Healthcare-associated infections due to multiply-resistant organisms cause significant morbidity and mortality in acute care settings. Antimicrobial stewardship programs (ASP) are one practice used to limit resistance and are especially crucial given the lack of new antimicrobials in development. The aim of this study is to describe the presence of ASP in a national sample of acute care hospitals and examine the engagement of Infection Preventionists (IPs) in antimicrobial stewardship activities.
In winter of 2018, we conducted an electronic survey of IPs working in acute care hospitals who are members of the Association of Professionals in Infection Control and Epidemiology (APIC). An initial invitation email was sent out directly by APIC and reminders were included in a weekly e-blast over a period of 6 weeks. Descriptive statistics were computed to describe the ASP in place, as well as IP engagement in these programs.
Overall, 255 IPs participated in the survey. Of these, the majority (79%) reported the presence of an established ASP; another 13% reported that ASP activities are conducted without a formalized ASP. The presence of specific ASP policies and activities are presented in the Figure. The majority (88%) reported that an IP was a member of the core ASP team. Few IPs reported budgeted financial support and specific time commitment in the IP job description for ASP activities (14% and 9%, respectively). The majority of respondents agreed with the statement that ASP cannot be successful without a strong infection prevention and control (ICP) program (87%); however, only half agreed that the IP role in ASP is well-defined (46%) and that IPs have adequate AS knowledge to participate in ASP activities (59%). The most frequently reported barriers for IP participation in ASP included: time (41%), no allocated FTE (23%), no defined IP role or responsibility (20%) and lack of knowledge (18%).
This survey represents a current snapshot of the implementation of ASP policies in U.S. acute care hospitals and identifies important barriers to IP engagement in ASP activities. Future work should focus how best to facilitate IP participation and engagement in ASP activities.