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Antibiotic Stewardship in Hospitals: Is Bed Size a Factor?

If you’re trying to implement a formal antimicrobial stewardship program (ASP) at your hospital, you may have better luck if your facility has more beds, according to separate research studies published in Infection Control and Hospital Epidemiology and Hospital Pharmacy.1,2 While many smaller hospitals have launched formal ASPs, other hospitals have implemented specific antimicrobial stewardship policies that appear to be effective without a formal program with dedicated, full-time staff in place.

The Hospital Pharmacy study surveyed Michigan hospitals in 2014 and found that of hospitals overall in the state, 83% had antimicrobial strategies in place and 63% of them had multidisciplinary stewardship  teams. When looking at hospitals with fewer than 150 beds, 60% had antimicrobial stewardship policies implemented and 45% of those had multidisciplinary teams.

All of the Michigan facilities that did not have any antimicrobial stewardship policies reported having fewer than 150 beds.

Bed size was also significantly associated with interventions by pharmacists. In facilities with more than 150 beds, pharmacists were much more likely to recommend de-escalation or discontinuation of antimicrobials (85%) than those in hospitals with fewer beds (52%) and they were more likely to have infectious disease training (47% compared to 27%).

Across all hospitals, respondents reported that the primary barriers to implementing or maintaining an ASP were funding and lack of other resources , issues that may be more acute in smaller facilities.

The ICHE article also found lower rates of antimicrobial stewardship policies or programs among hospitals with smaller bed size. Nearly two-thirds of hospitals that responded to a national survey or made their National Health Safety Network data available to researchers had antimicrobial policies in place in 2011. Of the hospitals with more than 500 beds, 79% had antimicrobial stewardship policies. The percentage dropped to 75% among hospitals with 201-500 beds. Among those with fewer than 200 beds, just 55% reported having implemented antimicrobial stewardship policies.

How has bed size affected your hospital’s development of antimicrobial stewardship policies or programs?

  1. Curtis Collins, Dianne Miller, Rachel Kenney, Ryan Mynatt, Michael Tiberg, Kelli Cole, Jesse Sutton, and Jason Pogue. The State of Antimicrobial Stewardship in Michigan: Results of a Statewide Survey on Antimicrobial Stewardship Efforts in Acute Care Hospitals. Hospital Pharmacy: March 2015, Vol. 50, No. 3, pp. 180-184.

  2. Pogorzelska-Maziarz M, Herzig CTA, Larson EL, Furuya EY, Perencevich EN, Stone PW. Implementation of Antimicrobial Stewardship Policies in U.S. Hospitals: Findings from a National Survey. Infection control and hospital epidemiology. 2015;36(3):261-264. doi:10.1017/ice.2014.50.

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