrobial/content%20files%20pdf/APIC%20implementation%20guide%20chapter%20re%20ASP.pdf

Antimicrobials and ResistanceThis chapter from the fourth edition of APIC Text of Infection Control and Epidemiology discusses that although infection prevention traditionally has approached the problem of resistance primarily from the aspect of preventing transmission, more needs to be done to control how antimicrobials are commonly used. Click on the blue bar that reads, ‘Download a free chapter of the APIC Text on “Antimicrobials and Resistance.”

http://apic.org/APICStore/Products/Product?id=SLSTXT14

CDC Core Elements of Outpatient Antibiotic StewardshipLists practical ways to initiate or expand antibiotic stewardship activities in the outpatient setting based upon best practice.

https://www.cdc.gov/mmwr/volumes/65/rr/rr6506a1.htm

A Path to Better Antibiotic Stewardship in Inpatient SettingsProvided by the Pew Charitable Trust, 10 case studies map how to improve antibiotic use in acute and long-term care facilities.

http://www.pewtrusts.org/en/research-and-analysis/reports/2016/04/a-path-to-better-antibiotic-stewardship-in-inpatient-settings
















Outpatient Setting ToolkitProvided by the Lake Superior QIN, this document contain examples on how outpatient locations can implement all four core elements with hyperlinks to resources.

http://bit.ly/2gYziq0

The Core Elements of Antibiotic Stewardship for Nursing Homes Adapts the CDC Core Elements of Hospital Antibiotic Stewardship into practical ways to initiate or expand antibiotic stewardship activities in nursing homes.

http://www.cdc.gov/longtermcare/prevention/antibiotic-stewardship.html

CDC Informatics: Antimitotic Stewardship in Nursing Homes http://www.cdc.gov/longtermcare/pdfs/infographic-antibiotic-stewardship-nursing-homes.pdf

CDC Leading Antibiotic Stewardship in Nursing Homes http://www.cdc.gov/longtermcare/pdfs/factsheet-core-elements-leading-antibiotic-stewardship.pdf

Creating a Culture to Improve Antibiotic Use in Nursing Homes http://www.cdc.gov/longtermcare/pdfs/factsheet-core-elements-creating-culture-improve-use.pdf

InfectionsAdvancing Excellence in America’s Nursing Homes with identify baseline, examine process, and monitor and sustain as three of the seven steps.

https://www.nhqualitycampaign.org/goalDetail.aspx?g=inf#tab2

Nursing Home Antimicrobial Stewardship Modules Includes four tested, evidence-based toolkits to help optimize antibiotic use in nursing homes. The modules are intended to assist nursing homes develop antimicrobial programs.

http://www.ahrq.gov/professionals/quality-patient-safety/patient-safety-resources/resources/nh-aspguide/index.html








http://www.cdc.gov/longtermcare/pdfs/factsheet-core-elements-creating-culture-improve-use.pdf



http://www.cdc.gov/longtermcare/pdfs/factsheet-core-elements-leading-antibiotic-stewardship.pdf



http://www.cdc.gov/longtermcare/pdfs/infographic-antibiotic-stewardship-nursing-homes.pdf





Policy/Procedure/ProtocolResource Website

Guidelines for the Prevention of Antimicrobial Resistance in HospitalsThis joint SHEA/IDSA task force publication details how antimicrobial resistance results in increased morbidity, mortality and costs of health care. Prevention of the emergence of resistance and the dissemination of resistant microorganisms will reduce these adverse effects and their attendant costs. Appropriate antimicrobial stewardship that includes optimal selection, dose and duration of treatment, as well as control of antibiotic use, will prevent or slow the emergence of resistance among microorganisms. A comprehensively applied infection control program will interdict the dissemination of resistant strains.

http://www.ahaphysicianforum.org/resources/appropriate-use/antimicrobial/content%20files%20pdf/SHEA-Prevention-Guideline-1997.pdf

The California Public Health Antimicrobial Stewardship Program InitiativeAntimicrobial stewardship programs aim to promote and measure use of the appropriate agent, dose, duration, and route of administration of antimicrobial agents, in order to improve patient outcomes while minimizing adverse events including toxicity.

https://www.cdph.ca.gov/Programs/CHCQ/HAI/Pages/CA_AntimicrobialStewardshipProgramInitiative.aspx



Get Smart for Healthcare – Implementation ResourcesResources to assist in the implementation of hospital antibiotic stewardship programs, including guidelines, assessment tools, conceptual models, and a sample inter-facility infection control transfer form, from CDC.

http://www.cdc.gov/getsmart/healthcare/implementation.htm l

Tools and Sample FormsThis resource, from SHEA's Antimicrobial Stewardship task force, includes tools such as an adult inpatient antibiotic approval form, a blank order set for antifungal therapy, a sample checklist, a drug use evaluation form and others.

https://www.shea-online.org/index.php/practice-resources/priority-topics/antimicrobial-stewardship/implementation-tools-resources











The Tool BookA handbook of drug dosing and usage guidelines that improve clinical care at Barnes-Jewish Hospital (BJH), Washington University Medical Center in St. Louis, Missouri, USA. This site is co-managed by the Department of Pharmacy at BJH and the Division of Infectious Diseases, Washington University School of Medicine.

http://bjhtoolbook.wustl.edu/

The Sanford Guide to Antimicrobial Therapy 2016Perryville, VA: Sanford Guide

http://www.sanfordguide.com/

Infectious Diseases Society of America Infections by organismIncludes bacteria (Lyme Disease, Clostridium difficile, MRSA, NTM, & TB), fungi (Aspergillus, Blastomycosis, Coccidioidomycosis, Cryptococcal Disease, Candidiasis, Histoplasmosis, Sporotrichosis), HIV/AIDS, parasites (Leishmaniasis, Cysticercosis), and viruses (HCV, HBV, Influenza).

http://www.idsociety.org/Organism/

University of California, San Francisco Medical Center GuidelinesPolicies and guidelines include antimicrobial stewardship, diagnostic testing and prevention and treatment of infections.

http://idmp.ucsf.edu/ucsf-medical-center-guidelines

Guidelines specific to each University of California, San Francisco (UCSF)-affiliated teaching hospitalIncludes UCSF Benioff Children’s Hospital, San Francisco General Hospital, and Veterans Affairs Medical Center San Francisco.

http://idmp.ucsf.edu/hospital-specific-guidelines

Stanford Medicine Antimicrobial GuidebookThis guide provides information on antimicrobial lock therapy, intravenous to oral therapeutic interchange protocol, five clinical pathway treatment guidelines, surgical prophylaxis, and a Polymyxin B and Colistin tip sheet.

http://med.stanford.edu/bugsanddrugs/guidebook.html

John Hopkins Antimicrobial Stewardship ProgramThis guide was first created in 2001 and is updated annually.

http://www.hopkinsmedicine.org/AMP

University of California, San Francisco Medical Center Guidelines for Empiric Antimicrobial Therapy for Hospitalized PatientsIncludes additional links to bone and joint infections; central nervous system infections; endocarditis; gastrointestinal infections; gynecologic infections; head and neck infections; intravascular catheter-related infections; respiratory tract infections; severe sepsis with unknown source, skin, and soft tissue infections; and urinary tract infections.

http://idmp.ucsf.edu/guidelines-empiric-therapy-hospitalized-adults





http://www.hopkinsmedicine.org/AMP







http://www.idsociety.org/Organism/

http://www.sanfordguide.com/

http://bjhtoolbook.wustl.edu/

University of Kentucky Polices and GuidelinesIncludes links for empiric treatment of adults with suspected bacterial meningitis, empiric use of antifungal therapy in critically ill adults, measuring voriconazole concentrations, perioperative antimicrobial prophylaxis, treatment of adults with complicated intra-abdominal infections, treatment of patients with neutropenia and fever, and use of antifungal agents in adult hematopoietic stem cell transplant and leukemia patients.

http://www.hosp.uky.edu/pharmacy/amt/UKGuide.html

University of Wisconsin Health Antimicrobial Stewardship Drug Specific InformationIncludes Amphotericin, Daptomycin, Linezolid, Vancomycin, Antibiotic Lock Solution Guideline, Restricted Antimicrobial List, and Antiviral Drugs for Viruses other than HIV.

http://www.uwhealth.org/antimicrobial-stewardship/drug-specific/36432

Implementation resources Centers for Disease Control (CDC) Assessment tools for antibiotic use


The critical role of the staff nurse in antimicrobial stewardship – Unrecognized, but Already ThereClin Infect Dis. 2016;62(1):84-8


Antibiotic Stewardship for Staff Nurses - Five Key Ways You can Influence Antibiotic UseAmerican Nurse Today May 2016;11 (5);12-14

https://americannursetoday.com/wp-content/uploads/2016/05/ant5-Antibiotics-420.pdf

Redefining the Antibiotic Stewardship Team: Recommendations from the American Nurses Association/Centers for Disease Control and Prevention Workgroup on the Role of Registered Nurses in Hospital Antibiotic Stewardship PracticesThe purpose of this American Nurses Association (ANA)/Centers for Disease Control and Prevention (CDC) White Paper is to inform registered nurses in the United States about the problem of antibiotic resistance and facilitate their embracing an expanded and clearly recognized role in hospital antibiotic stewardship programs (ASPs) and activities.

http://www.nursingworld.org/ana-cdc-antibioticstewardship-whitepaper

The 5Ds—Diagnosis/Indication; Drug; Dose; Duration; and De-escalation + Door for Choosing the Best Setting of Care ASP documentationSouthwest Memorial Hospital Stewardship Committee Houston, TX: Southwest Memorial Hospital; 2016.















Successful ASP Actions: Antibiotic Time-Out, Essential Elements and Development Webinar and slide deck by Partnership for Quality Care (PQC).

http://pqc-usa.org/timeout/

Taking an Antibiotic TimeoutThis video highlights three steps to take towards Antibiotic Stewardship and is presented by Dr. Arjun Srinivasan of the CDC.

http://www.medscape.com/viewarticle/731784

Antibiotic self-stewardship: trainee-led structured antibiotic time-outs to improve antimicrobial useAnn Intern Med. 2014; 161(10 Suppl): S53-S58.

http://annals.org/article.aspx?articleid=1935743

Evaluation and Diagnosis of Penicillin Allergy for Healthcare ProfessionalsCDC: Before prescribing broad-spectrum antibiotics to a patient thought to be penicillin-allergic, evaluate the patient for true penicillin allergy (IgE-mediated) by conducting a history and physical, and, when appropriate, a skin test and challenge dose.

https://www.cdc.gov/antibiotic-use/community/for-hcp/Penicillin-Allergy.html

Wake Forest Baptist Medical Center Disease State Treatment Guidelines for AdultsProvides antimicrobial treatment guidelines for adults with various infectious diseases including Community Acquired Pneumonia Guidelines, Hospital Acquired Pneumonia Guidelines, Emergency Department Healthcare Associated Pneumonia (HCAP) Guide, Empiric Antibiotics for Sepsis, Guidelines for Interpreting Procalcitonin, Empiric Antibiotics for Infections (not sepsis), Neutropenic Fever Guidelines, Clostridium difficile-Associated Colitis Diagnosis and Management, C difficile Testing Algorithm, Treatment of Pyelonephritis for Patients with Severe Penicillin Allergy, and Procalcitonin to Guide Antibiotics - Cardiology Patients.

http://www.wakehealth.edu/School/CAUSE/Disease-State-Treatment-Guidelines.htm

Pediatric Stewardship ResourcesResources are available from SHEA that are specific to pediatric antimicrobial stewardship.

https://www.shea-online.org/index.php/practice-resources/priority-topics/antimicrobial-stewardship/pediatric-stewardship-resources

















UCSF Benioff Children’s Hospital San Francisco: 2016 Empiric Antimicrobial Therapy GuidelinesThese guidelines were developed to inform initial selection of empiric antimicrobial therapy for children at UCSF Benioff Children's Hospital San Francisco and affiliated outpatient sites. The guidelines were developed by the Pediatric Antimicrobial Stewardship Program in collaboration with multiple clinical groups. They represent consensus based on evidence-based guidelines and local microbiology and susceptibility patterns.

http://idmp.ucsf.edu/ucsf-benioff-childrens-hospital-san-francisco-empiric-antimicrobial-therapy-guidelines

Clinical practice guidelines for Clostridium difficile infection in adults: 2010 update by the society for healthcare epidemiology of America (SHEA) and the infectious diseases society of America (IDSA).

https://www.ncbi.nlm.nih.gov/pubmed/20307191

Multidrug-Resistant Organism & Clostridium difficile Infection moduleCDC Atlanta, GA: 2016

http://www.cdc.gov/nhsn/PDFs/pscManual/12pscMDRO_CDADcurrent.pdf

Practice guidelines for the management of infectious diarrheaClin Infect Dis. 2001 Feb 1; 32(3):331-51. Epub 2001 Jan 30.


