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Safe Antibiotic Use: A Patient Safety Priority

11/21/2022

By Christina Cordero, PhD, MPH, Project Director, Healthcare Standards Development

This week, The Joint Commission joins the Centers for Disease Control and Prevention (CDC) to recognize U.S. Antibiotic Awareness Week (USAAW). This annual observance raises awareness of the threat of antibiotic resistance and the importance of appropriate antibiotic use.

The Joint Commission has made appropriate antibiotic use a patient safety priority. In 2017, we launched our first set of antibiotic stewardship requirements to help healthcare organizations improve their antibiotic prescribing practices through antimicrobial stewardship programs (ASPs). These programs help provide critical infrastructure and optimize clinical outcomes while minimizing unintended consequences of antibiotic use, including:

  • adverse drug events
  • Clostridioides difficile infections (CDIs)
  • emerging antibiotic resistance

USAAW is particularly timely for The Joint Commission this year. Along with The Pew Charitable Trusts, The Joint Commission recently published a paper in Infection Control & Hospital Epidemiology about leading practices in ASPs. Additionally, our new/revised antibiotic stewardship requirements become effective soon for hospitals and critical access hospitals.

Leading Practices in Antimicrobial Stewardship Programs
Researchers from The Joint Commission and The Pew Charitable Trusts administered a questionnaire to learn more about leading practices in ASPs in Joint Commission accredited hospitals. Of the hospitals invited, 288 completed the questionnaire. Findings showed:

  • 161 hospitals (54.8%) reported implementing four facility-specific treatment guidelines (FSTGs), including for community-acquired pneumonia (CAP), urinary tract infection (UTI), skin and soft-tissue infection (SSTI), and sepsis
  • 214 hospitals (72.4%) performed interactive prospective audit and feedback
  • 105 hospitals (34.9%) implemented procedures to optimize diagnostic testing for CDI and UTI
  • 235 hospitals (79.8%) measured antibiotic utilization
  • 258 hospitals (88.2%) measured CDI
  • 110 hospitals (37.1%) measured FSTG adherence

Small and non-system hospitals were less likely to optimize diagnostic testing and measure antibiotic utilization. Non-system hospitals were also less likely to implement FSTGs.

The researchers conclude that significant variation exists in the adoption of ASP leading practices. While a minority of hospitals have taken action to optimize diagnostic testing and measure adherence to FSTGs, additional efforts are needed to expand adoption of leading practices across all acute-care hospitals.

New/Revised Antibiotic Stewardship Requirements
The Joint Commission’s new/revised antibiotic stewardship requirements, effective Jan. 1, 2023, for hospitals and critical access hospitals, include 12 expectations that align with federal regulations and recommendations from scientific and professional organizations. These requirements address key components for a successful ASP, including:

  • Allocating financial resources for staffing and information technology to support the program
  • Appointing a qualified physician and/or pharmacist to lead the ASP and outlining their responsibilities
  • Establishing a multidisciplinary committee to provide guidance and oversight for the program
  • Implementing the program throughout the healthcare organization to address inappropriate antibiotic use
  • Evaluating adherence to evidence-based guidelines for the most common indications for antibiotic use
  • Collecting, analyzing and reporting ASP data to hospital leadership and prescribers
  • Identifying opportunities to improve the hospital’s ASP

The prepublication standards are available on The Joint Commission website.

Additional Resources
In addition to the research paper and new/revised requirements, The Joint Commission has several resources to help healthcare organizations improve antibiotic stewardship, reduce antibiotic resistance and meet the new/revised requirements:

USAAW is the perfect time to review your organization’s ASP. We encourage you to use the many resources available from The Joint Commission and other organizations to learn about leading practices and apply them at your organization during USAAW and beyond. Together, we can help combat antibiotic resistance.

Christina Cordero, PhD, MPH, is a Project Director, Healthcare Standards Development in the Division of Healthcare Quality Evaluation at The Joint Commission. She leads standards development projects for new accreditation and certification requirements across multiple settings and programs. She also serves as a subject matter expert for several topics, including healthcare equity, antibiotic stewardship and telehealth. Prior to joining The Joint Commission, she conducted basic science and public health research at Northwestern University’s Feinberg School of Medicine in Chicago.