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Antimicrobial Stewardship Program Guidelines: Who’s on Your Team?

The success of an antimicrobial stewardship program (ASP) depends on having the right team. Who should be on yours? The Centers for Disease Control and Prevention and the Infectious Disease Society of America recommend the following individuals:1,2

A member of senior administration. Because ASPs involve many departments and key personnel within a hospital, they must have support from the hospital’s executive leadership to ensure they have sufficient budget, authority and resources. An effective ASP will also demand the attention of management to identify appropriate goals, prioritize policies and monitor program results. Enlisting the support of a senior administrator will give you the backing needed to succeed and help you identify the topics and discussion points that will have the greatest impact in securing funding and other resources.

An infectious disease physician. Typically, an infectious disease specialist serves as the champion and leader of the antimicrobial stewardship program. As a physician, he or she often has greater success persuading other clinical leaders to support good antimicrobial stewardship practices and can get through to senior physicians who may resist changing their prescribing habits.

An experienced clinical pharmacist, ideally with infectious disease training. Pharmacy plays a key role in any ASP and a clinical pharmacist who has primary responsibility for communicating proper prescribing practices must be a member of the team. He or she will intervene if providers fail to follow recommended prescribing practices in terms of selected agent, dosage or duration. The pharmacist may share leadership of the team with the infectious disease physician.

An infection preventionist. Infection preventionists are critical members of the ASP team and focus on reducing healthcare-associated infections (HAIs), which are often caused by multidrug resistant organisms. Their efforts to reduce infections dovetail with the ASP team’s goals and they can serve a vital function in educating staff, patients and visitors about hand hygiene, contact precautions and other ways to prevent the spread of infection in the hospital and into the community.

Hospitals may have the following recommended antimicrobial stewardship team members on staff or may contract for their services, depending on the size of the organization.

Clinical microbiologist. To help the team interpret the hospital’s antibiogram to ensure that a small data set has not distorted the results and to assist in development of the most relevant antibiogram for the organization, the ASP team needs a microbiologist. This individual can also provide valuable assistance by definitively identifying pathogens and recommending the most suitable therapy based on susceptibility data.

Hospital epidemiologist. The hospital epidemiologist provides expertise in infection surveillance and research. In addition, he or she may offer greater knowledge of the best use of technology to support the team’s overall effectiveness.

Information technology specialist. Many ASPs find that IT support enables them to leverage hospital data and systems to quickly identify at risk patients and efficiently produce reports. Some surveillance systems require significant support to aggregate information from various IT systems across the hospital and change clinical rules, while some electronic systems make the data consolidation and analysis more seamless and enable clinicians to easily modify rules as needed.

Quality assurance/patient safety manager. Many ASPs operate within the quality assurance or patient safety department of their hospital. For those that don’t, a member of the quality or safety team should serve on the ASP to help coordinate efforts.

Who serves on your hospital’s antimicrobial stewardship team? Would you add anyone to our list?

  1. Dellit et al: Clinical Infectious Diseases 2007; 44:159–77.

  2. American Society of Health-System Pharmacists. A Hospital Pharmacist’s Guide to Antimicrobial Stewardship Programs.

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