Clinical Practice Guideline for the Management of Candidiasis: 2016 Update by the Infectious Diseases Society of AmericaClin Infect Dis. 2016;62(4): e1-e50

http://cid.oxfordjournals.org/content/62/4/e1

International clinical practice guidelines for the treatment of acute uncomplicated cystitis and pyelonephritis in women: A 2010 update by the Infectious Diseases Society of America and the European Society for Microbiology and Infectious Diseases.Clin Infect Dis. 2011 Mar 1; 52(5):e103-20. Doi: 10.1093/cid/ciq257.


Infective endocarditis: diagnosis, antimicrobial therapy, and management of complications: a statement for healthcare professionals from the Committee on Rheumatic Fever, Endocarditis, and Kawasaki Disease, Council on Cardiovascular Disease in the Young, and the Councils on Clinical Cardiology, Stroke, and Cardiovascular Surgery and Anesthesia, American Heart Association: endorsed by the Infectious Diseases Society of America.




















Clinical practice guideline for the use of antimicrobial agents in neutropenic patients with cancer: 2010 update by the Infectious Diseases Society of America.


Guidelines for evaluation of new fever in critically ill adult patients: 2008 update from the American College of Critical Care Medicine and the Infectious Diseases Society of America.Crit Care Med. 2008 Apr; 36(4):1330-49. doi: 10.1097/CCM.0b013e318169eda9


Clinical practice guidelines by the Infectious Diseases Society of America for the treatment of methicillin-resistant Staphylococcus aureus infections in adults and children.Clin Infect Dis. 2011 Feb 1; 52(3):e18-55. doi: 10.1093/cid/ciq146. Epub 2011 Jan 4


Treatment of complicated skin and soft tissue infections.Surg Infect (Larchmt). 2009 Oct; 10(5):467-99. doi: 10.1089/sur.2009.012.


Practice guidelines for the diagnosis and management of skin and soft-tissue infections.Clin Infect Dis. 2005 Nov 15; 41(10):1373-406. Epub 2005 Oct 14.


Diagnosis and treatment of diabetic foot infections.Clin Infect Dis. 2004 Oct 1; 39(7):885-910. Epub 2004 Sep 10.


Infectious Diseases Society of America guidelines for the diagnosis and treatment of asymptomatic bacteriuria in adults.Clin Infect Dis. 2005 Mar 1; 40(5):643-54. Epub 2005 Feb 4.


Appropriate Antibiotic Use for Acute Respiratory Tract Infection in Adults: Advice for High-Value Care From the American College of Physicians and the Centers for Disease Control and PreventionAcute respiratory tract infection (ARTI) is the most common reason for antibiotic prescription in adults. Antibiotics are often inappropriately prescribed for patients with ARTI. This article presents best practices for antibiotic use in healthy adults (those without chronic lung disease or immunocompromising conditions) presenting with ARTI.

http://annals.org/aim/article/2481815/appropriate-antibiotic-use-acute-respiratory-tract-infection-adults-advice-high

Guidelines for the management of adults with hospital-acquired, ventilator-associated, and healthcare-associated pneumonia.Am J Respir Crit Care Med. 2005 Feb 15; 171(4):388-416.























Surviving Sepsis Campaign Resources http://www.survivingsepsis.org/guidelines/Pages/default.aspx

Diagnosis, prevention, and treatment of catheter-associated urinary tract infection in adults: 2009 International Clinical Practice Guidelines from the Infectious Diseases Society of America.Clin Infect Dis. 2010 Mar 1; 50(5):625-63.


Systematic Reviews in Outpatient Locations CDC provides a collection of systematic reviews that have examined the most effective interventions to improve antibiotic prescribing for outpatients.

https://www.cdc.gov/antibiotic-use/community/improving-prescribing/evidence/systematic-reviews.html

Systematic Reviews in Outpatient Locations - CommitmentCDC provides a collection of systematic reviews that have examined the most effective interventions to improve antibiotic prescribing for outpatients.

https://www.cdc.gov/antibiotic-use/community/improving-prescribing/evidence/commitment.html

Systematic Reviews in Outpatient Locations - ActionCDC provides a collection of systematic reviews that have examined the most effective interventions to improve antibiotic prescribing for outpatients.

https://www.cdc.gov/antibiotic-use/community/improving-prescribing/evidence/dataforactionaction.html

Systematic Reviews in Outpatient Locations – Tracking and ReportingCDC provides a collection of systematic reviews that have examined the most effective interventions to improve antibiotic prescribing for outpatients.

https://www.cdc.gov/antibiotic-use/community/improving-prescribing/evidence/trackingandreporting.html

Systematic Reviews in Outpatient Locations – EducationCDC provides a collection of systematic reviews that have examined the most effective interventions to improve antibiotic prescribing for outpatients.

https://www.cdc.gov/antibiotic-use/community/improving-prescribing/evidence/education.html

Model Stop the Line PolicySample policy giving all hospital personnel the responsibility and authority to intervene to prevent a patient safety event, from the Minnesota Hospital Association.

http://www.mnhospitals.org/Portals/0/documents/ptsafety/ti meout/stop- the-line-policy.doc

Clinical practice guidelines for the diagnosis and management of intravascular catheter-related infection: 2009 Update by the Infectious Diseases Society of America.


Antimicrobial Prophylaxis for Surgery (IDSA/SCIP guidelines) Clin Infect Dis. 1994; 18:422-427











http://www.mnhospitals.org/Portals/0/documents/ptsafety/timeout/stop-the-line-policy.doc






http://www.survivingsepsis.org/guidelines/Pages/default.aspx


Clinical Practice Guidelines for Antimicrobial Prophylaxis in SurgeryAuthored by ASHP, IDSA, the Surgical Infection Society (SIS) and SHEA these guidelines are intended to provide practitioners with a standardized approach to the rational, safe and effective use of antimicrobial agents for the prevention of surgical-site infections based on currently available clinical evidence and emerging issues.

http://www.ahaphysicianforum.org/resources/appropriate-use/antimicrobial/content%20files%20pdf/SHEA-Clinical-Guidelines.pdf

American Society of Health-System Pharmacists ASHP therapeutic guidelines on antimicrobial prophylaxis in surgeryAm J Health-Syst Pharm. 1999;56:1839-88


University of Wisconsin Health Surgical Prophylaxis Guidelines - Appendix B of Antimicrobial Use Guidelines

http://www.uwhealth.org/files/uwhealth/docs/antimicrobial/Appx_B-_Surgical_Prophylaxis_Guidelines_.pdf

University of Miami Health System Antimicrobial Surgical Prophylaxis ProtocolsAntimicrobial surgical prophylaxis general and solid organ transplant and LVADs is shared.

http://www.ugotabug.med.miami.edu/documents/UMHSurgicalProphylaxis.pdf

Diagnosis and management of complicated intra-abdominal infection in adults and children: guidelines by the Surgical Infection Society and the Infectious Diseases Society of AmericaClin Infect Dis. 2010;50(2):133-16


Infectious Diseases Society of America Infections by Antimicrobial Agent UseIncludes antimicrobial prophylaxis for surgery, antimicrobial stewardship, combat-related infections, neutropenic patients with cancer, outpatient parenteral anti-infective therapy (OPAT) and vancomycin.

https://www.idsociety.org/Antimicrobial_Agents/

Cleveland Clinic Guidelines for Antimicrobial UsageThis PDF file has bookmarks for gram stain morphology of selected organisms, key characteristics of selected organisms, usual acid-fast bacillus characteristics, mechanism of action of common antibacterial agents, nine different treatment guidelines, guide to dosing adults, antivirals, dosing guidelines, antimicrobial interactions, and five prophylactic dosing recommendations.

http://www.clevelandclinicmeded.com/medicalpubs/antimicrobial-guidelines/


















University of California, San Francisco Medical Center Guidelines for DosingIncludes access to adults not receiving hemodialysis, adults receiving hemodialysis, aminoglycoside dosing and monitoring recommendations for adults, dosing in pediatric patients, and dosing in neonates.

http://idmp.ucsf.edu/antimicrobial-dosing-guidelines

Antibiotic dosing in critical illnessJ Antimicrob Chemother. 2011 Apr; 66 Suppl 2:ii25-31. doi: 10.1093/jac/dkq516.


