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Delaware Healthcare-Associated Infections (HAI) Antibiotic Stewardship

What is Antibiotic (Antimicrobial) Stewardship?

Twenty to 50 percent of all antibiotics prescribed in U.S. acute care hospitals are either unnecessary or inappropriate. Antibiotic Stewardship refers to a set of coordinated strategies to improve the use of antimicrobial medications with the goal of enhancing patient health outcomes, reducing resistance to antibiotics and decreasing unnecessary costs. (SHEA: The Society for Healthcare Epidemiology of America).

Antibiotic Stewardship encourages health care providers to use the right dose and duration of antibiotics that will have the least amount of adverse reaction to achieve the best possible care for the patient.  When this is achieved, the likelihood of developing antimicrobial resistance will be drastically minimized and will also decrease the spread of infections caused by multidrug-resistant organisms. The misuse and overuse of antimicrobials is one of the world’s most pressing public health problems.

Antibiotic Stewardship Mission Statement

The Delaware Division of Public Health (DPH) and the Healthcare-Associated Infections Advisory Committee (HAIAC) support a coordinated statewide program to promote the appropriate use of antibiotics across the healthcare continuum, thus improving patient outcomes and decreasing the spread of multidrug-resistant bacteria.

White House Proclamation on Antibiotic Stewardship

The National Action Plan for Combating Antibiotic-Resistant Bacteria, issued by President Obama on September 18, 2014, provides a road map to guide the nation in rising to this challenge. It 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).

Although its primary purpose is to guide activities by the U.S. Government, the National Action Plan is also designed to guide action by public health, health care, and veterinary partners in a common effort to address urgent and serious drug-resistant threats that affect people in the U.S. and around the world. Implementation of the National Action Plan will also support World Health Assembly resolution 67.25 (Antimicrobial Resistance), which urges countries to take urgent action at the national, regional, and local levels to combat resistance.

Get Smart: Know When Antibiotics Work

Antibiotic resistance is a growing problem and the main cause of this problem is misuse of antibiotics. The Centers for Disease Control and Prevention (CDC)’s Get Smart: Know When Antibiotics Work program works to make sure antibiotics are prescribed only when they are needed and used as they should. The Get Smart program focuses on common illnesses that account for most of the antibiotic prescriptions written for children and adults in doctors’ offices and other outpatient settings.

Get Smart: Know When Antibiotics Work for Patients/Consumers

Common infections, whether caused by bacteria or viruses, are often painful and can get in the way of our well-being and everyday lives. Many infections do not require antibiotics, but there are other actions you can take to lessen symptoms.

Get Smart: Know When Antibiotics Work for Healthcare Professionals

CDC’s Get Smart program has resources for healthcare professionals working in outpatient and inpatient healthcare settings, as well as community pharmacies.

Get Smart: Know When Antibiotics Work for Outpatient Healthcare Professionals

Recommendations for appropriate antibiotic prescribing, including clinical practice guidelines, have been developed to improve outpatient treatment of common infections in children and adults. CDC’s Get Smart: Know When Antibiotics Work program has developed materials that outpatient healthcare professionals can use to educate their patients about when antibiotics treatment is appropriate.

Get Smart: Know When Antibiotics Work For Partners

Working with a wide variety of partners is critical to the success of the Get Smart: Know When Antibiotics Work program. Learn more about what partners are doing to combat antibiotic resistance in their communities and how you can become a partner.

Get Smart: About Antibiotics Use and Resistance

Since their discovery in the 1920s, antibiotics have transformed our ability to treat infections. As antibiotic resistance increases, these lifesaving drugs do not work as well as they once did, and successfully treating common infections becomes more difficult.

Educational Resources: Antibiotics and Antibiotic Resistance

These educational resources provide information on antibiotics and antibiotic resistance. They are intended for use by educators, health care professionals, and consumers.

Get Smart about Antibiotics Week

Get Smart Week is an annual observance to raise awareness of the threats of antibiotic resistance and the importance of appropriate antibiotic prescribing and use. The last Get Smart Week was November 12 to 18, 2017.

Quality Insights

There are many helpful resources for both practitioners and consumers. Providers working with Quality Insights have access to additional resources, including free e-learns for staff on infections. Nursing CEUs are provided.

CDC, ACP Issue Guidelines for Appropriate Antibiotic Use

On January 19, 2016, CDC and the American College of Physicians (ACP) issued new guidelines to help prevent inappropriate prescriptions of antibiotics.

Core Elements of Hospital Antibiotic Stewardship Programs

Antibiotics have transformed the practice of medicine, making once lethal infections readily treatable.

The Core Elements of Hospital Antibiotic Stewardship Programs cover these 6 important areas:

  • Leadership Commitment: Dedicating necessary human, financial and information technology resources.
  • Accountability: Appointing a single leader responsible for program outcomes.
  • Drug Expertise: Appointing a single pharmacist leader responsible for working to improve antibiotic use.
  • Action: Implementing at least one recommended action, such as systemic evaluation of ongoing treatment need after a set period of initial treatment.
  • Tracking: Monitoring antibiotic prescribing and resistance patterns.
  • Reporting: Regular reporting information on antibiotic use and resistance to doctors, nurses and relevant staff.
  • Education: Educating clinicians about resistance and optimal prescribing.

