Antibiotic Stewardship Programs in Hospital & Outpatient Settings

Lauri A. Hicks, DO, captain, US Public Health Service, director, Office of Antibiotic Stewardship, medical director, Get Smart: Know When Antibiotics Work, Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, discusses antibiotic stewardship programs in both the hospital and outpatient settings.

Interview Transcript (slightly modified for readability)

“Programs in hospitals are going to look quite a bit different than your antibiotic stewardship activities in the outpatient setting. So, I’ll start with hospitals; in hospitals, typically, your antibiotic stewardship team is comprised of a physician, a pharmacist, and ideally, multiple members of the healthcare team throughout the hospital. That means, we would really like to have nursing representation [and] representation from the critical care community within that hospital. We also believe that having a good connection and good relationships with the microbiology laboratory and the laboratory folks makes it more feasible to do stewardship. So, without a doubt, it requires the engagement of a number of different types of people throughout that system.

What I want to reinforce is that we view every single provider in the hospital as an antibiotic steward, whether it’s a hospitalist admitting the patient to the hospital to treat a patient with community-acquired pneumonia, the nurse who is administering the drug at the bedside, the medical student who is coming in and checking in on that patient, or their attending who’s also coming in and actually supervising that care. At every step of the way we are hoping and really trying to instill the concept that each and every healthcare provider can play a role in stewardship.

That is also the same for the outpatient space. So, whether we’re talking about a doctor in an outpatient clinic who runs a general practice clinic, or we’re talking about a nurse practitioner in a retail clinic, or a physician assistant working in an emergency room; all of these folks are critical for improving how antibiotics are used. In an outpatient setting, because there is not the same kind of infrastructure as there is in a hospital setting, we are looking toward individual clinicians to really take on this [role of stewardship] and make a commitment to practicing high quality prescribing. We’re also asking for facilities and health systems with clinics to make sure that they have principles and activities in place that facilitate appropriate antibiotic prescribing.”