Wake Forest Baptist Medical Center Antimicrobial Dosing GuidelinesProvide antimicrobial dosing recommendations for adults in the areas of Antimicrobial, Vancomycin, Gentamicin and Tobramycin, Amikacin dosing as well as Monitoring Guideline for Adults being treated with Aminoglycoside or Vancomycin.

http://www.wakehealth.edu/School/CAUSE/Antimicrobial-Dosing-Guidelines.htm

Stanford Medicine Dosing GuidesThis webpage provides information on dosing guides including renal, vancomycin (including loading dose), and aminoglycoside. In addition, extended infusion protocols are included for piperacillin-tazobactam, cefepime, meropenem, and extended infusion beta-lactam dosing timetables.

http://med.stanford.edu/bugsanddrugs/dosing-protocols.html

Nebraska Dosing ProtocolsLinks include alternative dosing protocol justification and education, antimicrobial desensitization, Colistin, dosing rounding policy, and renal dosing adjustment protocol for antimicrobials.

https://www.nebraskamed.com/for-providers/asp/dosing-protocols












Wake Forest Baptist Medical Center Prior Authorization of Restricted AntimicrobialsDescribes process for obtaining authorization by one of two methods as well as lists medication which require authorization including Acyclovir Intravenous (Zovirax), Amphotericin B Lipid Complex (ABLC, Abelcet), Aztreonam (Azactam), Ceftaroline (Teflaro), Ceftazidime (Fortaz), Ceftazidime/avibactam (Avycaz), Ceftolozane/tazobactam (Zerbaxa), Colistin, Colistimethate (Colymycin), Dalbavancin (Dalvance), Daptomycin (Cubicin), Ertapenem (Invanz), Fidaxomicin (Dificid), Imipenem (Primaxin), Isavuconazonium (Cresemba), Linezolid (Zyvox), Meropenem (Merrem), Micafungin (Mycamine), Peramivir (Rapivab), Posaconazole (Noxafil), Ribavirin inhaled, Quinupristin/Dalfopristin (Synercid), Tigecycline (Tygacil), and Voriconazole (Vfend).Notable drugs not on formulary include: Tedizolid (Sivextro), Doripenem (Doribax), Telavancin (Vibativ), Oritavancin (Orbactiv), Liposomal Amphotericin B (Ambisome), Amphotericin B Colloidal Dispersion (Amphotec).

http://www.wakehealth.edu/School/CAUSE/Prior-Authorization.htm

Nebraska Medicine Antimicrobial RestrictionsAnti-infective restriction process and use criteria summary for Ceftolozane/tazobactam, Colistin, Cytomegalovirus immune globulin, Daptomycin, Fosfomycin, Peramivir, Posaconazole, Tigecycline, and Oral Ribavirin for Respiratory Syncytial Virus (RSV).

http://www.nebraskamed.com/careers/education-programs/asp/restrictions

University of Kentucky Restricted Antimicrobial AgentsIncludes links to Amphotericin B Lipid Complex (Abelcet®), Itraconazole IV Daptomycin (Cubicin®), Itraconazole IV (Sporanox®), Linezolid (Zyvox®), Meropenem (Merrem®), Meropenem (Mycamine®), Quinupristin/Dalfopristin (Synercid®), Valganciclovir Ticarcillin/Clavulanate (Timentin®), Valganciclovir Tigecycline (Tygacil®), Valganciclovir (Valcyte®), Vancomycin, Voriconazole (VFend®) and Restricted Antimicrobial Ordering Process.

http://www.hosp.uky.edu/pharmacy/amt/RestrictedAgents.html

University of Miami Health System Antibiotic Desensitization ProtocolsIncludes following antibiotics: Azithromycin, Meropenem, Penicillin G, Piperacillin-tazobactam, Oral Bactrim and Cefoxitin.

http://www.ugotabug.med.miami.edu/umh-antimicrobial-stewardship-program/um-asp-policies-protocols










University of Miami Health System Adult Ethanol lock ordersWritten in checklist format, includes indication, catheter type, number of lumens, compatibility check, flush with normal saline prior to instillation, frequency, label, and dwell time.

http://www.ugotabug.med.miami.edu/documents/C-290ZjEthanolLockOrders2012.pdf

Telemedicine based antimicrobial stewardship program improves prescribing, reduces bacterial Resistance at a Rural Hospital Agency for Healthcare Research and Quality (AHRQ) Innovations Exchange

https://innovations.ahrq.gov/profiles/telemedicine-based-antimicrobial-stewardship-program-improves-prescribing-reduces-bacterial

University of Miami Health System Suggested Weekly Lab Parameters for Outpatient Parenteral and Oral Antimicrobial TherapyBased upon Clin Infect Dis. 2004; 38:1661

http://www.ugotabug.med.miami.edu/documents/OPATmonitoring.pdf

Outpatient Pediatric Treatment RecommendationsA table summarizes the most recent recommendations including epidemiology, diagnosis and management including appropriate antibiotic prescribing for pediatric patients in an outpatient setting including acute sinusitis, acute otitis media, pharyngitis, common cold or non-specific upper respiratory tract infection, bronchiolitis and urinary tract infections.

https://www.cdc.gov/antibiotic-use/community/for-hcp/outpatient-hcp/pediatric-treatment-rec.html

Outpatient Adult Treatment RecommendationsA table summarizes the most recent recommendations including epidemiology, diagnosis and management including appropriate antibiotic prescribing for adults seeking care in an outpatient setting for acute rhinosinusitis, acute uncomplicated bronchitis, common cold or non-specific upper respiratory tract infection, pharyngitis and acute uncomplicated cystitis.

https://www.cdc.gov/antibiotic-use/community/for-hcp/outpatient-hcp/adult-treatment-rec.html

University of California, San Francisco Guideline for Empiric Therapy: Adult OutpatientsIncludes guidelines for gastrointestinal infections, head and neck infections, respiratory tract infections, respiratory tract infections, skin and soft-tissue infections, urinary tract infections and urogenital infections.

http://idmp.ucsf.edu/guidelines-empiric-therapy-adult-outpatients














Viral Prescription PadAllows providers and pharmacists to check off diagnosis, explains why an antibiotic is not useful, general instruction to release signs and symptoms, and area to add OTC medications, and follow up plan.

English: https://www.cdc.gov/getsmart/community/materials-references/print-materials/hcp/viral-rx-pad-color.pdfSpanish:https://www.cdc.gov/getsmart/community/materials-references/print-materials/hcp/viral-rx-pad-color-sp.pdf

Not Just A Maid ServiceVideo describing how two hospitals engaged their environmental service workers to decrease transmission of CDI, from the Illinois Department of Public Health.

http://www.youtube.com/notjustamaidservice

CDC Options for Evaluating Environmental CleaningAll hospitals that have successfully achieved a Level I program should advance to Level II if continued high rates.

http://www.cdc.gov/HAI/pdfs/toolkits/Environ-Cleaning-Eval-Toolkit12-2-2010.pdf

The Guidelines for Environmental Infection Control in Health-Care Facilities, 2003This guideline is a compilation of recommendations for the prevention and control of infectious diseases that are associated with healthcare environments.

http://www.cdc.gov/hicpac/pdf/guidelines/eic_in_HCF_03.pdf

Inter-facility Infection Prevention Transfer ToolSample form for communication of infectious disease status, including CDI, during transitions of care, from the Arizona Department of Health Services.

http://www.azdhs.gov/documents/preparedness/epidemiology-disease-control/healthcare-associated-infection/cdiff-prevention-toolkit.pdf

Inter-facility Infection Control Transfer FormSample form to assist in fostering communication of infectious disease status during transitions of care, from CDC and the Utah Department of Health.

http://www.cdc.gov/hai/pdfs/toolkits/InfectionControlTransfe rFormExample1.pdf

Inter-facility Infection Prevention Transfer FormSample form for communication of infectious disease status, including CDI, during transitions of care, from the Cook County Department of Public Health in Illinois.

http://www.cookcountypublichealth.org/files/pdf/facility- transfer-form.pdf



http://www.cookcountypublichealth.org/files/pdf/facility-transfer-form.pdf




http://www.cdc.gov/hai/pdfs/toolkits/InfectionControlTransferFormExample1.pdf








https://www.cdc.gov/getsmart/community/materials-references/print-materials/hcp/viral-rx-pad-color.pdf



Nebraska Medicine Mobile AppThe Antimicrobial Stewardship Program at Nebraska Medicine has created a mobile app that puts the program’s clinical guidelines, protocols and dosing adjustments for antimicrobial use into a clinician's hands.

http://www.nebraskamed.com/careers/education-programs/asp/asp-app

Centers for Medicare and Medicaid Services (CMS) Hospital Infection Control WorksheetProvided by CMS, provides a list of items that must be assessed during the onsite survey, in order to determine compliance with the Infection Control Condition of Participation including antibiotic stewardship.

https://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/SurveyCertificationGenInfo/Downloads/Survey-and-Cert-Letter-15-12-Attachment-1.pdf

Infection Control Assessment and Response (ICAR)ICAR was developed by CDC for awardees under the Epidemiology and Laboratory Capacity (ELC) ICAR Program to assist health departments in assessing infection prevention practices and guide quality improvement activities (e.g., by addressing identified gaps). These tools may also be used by healthcare facilities to conduct internal quality improvement audits.

https://www.cdc.gov/hai/prevent/infection-control-assessment-tools.html

Antimicrobial Management Program Gap Analysis ChecklistProvided by the CDC.

https://www.cdc.gov/getsmart/healthcare/improve-efforts/resources/pdf/AMP-GapAnalysisChecklist.pdf

Hospital Antibiotic Stewardship Assessment ToolProvided by Lake Superior QIN and WHA, this excel document allows a hospital to conduct a gap analysis in comparison to best practice in order to make improvements. The first tab is instructions, the second tab is the assessment, and the third tab is the results of the assessment.

http://bit.ly/1r5bjbp






EducationResource Website

Stanford Medicine Educational CenterThe subjects include antimicrobial stewardship: optimization of antibiotic practices (six-hour course) and optimizing antimicrobial therapy with timeouts (two-hour course).

http://med.stanford.edu/bugsanddrugs/education.html

Center for Infectious Disease Research and Policy Antibiotic Stewardship ProgramListen to Dr. Fleming-Dutra on this Podcast (21.36 minutes) discuss her work to improve antimicrobial prescribing practices within the ambulatory care setting.

http://www.cidrap.umn.edu/asp/meet-the-experts/asp-podcast-dec-19-2016

Antimicrobial Stewardship: Optimization of Antibiotic Practices Stanford Medicine Online Continuing Medical Education (CME) Online CME Course.

https://online.stanford.edu/course/antimicrobial-stewardship-optimization-antibiotic-practices

American Society of Health-System Pharmacists (ASHP) Resources and virtual posters (online videos).

http://www.leadstewardship.org/vp

Get Smart: Know When Antibiotics WorkHere is an introductory slide set that lays out the case for antibiotic stewardship interventions.

https://www.cdc.gov/getsmart/healthcare/pdfs/getsmart-healthcare.pdf

CDC Commentary: Three Steps to Antibiotic StewardshipWatch this video (4.56 minutes) which Arjun Srinivasan describe three simple things you can do to improve antibiotic use in hospitals and long-term care facilities.

http://www.medscape.com/viewarticle/731784?src=par_cdc_stm_mscpedt&faf=1

The Evolution of Bacteria on a “Mega-Plate” Petri Dish (Kishony Lab)In this video (1.54 minutes) scientists from the Kishony Lab at HMS and Technion have designed a simple way to observe how bacteria move as they become impervious to drugs. It allows the viewer to see how bacteria which develops resistance appears even when they encounter higher doses of antibiotic and still survive and thrive.

https://youtu.be/plVk4NVIUh8



https://youtu.be/plVk4NVIUh8







http://www.leadstewardship.org/vp






Antimicrobial Stewardship Training ProgramsBasic Program: Designed to teach the basic skills and provide an overview of Antimicrobial Stewardship practice needed to develop an Antimicrobial Stewardship Program. Advanced Program: Designed to meet the needs of pharmacists, physicians and other providers that have some antimicrobial stewardship experience and/or basic skills in this area. CPE and CME credit for didactic portion provided by MAD-ID and NFID, respectively.

http://mad-id.org/antimicrobial-stewardship-programs/

Society of Infectious Disease Pharmacists (SIDP)Antimicrobial stewardship - A certificate program for pharmacists

http://www.sidp.org/page-1442823

Guidance for the knowledge and skills required for antimicrobial stewardship leadersInfect Control Hosp Epidemiol. 2014;35(12):1444-1451

http://www.jstor.org/stable/10.1086/678592

Get smart about antibiotics: an antibiotic stewardship curriculum for medical studentsWake Forest School of Medicine

http://www.wakehealth.edu/AS-Curriculum/

Save Money with Antibiotic Stewardship http://www.cdc.gov/getsmart/week/downloads/gsw-factsheet-cost.pdf