Appropriate Antibiotic Use for Acute Respiratory Care in Adults

Acute 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.

Core Elements of Antibiotic Stewardship for Nursing Homes

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. Nursing homes are encouraged to work in a step-wise fashion, implementing one or two activities to start and gradually adding new strategies from each element over time. Any action taken to improve antibiotic use is expected to reduce adverse events, prevent emergence of resistance, and lead to better outcomes for residents in this setting.

Antibiotic Resistance and Food Safety

Growth Promotion – The use of some antibiotics can destroy certain bacteria in the gut and help livestock and poultry convert feed to muscle more quickly causing more rapid growth. This class of use has been the subject of controversy and scrutiny, and in 2012, the FDA asked livestock and poultry producers to phase out the use of antibiotics for growth purposes.

Farm to Table

Animals can carry harmful bacteria in their intestines. When antibiotics are given to animals, antibiotics kill most bacteria. But resistant bacteria survive and multiply.

Healthcare Associated-Infections (HAIs)

State of Delaware, Delaware Health and Social Services, Division of Public Health.

Antimicrobial Stewardship Toolkit (SHEA)

The SHEA Antimicrobial Stewardship Toolkit is comprised of three sections: Hospital and health resources, clinician resources, and patient resources.


  • Acute care:  A branch of secondary health care where a patient receives active but short-term treatment for a severe injury or episode of illness, an urgent medical condition, or during recovery from surgery. In medical terms, care for acute health conditions is the opposite from chronic care, or longer-term care.
  • Adverse drug events:  When medical drugs, like antibiotics, have harmful effects; when someone has been harmed by a medication.
  • Antibiotic:  Type of antimicrobial agent made from a mold or bacterium that kills or slows the growth of other bacteria. Examples include penicillin and streptomycin.
  • Antimicrobial agents:  A general term for the drugs, chemicals, or other substances that either kill, inactivate, or slow the growth of microbes including bacteria, viruses, fungi and parasites. An agent that kills microorganisms or inhibits their growth. Antimicrobial medicines can be grouped according to the microorganisms they act primarily against e.g. antibacterial, antifungal and antiviral.
  • Antimicrobial resistance:  Antimicrobial resistance happens when microorganisms such as bacteria, fungi, viruses, and parasites change in ways that render the medications used to cure the infections they cause ineffective. When microorganisms become resistant to most antimicrobials they are often referred to as “superbugs”.
  • Bacteria:  Single-celled organisms that live in and around us. Bacteria are necessary for us to function normally, but in some conditions may cause sickness such as strep throat, ear infections, or pneumonia.
  • Centers for Disease Control and Prevention (CDC):  One of the foremost national agencies in the world that serves to support and advance public health. It provides disease surveillance, reference laboratory testing, field investigation and educational service expertise throughout the United States and abroad.
  • Deoxyrobinucleic acid (DNA):  A nucleic acid that contains the genetic instructions used in the development and functioning of all known living organisms with the exception of some viruses. The main role of DNA molecules is the long-term storage of information.
  • Drug resistance:  Drug resistance is the result of microbes changing in ways that reduce or eliminate the effectiveness of drugs, chemicals or other agents to cure or prevent infections.
  • Healthcare-associated infection (HAI):  Infection acquired during the course of medical care in a healthcare facility. Often referred to as a nosocomial infection.
  • Infection:  An invasion of an organism by a pathogen such as bacteria or viruses, often causing an immune response from the host. Some infections lead to disease.
  • Long-term care facility (LTCF):  A facility that provides rehabilitative, restorative, and/or ongoing skilled nursing care to patients or residents in need of assistance with activities of daily living. LTCFs include nursing homes, assisted living facilities, rehabilitation facilities, inpatient behavioral health facilities and long-term chronic care hospitals.
  • Microbes:  Organisms so small that a microscope is required to see them. Microbes are also called microorganisms.
  • Multi-drug resistant bacteria:  Organisms that have become resistant to several antibiotics, and these antibiotics can no longer be used to control or kill the bacteria.
  • Pathogens:  Bacteria, viruses, parasites, or fungi that can cause disease.
  • Ribonucleic acid (RNA):  A biologically important type of molecule that consists of a long chain of nucleotide units. Each nucleotide consists of a nitrogenous base, a ribose sugar, and a phosphate. RNA is very similar to DNA, but differs in a few important structural details.
  • Virus:  A strand of DNA or RNA in a protein coat that must get inside a living cell to grow and reproduce.Viruses cause many types of illness; for example, varicella virus causes chickenpox, and the human immunodeficiency virus (HIV) causes the acquired immune deficiency syndrome, or AIDS.

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