Posted on January 23, 2015
An effective antimicrobial stewardship (AMS) program impacts many aspects of hospital operations and requires the participation of many departments, making the support and full engagement of key members of the AMS team one of the first priorities when establishing a program. At a minimum, the Infectious Disease Society of America/SHEA recommend the following professionals:1
Infectious disease physician—To facilitate communication and cooperation with other members of the medical staff, an infectious disease specialist frequently heads an AMS team. Physicians who assume this role should be compensated for their involvement in antimicrobial stewardship activities as they will take time away from patient care and otherwise provide a disincentive for consistent participation and leadership.2
Clinical pharmacist with infectious diseases training—The central role of pharmacy in ensuring proper prescribing practices and appropriate drug, dose and duration make an experienced pharmacist essential to the AMS team. Often the pharmacist shares leadership with the infectious disease physician. While the IDSA/SHEA guidelines recommend a pharmacist with training in infectious diseases, a dearth of pharmacists with this training means that pharmacists with more general backgrounds often take on key roles in AMS. Like the physician champion, the clinical pharmacist should receive compensation for AMS activities.
Clinical microbiologist—As rapid diagnostic tests gain importance in identification of pathogens and selection of appropriate antimicrobials, a clinical microbiologist has become an increasingly important member of the team. The microbiologist can help the team understand options for sorting among susceptibility data to achieve the most relevant antibiogram for the facility and its units for various time periods and for interpreting the antibiogram so that small data sets do not distort results.
Information system specialist—A healthcare information specialist works with the team to leverage the information and technology available to improve surveillance, speed reporting and generate real-time alerts to improve patient care and reduce the spread of infections.
Infection preventionist—Infection prevention and control specialists naturally work closely with the antimicrobial stewardship team as they monitor healthcare-associated infections (HAIs) such as Clostridium difficile and other “superbug” rates. They also often educate staff on ways to reduce such infections, which include key AMS policies such as ensuring a good match between therapies used and clinically confirmed infections.
Hospital epidemiologist—Epidemiologists bring expertise in infection surveillance and research to the team and can help identify areas where technology can increase the effectiveness of the entire team.
Quality assurance/Patient safety manager—Frequently AMS programs run under the direction or in tight coordination with quality assurance and patient safety departments as antimicrobial stewardship is an important aspect of quality care, with significant implications for patient safety. At a minimum, a representative from these departments should serve on the team to ensure the programs and initiatives work well together and do not overwhelm staff with the simultaneous introduction of multiple new policies.
Hospital leadership—Support from hospital leadership underpins every high performing AMS program. Executive buy-in and advocacy ensures the team has the budget, key personnel and authority to succeed.
What other members do you include in your antimicrobial stewardship team? Please leave your comments below.
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.