Resistance Anywhere is Resistance Everywhere http://www.cdc.gov/getsmart/week/downloads/gsw-factsheet-global.pdf

Educating Patients About Antibiotic UseThis video (7.17 minutes) provided by New York State Department of Health and features discussions between health care providers and patients on antibiotic resistance and the prudent use of antibiotics.

https://youtu.be/YHYmb2OKoMU



https://youtu.be/YHYmb2OKoMU

http://www.cdc.gov/getsmart/week/downloads/gsw-factsheet-global.pdf

http://www.cdc.gov/getsmart/week/downloads/gsw-factsheet-global.pdf

http://www.cdc.gov/getsmart/week/downloads/gsw-factsheet-cost.pdf

http://www.cdc.gov/getsmart/week/downloads/gsw-factsheet-cost.pdf





http://www.sidp.org/page-1442823



Nebraska Medicine: Five part series on Antimicrobial Stewardship in Long-term Care Facilities• Antimicrobial Stewardship and Long-term Care Facilities: Introduction - Video 1 (11

min.)• What is Antimicrobial Stewardship - Video 2 (10 minutes)• Antimicrobial Stewardship in Long-term Care Facilities - Video 3 (10 min.)• Stewardship Interventions in Long-term Care Facilities - Video 4 (16 min.)• Interpreting Clinical Microbiology Reports - Video 5 (15 min.)

http://www.nebraskamed.com/careers/education-programs/asp



Preserve the Power of Antibiotics – For Providers http://www.cdc.gov/getsmart/week/downloads/gsw-factsheet-providers.pdf

CDC Glossary for Antibiotic or Antimicrobial Stewardship https://www.cdc.gov/antibiotic-use/community/about/glossary.html

Community Antibiotic QuizCDC interactive quiz includes eight questions with rational in scoring.

https://www.cdc.gov/antibiotic-use/community/about/quiz.html

Antibiotics: Pharmacists Can Make the DifferenceIn this podcast, a pharmacist counsels a frustrated father about appropriate antibiotic use and symptomatic relief options for his son’s cold.

https://www2c.cdc.gov/podcasts/player.asp?f=14198

ASHP Guidelines on Pharmacist-Conducted Patient Education and CounselingA coordinated effort among health care team members will enhance patients’ adherence to pharmacotherapeutic regimens, monitoring of drug effects, and feedback to the health system. ASHP believes this patient education and counseling guidelines are applicable in all practice settings—including acute inpatient care, ambulatory care, home care and long-term care—whether these settings are associated with integrated health systems, managed care organizations or are freestanding.

http://www.ahaphysicianforum.org/resources/appropriate-use/antimicrobial/content%20files%20pdf/ASHP-pharmacist-patient-education.pdf








https://www.cdc.gov/antibiotic-use/community/about/glossary.html

https://www.cdc.gov/antibiotic-use/community/about/glossary.html

http://www.cdc.gov/getsmart/week/downloads/gsw-factsheet-providers.pdf







Get Smart: Know When Antibiotics Work – Print Materials for Healthcare ProfessionalsThese print materials focus on when it is and is not appropriate to prescribe antibiotics and explain why antibiotic resistance is one of the world's most pressing public health problems. Antibiotic Stewardship Commitment posters as written public commitments in support

of antibiotic stewardship that are placed in examination rooms have been shown to reduce inappropriate antibiotic prescriptions. These posters can also facilitate patient communication about appropriate antibiotic use. We encourage you to add your healthcare facility logo, healthcare professional photo or signature to any of these posters. Print the posters via your office printers, or send to a professional printer, and post in patient examination rooms. Posters can be printed in color or black and white.

Checklist for Antibiotic Prescribing in Dentistry Is it Really a Penicillin Allergy Save Money with Antibiotic Stewardship Preserve the Power of Antibiotics- For Providers Antibiotics Aren’t Always the Answer – For Parents Antibiotic Resistance – The Global Threat Resistance Anywhere is Resistance Everywhere Prescription Pads include: o Taking Your Antibiotics Appropriatelyo Symptomatic Relief for Viral Illnesso What is Delayed Prescribing?o What is Watchful Waiting?

Return to Day Care sample letter

https://www.cdc.gov/getsmart/community/materials-references/print-materials/hcp/index.html

Bob Has a Respiratory Infection VideoTarget Audience: Clinicians This video (2:15 minutes) posted by Global Respiratory Infection Partnership demonstrates how clinicians can work with patients when they request antibiotics.

https://youtu.be/72jPQhoQ05Y



https://youtu.be/72jPQhoQ05Y




CDC Commentary: Antibiotic Stewardship in the Outpatient SettingTarget Audience: CliniciansThis video (5:54 minutes) provides an overview of CDC’s latest resource to support antibiotic stewardship in the outpatient setting: the Core Elements of Outpatient Antibiotic Stewardship.


CDC Commentary: Antibiotics for Acute Otitis Media in ChildrenTarget Audience: Pediatricians and clinicians who care for childrenThis video (5:35 minutes) shared the principles of judicious antibiotic prescribing related to AAP’s clinical practice guidelines for the diagnosis and management of acute otitis media.


CDC Commentary: Don’t Give In and Give Those Antibiotics!Target Audience: CliniciansThis video (3:45 minutes) provides tips on how to communicate with patients about appropriate antibiotic prescribing for upper respiratory infections.


Get Smart: Know When Antibiotics WorkThese print materials focus on the issue of antibiotic resistance, as well as the importance of prescribing and using antibiotics wisely.

http://www.cdc.gov/getsmart/community/materials-references/print-materials/index.html

Choosing Wisely. Antibiotics: Will They Help or Hurt You? New York NY: Consumer Reports; 2015

http://consumerhealthchoices.org/wp-content/uploads/2015/02/3AntibioticsTri-Fold_DownloadGenericFINAL.pdf

Choosing Wisely. Antibiotics: When you need them – and when you don’t. New York, NY: Consumer Reports Health; 2014

http://consumerhealthchoices.org/wp-content/uploads/2014/02/ChoosingWiselyAntibioticsRoundup.pdf

Choosing Wisely. Antibiotic treatment in the hospital: sometimes it can be stopped. New York, NY: Consumer Reports Health; 2016

http://consumerhealthchoices.org/wp-content/uploads/2016/02/ChoosingWiselyAntibioticsHospitalSHEA-ER.pdf
























Speak Up: Antibiotics - Know the FactsTaking an antibiotic when you shouldn’t kills good bacteria in your body, which can cause you more problems, and your body can become resistant to antibiotics. This short video highlights why an antibiotic is not always needed.

https://www.jointcommission.org/topics/speakup_antibiotics.aspx

Speak Up: Antibiotics InfographicThe Joint Commission provides a ready to print educational aid for patients to increase their understanding of why antibiotic are not always needed.

https://www.jointcommission.org/assets/1/6/Speak_Up_infographic_Antibiotics_2017.pdf

Antibiotics Aren’t Always the AnswerThis fact sheet from the CDC briefly explains six simple facts about antibiotic use and when they can help treat your child’s illness.

https://www.cdc.gov/antibiotic-use/community/pdfs/aaw/AU_Arent_Always_The_Answer_fs_508.pdf

Cold or Flu. Antibiotics Don’t Work For You.This tri-fold brochure from the CDC briefly explains the difference between bacteria and viruses and how bacteria become resistant. It also answers some common questions about when it is and is not appropriate to use an antibiotic.

http://www.ahaphysicianforum.org/resources/appropriate-use/antimicrobial/content%20files%20pdf/CDC-Cold-or-Flu.pdf

Ask Questions about Your MedicinesThis guide from APIC explains to patients when antibiotics work, when they don’t and when prescribed why it’s important to finish the course of antibiotics as the prescriber recommends.

http://apic.org/For-Consumers/Monthly-alerts-for-consumers/Article?id=get-smart-about-antibiotics-and-antibiotic-re

ABC’s of AntibioticsThis infographic from APIC helps patients and families better understand their role in preventing infections and includes a list of questions to ask their healthcare provider about antibiotics.

http://www.ahaphysicianforum.org/resources/appropriate-use/antimicrobial/content%20files%20pdf/APIC-ABCsAntibiotic.pdf

Antibiotics: Miracle DrugsPodcast (2:18 minutes)Target Audience: General publicThe overuse of antibiotics has led to the development of resistance among bacteria, making antibiotics ineffective in treating certain conditions. This podcast discusses the importance of talking to your healthcare professional about whether or not antibiotics will be beneficial if you’ve been diagnosed with an infectious disease.

















Get Smart: Know When Antibiotics Work – For EveryoneThese print materials focus on the issue of antibiotic resistance, as well as the importance of prescribing and using antibiotics wisely. All materials are provided in low-resolution for office printers. Includes chart on Viruses or Bacteria – What’s Got You Sick, Preventing and Treating Ear Infections, Antibiotic Safety: Do’s and Don’ts at the Dentist, Antibiotic Resistance – The Global Threat, Resistance Anywhere is Resistance Everywhere.

https://www.cdc.gov/antibiotic-use/community/materials-references/print-materials/everyone/index.html

Antibiotic Prescribing and Use in Outpatient SettingTarget Audience: General PublicMultiple resources posted including, and Do You Need Antibiotics? Antibiotics Aren’t Always The Answer, Virus Or Bacteria – What’s Got You Sick, Antibiotics Aren’t Always The Answer, Preventing And Treating Bronchitis, U.S. Antibiotics Awareness Week, Preventing And Treating Ear Infections, Antibiotic Resistance The Global Threat, Do I Really Need Antibiotics, Do Antibiotics Have Side Effects, Improving Antibiotic Use, What Is Antibiotic-Resistance Bacteria, An Antibiotic Is The Wrong Tool To Treat A Virus?


Chart: Viruses or Bacteria — What’s Got You Sick?Target Audience: General PublicLearn when antibiotics are and aren’t needed.

https://www.cdc.gov/antibiotic-use/community/pdfs/aaw/AU_viruses-or-bacteria-Chart_508.pdf

Get Smart: Know When Antibiotics Work – Print Materials for AdultsThese print materials focus on the issue of antibiotic resistance, as well as the importance of prescribing and using antibiotics wisely. All materials are provided in low-resolution for office printers. Includes Cold or Flu – Antibiotics Don’t Work for You and Warning: Antibiotics Don’t Work for Viruses Like Colds and the Flu.

https://www.cdc.gov/getsmart/community/materials-references/print-materials/adults/index.html

Antibiotics Aren’t Always the Answer - For Parents https://www.cdc.gov/antibiotic-use/community/pdfs/aaw/AU_Arent_Always_The_Answer_fs_508.pdf












Get Smart: Know When Antibiotics Work – Print Materials for Parents of Young ChildrenThese print materials focus on the issue of antibiotic resistance, as well as the importance of prescribing and using antibiotics wisely. All materials are provided in low-resolution for office printers. Includes Antibiotics Aren’t Always the Answer, Snort. Sniffle. Sneeze. No Antibiotics Please, Preventing and Treating Ear Infections, Antibiotics Aren’t Always the Answer – For Parents, Six Smart Facts About Antibiotic Use, Fluid in the Middle Ear Q&A, Runny Nose Q&A, and Return to Day Care Letter.

https://www.cdc.gov/getsmart/community/materials-references/print-materials/parents-young-children/index.html

Know When Antibiotics WorkPodcast (1:12 minutes) Target Audience: General public, particularly parents of young children. This podcast provides a brief background about antibiotics and quick tips to help prevent antibiotic resistance.


