Core Components of Programs

Attachment C: Core components of antimicrobial stewardships (AS) programs implemented by state and local health departments

Purpose: Provide guidance to health departments and organizations focused on quality improvement to establish an effective program to support appropriate antibiotic use as part of a coordinated approach to prevent and reduce antibiotic resistance

Components	More details
Establish AS leadership and support within program	Identified lead to evaluate and incorporate AS activities into HAI program Secure expertise knowledgeable on AS activities and tools (steering committee) Staff available to diagnose and investigate ASP and AR patterns and trends
Surveillance to understand current AS practices/needs across facilities, antibiotic use, resistance patterns and outbreaks	Assess ASP activities and needs Evaluate progress in ASP implementation Monitor resistance (CRE, CDI, ESBL) Monitor antibiotic susceptibility patterns Improve tracking to antibiotic use and trends to aid AS Disease prevalence at points in time (i.e. flu surveillance)
Coordination of AS activities with resistance prevention and quality improvement efforts	Interdepartmental within own agency Other CDC programs (EIP, EpiCenters academic institutions, other ELC and non-funded States) CMS (QIO/QINs efforts) Hospital Association (HEN) Pharmacy and medical societies
Education and tools on appropriate antimicrobial prescribing for facilities and healthcare professionals Convene AS prevention collaboratives (for facilities who commit to sharing tools and best practices)	Key AS resources available on website Train and support professionals and facilities on AS (online or in-person education) Technical assistance targeted by surveillance Link facilities with each other to enhance AS across a region; share effective methods for AS implementation and promote guidance and best practices
Communication strategy to reach and maintain relationships with facilities and organization with similar goals. Raise Public awareness of antimicrobial overuse and potential risks	Develop and maintain useful website Build and use list-serves to share info. Incorporate ASP and AU into departmental reports and improvement plans Reach out to public regarding appropriate AU and issue of AR Media presence Assist facilities with patient/family education tools
Policy to support antimicrobial stewardship programs

Aligns with: CDC ELC K2 State Antibiotic Resistance Program (2015); ASTHO Combatting AR: Policies to Promote ASPs (2015); CSTE Recommendations for Strengthening AS in the US, including the Role of the State and Local Health Departments (2014); PHF Public Health Role in AS (2013); The role of public health in antimicrobial stewardship in healthcare. Clin Infect Dis. 2014;59:S101-3

(LPollack – Components AS implementation)