Snort. Sniffle. Sneeze. No Antibiotics Please!Target Audience: Parents of young childrenThis video (3:47 minutes) features a doctor, who's also a concerned mom, and a humorous turn on a possible doctor's visit.

https://youtu.be/e5qP891fy9E

Do I really need antibiotics? Target Audience: General PublicThis CDC fact sheet provides information on why antibiotics are only needed for treating certain infections caused by bacteria.

https://www.cdc.gov/antibiotic-use/community/pdfs/aaw/AU_Do-I-Need-antibiotics-Infographic_8_5x5_5_1_508.pdf

The Right ToolTarget Audience: General PublicVideo: 33 secondsThis CDC video provides a visual example of using the wrong tool when antibiotics are used inappropriately.

https://www.youtube.com/watch?v=dETK7Jc-XWA






https://youtu.be/e5qP891fy9E






An Antibiotic Is The Wrong Tool To Treat A Virus Target Audience: General PublicThis CDC fact sheet provides a visual example of using the wrong tool and reinforces The Right Tool video.

8.5” X 11”: https://www.cdc.gov/antibiotic-use/community/pdfs/aaw/AU_Print_PSA_Right_Tool_11-10-17-FINAL_508.pdf11” X 17”: https://www.cdc.gov/antibiotic-use/community/pdfs/aaw/AU_Print_PSA_Right_Tool_11x17_11-10-17_FINAL-508.pdf

Do you need antibiotics?Target Audience: General PublicThis CDC fact sheet provides information on eight antibiotic side effects.

https://www.cdc.gov/antibiotic-use/community/pdfs/aaw/AU_Wait_Room_Poster_508.pdf

Examples of How Antibiotic Resistance SpreadsTarget Audience: General PublicThis CDC infographic demonstrates how antibiotics creates resistance.

https://www.cdc.gov/antibiotic-use/community/images/howAR-spreads.jpg

What is antibiotic-resistant bacteria?Target Audience: General PublicThis CDC fact sheet provides information on what happens when bacteria no longer respond to drugs designed to kill them.

https://www.cdc.gov/antibiotic-use/community/pdfs/aaw/AU_What-is-antibiotic-resistant-Infographic_8_5x5_5_3_508.pdf

Improving Antibiotics UseTarget Audience: General PublicThis CDC fact sheet combines provides information on why antibiotics are only needed for treating certain infections caused by bacteria and common side effects of antibiotics.

https://www.cdc.gov/antibiotic-use/community/pdfs/aaw/AU_improving-antibiotics-Infographic_8_5x11_508.pdf

Do antibiotics have side effects?Target Audience: General PublicThis CDC fact sheet provides information on common side effects of antibiotics.

https://www.cdc.gov/antibiotic-use/community/pdfs/aaw/AU_Do-antibiotics-have-side-Infographic_8_5x5_5_2_508.pdf


















Preventing and Treating Ear Infections Fact SheetTarget Audience: Parents of young childrenThis CDC fact sheet provides information on what is an ear infection, common causes, prevention, and how it is treated.

https://www.cdc.gov/antibiotic-use/community/downloads/Preventing-and-Treating-Ear-Infections.pdf

Preventing and Treating BronchitisThis CDC two-page, full color 8.5″x11″ fact sheet explains acute bronchitis and how it can be prevented and treated.

https://www.cdc.gov/antibiotic-use/community/downloads/Flyer-Bronchitis.pdf

Get Smart: Know When Antibiotics Work – Print Materials for Spanish SpeakersSame material as posted on the CDC but in Spanish.

https://www.cdc.gov/getsmart/community/sp/materials/index.html

Wisconsin Healthcare-associated infection (HAIs) websiteTutorials are designed to help with some of the more common NHSN functions in real-time, short segments related to NHSN.

https://www.dhs.wisconsin.gov/hai/tutorials.htm

IP Collaboration Project This Educational Toolkit has been developed by the Association for Professionals in Infection Control and Epidemiology (APIC) and the American Society for Microbiology (ASM).

http://labproject.site.apic.org/files/2012/11/Final-Draft-of-Lab-Toolkit-v21.pdf

Antimicrobial Stewardship: A Collaborative Partnership between Infection Preventionists and Health Care EpidemiologistsAmerican Journal of Infection Control 40 (2012) 94-5


How to be a Good Visitor!Infection Prevention and You: Patient and Families provided by APIC

http://consumers.site.apic.org/infection-prevention-basics/how-to-be-a-good-visitor/

Guidance on Contact Precautions for Hospital VisitorsSociety for Healthcare Epidemiology of America (SHEA) 2015

https://www.shea-online.org/index.php/journal-news/press-room/press-release-archives/99-new-guidance-on-contact-precautions-for-hospital-visitors
















Isolation Precautions for VisitorsSociety for Healthcare Epidemiology of America (SHEA) 2015

https://www.shea-online.org/index.php/practice-resources/41-current-guidelines/422-expert-guidance-isolation-precautions-for-visitors

Peggy Lillis Foundation C. difficile education and patient advocacy

http://peggyfoundation.org/

The Story of Peggy Lillis: The Other Side of AntibioticsIn this video, Christian Lillis, son of Peggy Lillis, shares his personal story of losing his mother to a Clostridium difficile infection (C. difficile) caused by antibiotic use. YouTube (2:39 minutes)

https://youtu.be/ggl7Qgx-VeY

Patient Voice Institute http://gopvi.org/Quinolone Vigilance Foundation http://www.saferpills.org/Consumer Union Safe Patient Project http://safepatientproject.org/Fecal Transplant Foundation http://

thefecaltransplantfoundation.org/Supermoms Against SuperbugsSupported by the PEW Charitable Trusts, a group of advocates from across the country who are concerned about the problem of antibiotic resistance.

http://www.pewtrusts.org/en/research-and-analysis/collections/2015/03/supermoms-against-superbugs

Rory Staunton Foundation: Sepsis prevention https://rorys tauntonfoundationforsepsis.org/

Be Antibiotics Aware, Smart use, Best Care Stickers10 stickers per page on a 8.5” X11” page

https://www.cdc.gov/antibiotic-use/community/downloads/stickers-au-v2-FINAL.pdf

Be Antibiotics Aware, Smart use, Best Care Logo https://www.cdc.gov/antibiotic-use/community/downloads/au-logos-final.pdf



https://rorystauntonfoundationforsepsis.org/

https://rorystauntonfoundationforsepsis.org/

http://thefecaltransplantfoundation.org/

http://thefecaltransplantfoundation.org/

http://safepatientproject.org/

http://www.saferpills.org/

http://gopvi.org/

https://youtu.be/ggl7Qgx-VeY

I am Antibiotic Aware Button or Banners <a href=”https://www.cdc.gov/antibiotic-use/week/″ title=”I am Antibiotics Aware”><img src=”https://www.cdc.gov/week/images/products/CDC_AU_Badge_450x375_Option1_v3-I-AM-AA-FINAL-small.png” style=”width:235px; height:196px; border:0px;” alt=”I am Antibiotic Aware” /></a>

CDC Vital Signs: Improving Antibiotic Use among Hospitalized PatientsAntibiotic prescribing for inpatients is common, and there is ample opportunity to improve use and patient safety by reducing incorrect antibiotic prescribing. Hospital administrators and health care providers can reduce potential harm and risk for antibiotic resistance by implementing formal programs to improve antibiotic prescribing in hospitals.

http://www.ahaphysicianforum.org/resources/appropriate-use/antimicrobial/content%20files%20pdf/CDC-MMWR-Vital-Signs-Improving-Antibiotic-Use.pdf

CDC Vital Signs: Making Health Care Safer Protecting Patients form Antibiotic ResistanceHighlights why critical efforts are necessary listing actions needed by Federal government, State and Local departments, Healthcare CEOs, healthcare providers, and patient and families.

https://www.cdc.gov/vitalsigns/pdf/2016-03-vitalsigns.pdf

Educational Module for Nurses in Long-term Care Facilities: Antibiotic Use & Antibiotic ResistanceThis module created in Minnesota defines antibiotic resistance, describes how antibiotic-resistant organisms develop, outlines the impact of antibiotic resistance on you, your family, and long-term care facility residents, and provides action steps to manage the development and spread of antibiotic-resistant organisms.

http://www.health.state.mn.us/divs/idepc/dtopics/antibioticresistance/asp/ltc/modprintnurseabx.pdf






Community Patient Education Poster Provided by Lake Superior QIN, this document can be downloaded in many forms but can be used to educate patient, parents or guardians on why antibiotic are only when necessary.

Word: http://bit.ly/2l8LfLxPDF: http://bit.ly/2lQ3MfmPowerPoint: https://www.lsqin.org/wp-content/uploads/2017/08/LakeSuperiorQIN_poster.pptx

Community Pharmacy Patient Education Poster Provided by Lake Superior QIN, this document can be downloaded in many forms but can be used to educate patient, parents or guardians on why antibiotic are only when necessary.

Word: https://www.lsqin.org/wp-content/uploads/2016/08/C310_poster_pharmacy_health_photo_smpix.docxPDF: https://www.lsqin.org/wp-content/uploads/2017/10/C310_poster_health_pharm_photo.pdf

Outpatient Core Element: CommitmentProvided by Lake Superior QIN, this on demand video (less than nine minutes long) provides and explanation of this CDC core element specific to the outpatient location.

https://youtu.be/IJqBF7T7dJU

Outpatient Core Element: ActionProvided by Lake Superior QIN, this on demand video (less than nine minutes long) provides and explanation of this CDC core element specific to the outpatient location.

https://youtu.be/xM1ktHGMoEM

Outpatient Core Element: Tracking and ReportingProvided by Lake Superior QIN, this on demand video (less than nine minutes long) provides and explanation of this CDC core element specific to the outpatient location.

https://youtu.be/e5PMB1JYN24

Outpatient Core Element: Education and ExpertiseProvided by Lake Superior QIN, this on demand video (less than nine minutes long) provides and explanation of this CDC core element specific to the outpatient location.

https://youtu.be/GPkZx23PwLs

Nasal Wash or Irrigation Provided by Lake Superior QIN, this patient teaching sheet can be used to walk an individual on benefits, preparation, different methods of washing and cleaning the equipment.

https://www.lsqin.org/wp-content/uploads/2018/01/C.3.10_nasal_wash_flyer_112017_updated.pdf



http://bit.ly/2lQ3Mfm

http://bit.ly/2l8LfLx

How to Feel BetterProvided by Lake Superior QIN, this patient teaching sheet can be used to address signs and symptoms of viral infection with both over-the-counter medication as well as non-medication methods.

https://www.lsqin.org/wp-content/uploads/2018/01/C.3.10_Feel_better_flyer_112017.pdf

Dialogue Around Respiratory Illness Treatment: Optimizing Communication with Parents (DART)

https://www.hhs.gov/sites/default/files/mangione-smith-91317.pdf



Tracking, Monitoring Antibiotic Use, and Process MeasuresResource Website

Antibiotic Stewardship Measurement FrameworkThis document describes selected measures that could be used to measure the change concepts summarized in the Antibiotic Stewardship Drivers and Change Package.

http://www.cdc.gov/getsmart/healthcare/pdfs/antibiotic_stewardship_measurement_framework.pdf

Clinical and Economic Outcomes of a Prospective Antimicrobial Stewardship ProgramIn ASHP’s American Journal of Health-System Pharmacy, the authors found antimicrobial expenditures, which had increased by an average of 14.4 percent annually in the years preceding ASP implementation, decreased by 9.75 percent in the first year of the program and remained relatively stable in subsequent years, with overall cumulative cost savings estimated at $1.7 million. Rates of nosocomial infections involving Clostridium difficile, methicillin-resistant Staphylococcus aureus and vancomycin-resistant enterococci all decreased after ASP implementation.


Antibiotic Resistance Solutions Initiative InfographicCenters for Disease Control and Prevention (CDC) Atlanta, GA: CDC; 201

https://www.cdc.gov/drugresistance/pdf/state-ar-prevention-protect-programs.pdf

Antimicrobial Management Program Gap Analysis ChecklistProvided by CDC Get Smart for Healthcare, this document includes aspects which should be included in policy, procedures, and monitoring.

http://www.cdc.gov/getsmart/healthcare/improve-efforts/resources/doc/AMP-GapAssessment.doc

The Current State of Hospital Antibiotic Stewardship: Findings from our Antibiotic Stewardship Program Survey Washington, DC: The Advisory Board; 2015

https://www.advisory.com/technology/crimson-continuum-of-care/members/expert-insights/the-current-state-of-hospital-antibiotic-stewardship















Optimizing Antimicrobial Therapy with TimeoutsNational organizations, including the CDC and the Joint Commission, advocate for a formal “Antibiotic Timeout” to reassess empiric antibiotics 48-72 hours after their initiation.

https://med.stanford.edu/cme/courses/online/optimizing-antimicrobial-therapy.html

Facilitators and barriers to implementing antimicrobial stewardship strategies: Results from a qualitative studyPublished in 2014 by the American Journal of Infection Control provides several factors that may influence ASP success in the implementation of strategies.

http://www.ajicjournal.org/article/S0196-6553(14)00734-2/abstract

Antimicrobial Management Program Gap Analysis ChecklistProvided by CDC Get Smart for Healthcare, this document includes aspects which should be included in policy, procedures and monitoring.


Starting and Growing Your Antimicrobial Stewardship Program (ASP)Provided by Mount Sinai Hospital & University Health Network, this website includes resources for sense of urgency through gathering and analyzing data; creating the guiding coalition; creating and communicate the vision; empowering and planning; and finally, consolidate and anchor.


CDC Vital Signs: Improving Antibiotic Use among Hospitalized PatientsAntibiotic prescribing for inpatients is common, and there is ample opportunity to improve use and patient safety by reducing incorrect antibiotic prescribing. Hospital administrators and health care providers can reduce potential harm and risk for antibiotic resistance by implementing formal programs to improve antibiotic prescribing in hospitals.


CDC Vital Signs: Making Health Care Safer Protecting Patients form Antibiotic ResistanceHighlights why critical efforts are necessary listing actions needed by Federal government, State and Local departments, Healthcare CEOs, healthcare providers, and patient and families.

https://www.cdc.gov/vitalsigns/pdf/2016-03-vitalsigns.pdf














Antibiotic Stewardship Driver Diagram and Change PackageThe Centers for Disease Control and Prevention (CDC) and the Institute for Healthcare Improvement (IHI) partnered in an effort to develop this conceptual model of key drivers for reducing inappropriate antibiotic utilization.


Antimicrobial stewardship— qualitative and quantitative outcomes: the role of measurementCurr Infect Dis Rep. 2014;16(11):43

http://link.springer.com/article/10.1007%2Fs11908-014-0433-x

Benchmarking antimicrobial drug use in hospitalsExpert Rev Anti Infect Ther. 2012;10(4):445–457

http://www.tandfonline.com/doi/full/10.1586/eri.12.18#.V1AcQrsg-jc

Assessment for the Appropriateness of Antibiotic CDC offers access to assessment tools which can downloaded.

http://www.cdc.gov/getsmart/healthcare/pdfs/gen-assessment.docx

Toolkit for Reduction of Clostridium difficile Infections Through Antimicrobial Stewardship: Medication Use Evaluation TemplateSample template for reviewing antibiotic use patterns, including graphic comparisons over time, from the Agency for Healthcare Research and Quality (AHRQ)

http://www.ahrq.gov/professionals/quality-patient- safety/patient-safety- resources/resources/cdifftoolkit/cdiffl2tools4d.html

Clostridium diffcile Infection Awareness Campaign Challenge #2: Antibiotic StewardshipSelf-assessment to help facilities assess their current state of antibiotic stewardship and choose action oriented challenges to address from Kepro Ohio Quality Improvement Organization.

http://studylib.net/doc/13567693/antibiotic-stewardship-cdi-awareness-campaign-challenge-%23-2-

Measuring Outpatient Antibiotic PrescribingMonitoring of outpatient antibiotic prescribing data is regularly conducted to analyze national and state antibiotic prescribing data in order to better understand trends in outpatient antibiotic prescribing, to identify where interventions to improve prescribing are most needed, and to measure progress.

https://www.cdc.gov/antibiotic-use/community/programs-measurement/measuring-antibiotic-prescribing.html






http://www.ahrq.gov/professionals/quality-patient-safety/patient-safety-resources/resources/cdifftoolkit/cdiffl2tools4d.html















Assessment for the Appropriateness of Antibiotic for Urinary Tract Infections (UTIs)CDC offers access to assessment tools which can downloaded.

http://www.cdc.gov/getsmart/healthcare/pdfs/uti-assessment.docx

Assessment for the Appropriateness of Antibiotic for Community-Acquired Pneumonia (CAP)CDC offers access to assessment tools which can downloaded.

http://www.cdc.gov/getsmart/healthcare/pdfs/cap-assessment.docx

Assessment for the Appropriateness of Antibiotic Use for Resistant Gram-Positive InfectionsCDC offers access to assessment tools which can downloaded.

http://www.cdc.gov/getsmart/healthcare/pdfs/gram-pos-assessment.docx

Measure #407: Appropriate treatment of methicillin-sensitive staphylococcus aureus (MSSA) bacteremia – National Quality Strategy Domain: effective clinical car CMS. gov. Physician Quality Reporting System

https://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=1&ved=0ahUKEwjMiraD4qrYAhVq4IMKHfy-BikQFggsMAA&url=https%3A%2F%2Fpqrs.cms.gov%2Fdownload%2Fm66s-yxfb%2Fapplication%252Fpdf&usg=AOvVaw2Ax1K8-XMktO3nNwKMCN1N

Antimicrobial Use and Resistance (AUR) ModuleCenters for Disease Control and Prevention (CDC). Atlanta, GA:2016

http://www.cdc.gov/nhsn/PDFs/pscManual/11pscAURcurrent.pdf

NQF-endorsed Standardized Antibiotic Administration Ratio National Quality Forum (NQF). Quality Positioning System

http://www.qualityforum.org/QPS/QPSTool.aspx?m=2720&e=1

Arizona Antibiogram ToolkitGuidance on preparing an antibiogram and ideas for educating providers about reading and interpreting the antibiogram, from the Arizona Department of Health Services

http://www.azdhs.gov/documents/preparedness/epidemiology-disease-control/healthcare-associated-infection/advisory-committee/antimicrobial-stewardship/antibiogram-toolkit.pdf
















Antibiograms: developing cumulative reports for your clinicians’ quick guide Clinical and Laboratory Standards Institute. M39-A4 QG.

https://clsi.org/standards/products/microbiology/companion/m39qg/

Antibiogram demo exercise: advanced line list Centers for Disease Control and Prevention (CDC); National Healthcare Safety network (NHSN). Atlanta, GA: CDC; 201

http://www.cdc.gov/nhsn/PDFs/demo/2-AdvancedLineList.pdf

Concise Antibiogram ToolkitGuidance for facilities on creating and interpreting an antibiogram, from the Agency for Healthcare Research and Quality (AHRQ).

http://www.ahrq.gov/sites/default/files/wysiwyg/professional s/quality- patient-safety/patient-safety- resources/resources/nh- aspguide/module2/toolkit1/cat_sources.pdf

The Antimicrobial Resistance Management (ARM) Program is a project run by the University of Florida and is an ongoing project designed to:• Document trends in antimicrobial susceptibility patterns• Identify relationships between antibiotic use and resistance ratesQualifying hospitals or systems may participate in the ARM program at no cost to them.Participants receive a customized analysis of antimicrobial susceptibility trends within their hospital/system. The trends are benchmarked against national, regional and state comparators.

http://www.armprogram.com/Default.html

InfectionsAdvancing Excellence in America’s Nursing Homes with identify baseline, examine process, and monitor and sustain as three of the seven steps.


The Development of Minimum Criteria for the Initiation of Antibiotics in Residents of Long-Term-Care Facilities: Results of a Consensus Conference (aka Loeb criteria).Deciding when to initiate antibiotics can be particularly challenging but this article guides when antibiotic use is appropriate.

http://www.jstor.org/stable/10.1086/501875?seq=1#page_scan_tab_contents











http://www.ahrq.gov/sites/default/files/wysiwyg/professionals/quality-patient-safety/patient-safety-resources/resources/nh-aspguide/module2/toolkit1/cat_sources.pdf











Options for Evaluating Environmental CleaningElements of programs to assess environmental cleaning processes for HAI prevention, including CDC Environmental Checklist for Monitoring Terminal Cleaning and spreadsheet for data entry and scoring, from CDC.

http://www.cdc.gov/hai/toolkits/Evaluating-Environmental- Cleaning.html

Plan – Do - Study – Act StepsProvided by Lake Superior QIN and WHA, this word document can be used to document an organization’s PDSA plan and monitor results.

http://bit.ly/29OOG7E

Design Plan for Small Test of ChangeProvided by Lake Superior QIN and WHA, this word document can be used to document an organization’s small steps taken to reach a goat and monitor results.

Completed sample: https://www.lsqin.org/wp-content/uploads/2017/10/ASP-Tool-Phase-filled-out-form-sample.docxDocument: https://www.lsqin.org/wp-content/uploads/2017/10/Small-Test-of-Change-Form.docx



https://www.lsqin.org/wp-content/uploads/2017/10/ASP-Tool-Phase-filled-out-form-sample.docx



http://www.cdc.gov/hai/toolkits/Evaluating-Environmental-Cleaning.html



Reporting Information to Staff on Improving Antibiotic Use and Resistance – Antibiotic Use and Outcome MeasureResource Website

Antibiotic Stewardship Driver Diagram and Change PackageA Framework to Reduce Inappropriate Antibiotic Utilization in HospitalsThe Centers for Disease Control and Prevention (CDC) and the Institute for HealthcareImprovement (IHI) partnered in an effort to develop this conceptual model of key drivers for reducing inappropriate antibiotic utilization.

https://www.cdc.gov/getsmart/healthcare/pdfs/antibiotic_stewardship_change_package.pdf

Antibiotic Stewardship Driver DiagramThe Centers for Disease Control and Prevention (CDC) and the Institute for Healthcare Improvement (IHI) partnered in an effort to develop this conceptual model of key drivers for reducing inappropriate antibiotic utilization.

https://www.cdc.gov/getsmart/healthcare/pdfs/antibiotic_stewardship_driver_diagram.pdf

Antibiotic Stewardship Measurement FrameworkThis document describes selected measures that could be used to measure the change concepts summarized in the Antibiotic Stewardship Drivers and Change Package.

https://www.cdc.gov/getsmart/healthcare/pdfs/antibiotic_stewardship_measurement_framework.pdf

Antimicrobial stewardship— qualitative and quantitative outcomes: The Role of MeasurementCurr Infect Dis Rep. 2014;16(11):433

http://dx.doi.org/10.1007/s11908-014-0433-x

Toolkit for Reduction of Clostridium difficile Infections Through Antimicrobial Stewardship: Possible Methods for Evaluating Antibiotic UseTable of possible metrics to use for measurement and evaluation of antibiotic use, from the Agency for Healthcare Research and Quality (AHRQ)

http://www.ahrq.gov/professionals/quality-patient- safety/patient-safety- resources/resources/cdifftoolkit/cdiffl2tools2c.html

Starting and Growing Your Antimicrobial Stewardship Program (ASP)Provided by Mount Sinai Hospital & University Health Network website and includes resources for sense of urgency through gather and analyzing data, create the guiding coalition, create and communicate the vision, empower & plan, and finally, consolidate and anchor.







http://www.ahrq.gov/professionals/quality-patient-safety/patient-safety-resources/resources/cdifftoolkit/cdiffl2tools2c.html





http://dx.doi.org/10.1007/s11908-014-0433-x

http://dx.doi.org/10.1007/s11908-014-0433-x










Software vendors who support the CDC antimicrobial use and resistance initiative Society for Infectious Diseases Pharmacists (SIDP)

http://www.sidp.org/aurvendors

Strategies To Assess Antibiotic Use To Drive Improvements In HospitalsThe suggestions outlined in this document are intended to help antibiotic stewardship programs in hospitals assess antibiotic use to see if there are opportunities for improvement.


Assessment of Appropriateness of Antibiotics for Urinary Tract Infections (UTIs) https://www.cdc.gov/antibiotic-use/healthcare/pdfs/UTI-Assessment.docx

Assessment of Appropriateness of Antibiotics for Community-Acquired Pneumonia (CAP)

https://www.cdc.gov/getsmart/healthcare/pdfs/cap-assessment.docx

Assessment of Appropriateness of Antibiotic Use for Resistant Gram-Positive Infections

https://www.cdc.gov/getsmart/healthcare/pdfs/gram-pos-assessment.docx

Assessment of Appropriateness of Inpatient Antibiotics https://www.cdc.gov/getsmart/healthcare/pdfs/gen-assessment.docx

The Development of Minimum Criteria for the Initiation of Antibiotics in Residents of Long-Term-Care Facilities: Results of a Consensus Conference (aka Loeb criteria).Deciding when to initiate antibiotics can be particularly challenging but this article guides when antibiotic use is appropriate.


Aspirus 2017 Scorecard TemplateAspirus Healthcare has provided an excel template which can be used to collect and display data for distribution within a healthcare system as documented in the Aspirus Action Plan.

https://www.lsqin.org/wp-content/uploads/2017/10/Aspirus-ASP-Scorecard-2017-Blank-Template.xlsx






https://www.cdc.gov/getsmart/healthcare/pdfs/gen-assessment.docx












http://www.sidp.org/aurvendors

Aspirus Action PlanAspirus Healthcare has provided a word document which their organizational goals and progress are documented. The goals are they placed in the Aspirus Scorecard Template for tracking and reporting.

https://www.lsqin.org/wp-content/uploads/2017/10/Action-Plan-ASP-Template.doc

Outpatient Audit Worksheet for Acute BronchitisProvided by Telligent, the Quality Innovation Network National Coordinating Center, with four steps to take in order to track antibiotic prescribing in an area which antibiotic are not always necessary.

https://www.lsqin.org/wp-content/uploads/2016/08/Bronchitis_Self-Audit_20170825_FNLv2_508.pdf

Outpatient Audit Worksheet for Viral Upper Respiratory InfectionsProvided by Telligent, the Quality Innovation Network National Coordinating Center, with four steps to take in order to track antibiotic prescribing in an area which antibiotic are not always necessary.

https://www.lsqin.org/wp-content/uploads/2016/08/Viral_URI_Self-Audit_20171024_FNLv3_508.pdf



Antibiotic Stewardship – Pharmacy-Driven InterventionsResource Website

Tools for Daily Activities of StewardshipSample pharmacist’s daily routine for reviewing and streamlining antibiotic use, from the Society for Healthcare Epidemiology of America (SHEA)

https://www.shea-online.org/index.php/component/content/article?id=381:antimicrobial-stewardship-implementation-tools-resources

The Role of Antimicrobial Management Programs in Optimizing Antibiotic Prescribing within HospitalsManaging serious infections is a balance between providing timely and appropriate broad-spectrum empirical therapy for individual patients, which has been consistently shown to improve outcomes, and reducing unnecessary use of antimicrobial agents, which may contribute to the development of antimicrobial resistance. 2006

http://cid.oxfordjournals.org/content/42/Supplement_2/S90.full.pdf+html

ASHP Statement on the Pharmacist’s Role in Antimicrobial Stewardship and Infection Prevention and ControlPharmacists have a responsibility to take prominent roles in ASPs and participate in the infection prevention and control programs of hospitals and health systems. Pharmacists’ responsibilities for antimicrobial stewardship and infection prevention and control include promoting the optimal use of antimicrobial agents, reducing the transmission of infections and educating health professionals, patients and the public.

http://www.ahaphysicianforum.org/resources/appropriate-use/antimicrobial/content%20files%20pdf/ASHP-statement.pdf

The essential role of pharmacists in antimicrobial stewardshipInfect Control Hosp Epidemiol. 2016; April 13:1-2

http://journals.cambridge.org/action/displayAbstract?fromPage=online&aid=10280244&fileId=S0899823X16000829

Antibiotics: Pharmacists Can Make the DifferenceIn this podcast, a pharmacist counsels a frustrated father about appropriate antibiotic use and symptomatic relief options for his son’s cold.

https://www2c.cdc.gov/podcasts/player.asp?f= 14198

Successful ASP Actions: Antibiotic Time-Out, Essential Elements and Development Webinar and slide deck by Partnership for Quality Care (PQC)














Taking an Antibiotic TimeoutThis video highlights three steps to take towards Antibiotic Stewardship and is presented by Dr. Arjun Srinivasan of the CDC.


Antibiotic self-stewardship: trainee-led structured antibiotic time-outs to improve antimicrobial use Ann Intern Med. 2014; 161(10 Suppl): S53-S58.


Wake Forest Baptist Medical Center Disease State Treatment Guidelines for AdultsProvides antimicrobial treatment guidelines for adults with various infectious diseases including Community Acquired Pneumonia Guidelines, Hospital Acquired Pneumonia Guidelines, Emergency Department Healthcare Associated Pneumonia (HCAP) Guide, Empiric Antibiotics for Sepsis, Guidelines for Interpreting Procalcitonin, Empiric Antibiotics for Infections (not sepsis), Neutropenic Fever Guidelines, Clostridium difficile-Associated Colitis Diagnosis and Management, C diffcile Testing Algorithm, Treatment of Pyelonephritis for Patients with Severe Penicillin Allergy, and Procalcitonin to Guide Antibiotics - Cardiology Patients


Pediatric Stewardship ResourcesResources are available from SHEA that are specific to pediatric antimicrobial stewardship.

http://www.shea-online.org/PriorityTopics/AntimicrobialStewardship/PediatricStewardshipResources.aspx

UCSF Benioff Children’s Hospital San Francisco: 2016 Empiric Antimicrobial Therapy GuidelinesThese guidelines were developed to inform initial selection of empiric antimicrobial therapy for children at UCSF Benioff Children's Hospital San Francisco and affiliated outpatient sites. The guidelines were developed by the Pediatric Antimicrobial Stewardship Program in collaboration with multiple clinical groups. They represent consensus based on evidence-based guidelines and local microbiology and susceptibility patterns.


Clinical practice guidelines for Clostridium difficile infection in adults: 2010 update by the society for healthcare epidemiology of America (SHEA) and the infectious diseases society of America (IDSA).



















Multidrug-Resistant Organism & Clostridium difficile Infection moduleCenters for Disease Control and Prevention (CDC) Atlanta, GA: 2016


Clinical Practice Guideline for the Management of Candidiasis: 2016 Update by the Infectious Diseases Society of AmericaClin Infect Dis. 2016;62(4): e1-e50


International clinical practice guidelines for the treatment of acute uncomplicated cystitis and pyelonephritis in women: A 2010 update by the Infectious Diseases Society of America and the European Society for Microbiology and Infectious Diseases.Clin Infect Dis. 2011 Mar 1; 52(5):e103-20. Doi: 10.1093/cid/ciq257.


Infective endocarditis: diagnosis, antimicrobial therapy, and management of complications: a statement for healthcare professionals from the Committee on Rheumatic Fever, Endocarditis, and Kawasaki Disease, Council on Cardiovascular Disease in the Young, and the Councils on Clinical Cardiology, Stroke, and Cardiovascular Surgery and Anesthesia, American Heart Association: endorsed by the Infectious Diseases Society of America.


Clinical practice guideline for the use of antimicrobial agents in neutropenic patients with cancer: 2010 update by the Infectious Diseases Society of America.


Guidelines for evaluation of new fever in critically ill adult patients: 2008 update from the American College of Critical Care Medicine and the Infectious Diseases Society of America.Crit Care Med. 2008 Apr; 36(4):1330-49. doi: 10.1097/CCM.0b013e318169eda9


Clinical practice guidelines by the Infectious Diseases Society of America for the treatment of methicillin-resistant Staphylococcus aureus infections in adults and children.Clin Infect Dis. 2011 Feb 1; 52(3):e18-55. doi: 10.1093/cid/ciq146. Epub 2011 Jan 4


Treatment of complicated skin and soft tissue infections.Surg Infect (Larchmt). 2009 Oct; 10(5):467-99. doi: 10.1089/sur.2009.012.


Practice guidelines for the diagnosis and management of skin and soft-tissue infections.Clin Infect Dis. 2005 Nov 15; 41(10):1373-406. Epub 2005 Oct 14.


























Diagnosis and treatment of diabetic foot infections.Clin Infect Dis. 2004 Oct 1; 39(7):885-910. Epub 2004 Sep 10.


Infectious Diseases Society of America guidelines for the diagnosis and treatment of asymptomatic bacteriuria in adults.Clin Infect Dis. 2005 Mar 1; 40(5):643-54. Epub 2005 Feb 4.


Appropriate Antibiotic Use for Acute Respiratory Tract Infection in Adults: Advice for High-Value Care From the American College of Physicians and the Centers for Disease Control and PreventionAcute respiratory tract infection (ARTI) is the most common reason for antibiotic prescription in adults. Antibiotics are often inappropriately prescribed for patients with ARTI. This article presents best practices for antibiotic use in healthy adults (those without chronic lung disease or immunocompromising conditions) presenting with ARTI.


Guidelines for the management of adults with hospital-acquired, ventilator-associated, and healthcare-associated pneumonia.Am J Respir Crit Care Med. 2005 Feb 15; 171(4):388-416.


Surviving Sepsis Campaign Resources http://www.survivingsepsis.org/guidelines/Pages/default.aspx

Diagnosis, prevention, and treatment of catheter-associated urinary tract infection in adults: 2009 International Clinical Practice Guidelines from the Infectious Diseases Society of America.Clin Infect Dis. 2010 Mar 1; 50(5):625-63.


Model Stop the Line PolicySample policy giving all hospital personnel the responsibility and authority to intervene to prevent a patient safety event, from the Minnesota Hospital Association.

http://www.mnhospitals.org/Portals/0/documents/ptsafety/ti meout/stop- the-line-policy.doc

Clinical practice guidelines for the diagnosis and management of intravascular catheter-related infection: 2009 Update by the Infectious Diseases Society of America.


Antimicrobial Prophylaxis for Surgery (IDSA/SCIP guidelines) Clin Infect Dis. 1994; 18:422-427

























Clinical Practice Guidelines for Antimicrobial Prophylaxis in SurgeryAuthored by ASHP, IDSA, the Surgical Infection Society (SIS) and SHEA these guidelines are intended to provide practitioners with a standardized approach to the rational, safe and effective use of antimicrobial agents for the prevention of surgical-site infections based on currently available clinical evidence and emerging issues.


University of Wisconsin Health Surgical Prophylaxis GuidelinesAppendix B of Antimicrobial Use Guidelines


University of Miami Health System Antimicrobial Surgical Prophylaxis ProtocolsAntimicrobial surgical prophylaxis general and solid organ transplant and LVADs is shared.

http://www.ugotabug.med.miami.edu/documents/UMHSurgicalProphylaxis.pdf

Diagnosis and management of complicated intra-abdominal infection in adults and children: guidelines by the Surgical Infection Society and the Infectious Diseases Society of AmericaClin Infect Dis. 2010;50(2):133-16


Infectious Diseases Society of America Infections by Antimicrobial Agent UseIncludes antimicrobial prophylaxis for surgery, antimicrobial stewardship, combat-related infections, neutropenic patients with cancer, outpatient parenteral anti-infective therapy (OPAT) and vancomycin.


Cleveland Clinic Guidelines for Antimicrobial UsageThis PDF file has bookmarks for gram stain morphology of selected organisms, key characteristics of selected organisms, usual acid-fast bacillus characteristics, mechanism of action of common antibacterial agents, nine different treatment guidelines, guide to dosing adults, antivirals, dosing guidelines, antimicrobial interactions, and five prophylactic dosing recommendations.


University of California, San Francisco Medical Center Guidelines for DosingIncludes access to adults not receiving hemodialysis, adults receiving hemodialysis, aminoglycoside dosing and monitoring recommendations for adults, dosing in pediatric patients, and dosing in neonates.



















American Society of Health-System Pharmacists ASHP therapeutic guidelines on antimicrobial prophylaxis in surgeryAm J Health-Syst Pharm. 1999;56:1839-88


University of Kentucky Restricted Antimicrobial AgentsIncludes links to Amphotericin B Lipid Complex (Abelcet®), Itraconazole IV Daptomycin (Cubicin®), Itraconazole IV (Sporanox®), Linezolid (Zyvox®), Meropenem (Merrem®), Meropenem (Mycamine®), Quinupristin/Dalfopristin (Synercid®), Valganciclovir Ticarcillin/Clavulanate (Timentin®), Valganciclovir Tigecycline (Tygacil®), Valganciclovir (Valcyte®), Vancomycin, Voriconazole (VFend®) and Restricted Antimicrobial Ordering Process


University of Miami Health System Antibiotic Desensitization ProtocolsIncludes following antibiotics: Azithromycin, Meropenem, Penicillin G, Piperacillin-tazobactam, Oral Bactrim and Cefoxitin.

http://www.ugotabug.med.miami.edu/umh-antimicrobial-stewardship-program/um-asp-policies-protocols

Guidance to Providers: Testing for C. difficile InfectionRecommendations for CDI testing, including a sample diagnostic algorithm (pg. 2), from Vanderbilt University Medical Center.

http://www.mc.vanderbilt.edu/documents/infectioncontrol/fil es/ Guidance%20for%20Providers%20FINAL%202011.pdf

Stanford Medicine Criteria for C. difficile Testing This document defines when to test, prerequisite and exemptions based upon the Society for Healthcare Epidemiology of America, Infectious Diseases Society of America. 2010. Clinical practice guidelines for Clostridium difficile infection in adults: 2010 update by the society for healthcare epidemiology of America (SHEA) and the infectious diseases society of America (IDSA).

http://med.stanford.edu/bugsanddrugs/clinical-microbiology/_jcr_content/main/panel_builder/panel_0/download_696064726/file.res/C.diff%20PCR%20rejection%20criteria%206-9-15.pdf

University of Miami Health System Clostridium difficile Testing Algorithm and Treatment

http://www.ugotabug.med.miami.edu/documents/CdiffMD.pdf









http://www.mc.vanderbilt.edu/documents/infectioncontrol/files/Guidance%20for%20Providers%20FINAL%202011.pdf









Sample Clostridium difficile Infection (CDI) Orders http://www.apic.org/Resource_/TinyMceFileManager/Practice_Guidance/cdiff/CDifficileInfectionCDIOrdersandCDifficileToxinScreeningandOrders.pdf

Clostridium difficile Infection (CDI) Prevention Collaborative Laboratory Testing Information Overview of C. difficile laboratory tests with table comparing tests on pg. 2, from the Florida Department of Health.

http://www.fadona.org/CDILabTestInfoSheet122210.pdf

A Practical Guidance Document for the Laboratory Detection of Toxigenic Clostridium difficile Recommended practices and sample algorithms for C. difficile laboratory testing, from the American Society for Microbiology (ASM).

http://www.asm.org/images/pdf/Clinical/clostridiumdifficile9- 21.pdf

Guidance to Providers: Testing for C. difficile InfectionRecommendations for CDI testing, including a sample diagnostic algorithm (pg. 2), from Vanderbilt University Medical Center.

http://www.mc.vanderbilt.edu/documents/infectioncontrol/fil es/Guidance%20for%20Providers%20FINAL%202011.pdf

FAQ on Testing Asymptomatic Patients for C. difficileAn article out of the American Journal of Infection Control, said that testing patients with three risk factors upon hospital admission has potential to identify nearly three out of four asymptomatic carriers of C. difficile at their institution. Given that CDC does not currently recommend testing of asymptomatic patients for C. difficile, FAQs on this issue was created.

http://www.apic.org/Resource_/TinyMceFileManager/FAQ_on_Testing_Asymptomatic_Patients_for_Cdiff_04262013.pdf










http://www.asm.org/images/pdf/Clinical/clostridiumdifficile9-21.pdf





http://www.apic.org/Resource_/TinyMceFileManager/Practice_Guidance/cdiff/CDifficileInfectionCDIOrdersandCDifficileToxinScreeningandOrders.pdf



Antibiotic Stewardship – Diagnosis and Infection Specific InterventionsResource Website

Nebraska Gastrointestinal Pathogen Panel GuidanceTo improve the detection of intestinal pathogens, the microbiology lab introduced multiplex PCR testing using the FilmArray Gastrointestinal (GI) panel, which detects 22 common viruses, bacteria and parasites that cause infectious diarrhea.

https://www.nebraskamed.com/sites/default/files/documents/for-providers/asp/GI_Panel_Guidance_2-17.pdf

Nebraska Recommendations Regarding Use of Rapid Blood Pathogen Identification Panel DataFDA approved test called the Blood Pathogen Panel (BPP, performed on the BioFire BCID instrument). This test uses a PCR-based approach to amplify DNA targets directly from positive blood cultures allowing rapid identification of pathogens and earlier transition to most appropriate therapy.

https://www.nebraskamed.com/sites/default/files/documents/for-providers/asp/biofire-recs.pdf

Nebraska Rapid Blood Pathogen Identification PanelThis document provides support for the Blood Pathogen Panel (performed on the BioFire BCID instrument) which uses a PCR-based approach to amplify DNA targets directly from positive blood cultures.

http://www.nebraskamed.com/app_files/pdf/careers/education-programs/asp/biofire-recs.pdf

Nebraska Antibiotic Guidance for Treatment of Acute Exacerbations of COPD (AECOPD) in AdultsAntibiotics are not recommended for all patients with AECOPD as bacterial infection is implicated in less than one-third of AECOPD. Procalcitonin (PCT) may be helpful in determining if antibiotics are necessary or the duration of treatment.

https://www.nebraskamed.com/sites/default/files/documents/for-providers/asp/COPD_pathway2016_Final.pdf

Nebraska Clostridium difficile Infection (CDI) Management GuidelineThis document provides a management guideline and was updated in the fall of 2017.

https://www.nebraskamed.com/sites/default/files/documents/for-providers/asp/CDI_final.pdf

Nebraska Diabetic Foot Infections: Institutional Treatment GuidanceThese guidelines should not replace clinical judgment. Therapeutic decisions should be based on clinical data including patient history, comorbidities, antimicrobial susceptibility patterns, and cost and was updated in the fall of 2017.

https://www.nebraskamed.com/sites/default/files/documents/for-providers/asp/DFI_institutional_guideline_final.pdf



A randomized clinical trial comparing use of rapid molecular testing for Staphylococcus aureus for patients with cutaneous abscesses in the emergency department with standard of careInfect Control Hosp Epidemiol


Serum procalcitonin measurement and viral testing to guide antibiotic use for respiratory infections in hospitalized adults: a randomized controlled trialJ Infect Dis. 2015;212(11):1692-1700

http://jid.oxfordjournals.org/content/212/11/1692

University of Pennsylvania Medical Center Clinical Microbiology Laboratory Information and Non-UPHS Guidelines for Antimicrobial TherapyTable of contents includes Endocarditis and Endovascular Infections, Fungal Infections, Gastrointestinal Tract Infections, Intraabdominal Infections, Hepatitis, Urinary Tract Infections, Sexually Transmitted Diseases, IDSA and BSAC Guidelines, Pneumonia and Upper Respiratory Tract Infections, Tuberculosis, Parasitic, Tick-borne, Travel-related Infections and HIV.

http://www.uphs.upenn.edu/bugdrug/antibiotic_manual/table%20of%20contents.htm

Johns Hopkins Specimen GuidelinesThe proper collection of a specimen for culture is the most important step in the recovery of pathogenic organisms responsible for infectious disease. A poorly collected specimen may lead to failure in isolating the causative organism(s) and/or result in the recovery of contaminating organisms.

http://www.hopkinsmedicine.org/microbiology/specimen/index.html

Clinical and Laboratory Standards Institute Provides multiple resources including developing cumulative reports for your Clinicians Quick Guide, performance Standards for Antimicrobial Susceptibility Testing, performance Standards for Antimicrobial Disk Susceptibility Tests, & Methods for Dilution Antimicrobial Susceptibility Tests for Bacteria That Grow Aerobically.

www.clsi.org

CDC Clinician Guide for Collecting Cultures http://www.cdc.gov/getsmart/healthcare/implementation/clinicianguide.html



http://www.cdc.gov/getsmart/healthcare/implementation/clinicianguide.html

http://www.cdc.gov/getsmart/healthcare/implementation/clinicianguide.html

http://www.clsi.org/









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