Becker's Clinical Quality & Infection Control

42 ANTIBIOTIC RESISTANCE AND STEWARDSHIP CMS' Proposed Rule for Hospitals: Reduce Antibiotic Use or Exit Medicare By Heather Punke C MS released a proposed rule change to its Conditions of Partici- pation June 13 which would, among other changes, require hospitals to imple- ment antibiotic stewardship programs to participate in Medicare and Medicaid. "We believe that benefits of the proposed revisions would include reduced incidence of hospital-acquired conditions, including reduced incidence of healthcare-associated infections; reduced inappropriate antibiotic use; and strengthened patient protections overall," the rule change reads. In addition to requiring a hosptialwide infection prevention and control program and antibiotic stewardship program, CMS' proposed rule change would require hospi- tals to appoint designated, qualified leaders for those programs. Antibiotic overuse and misuse are a "very important and serious public health problem in the U.S.," Arjun Srinivasan, MD, associate director for HAI prevention programs within the CDC, has said. Drug-resistant bacteria cause 2 million illnesses and 23,000 deaths annually, and have been even more of a focus aer an untreatable superbug was identified for the first time in the U.S. in April. Studies have shown stewardship programs may lower the use of antibiotics by almost 20 percent and have linked such programs to a drop in infection rates. In a statement to e Wall Street Journal, the American Hospital Association said, "e emphasis on good infection control and antibiotic stewardship is consistent with the important work hospitals are doing to reduce infections and preserve the effec- tiveness of our current antibiotics. We join CMS in recognizing the importance of these programs and are always looking to make them more effective." Unrelated to antibiotic stewardship or infection control, the proposed rule change would also require hospitals to establish a policy prohibiting discrimination on the base of race, color, religion, national origin, sex and gender identity, sexual orientation, age or disability to participate in Medicare and Medicaid. CMS is accepting comments on the pro- posed rule through Aug. 15. n Antibiotic Stewardship Programs at VA Facilities: 6 Things to Know By Shannon Barnet A ntibiotic stewardship program implementation var- ies significantly across Veterans Affairs facilities in the U.S., but a study published in Infection Control & Hospital Epidemiology in May shows having a clinician with formal infectious diseases training may help. To determine variations in antimicrobial stewardship structure and practices, researchers distributed a web- based survey to 130 inpatient Veterans Affairs facilities in 2012. Highlighted below are six findings from the surveys. 1. Of the 130 facilities surveyed, 29 (22 percent) had a formal policy establishing an antimicrobial stewardship program and 12 (9 percent) had an approved antimicrobi- al stewardship program business plan. 2. Forty-nine facilities (38 percent) had an antimicro- bial stewardship team. Of those teams, 34 included a clinical pharmacist with formal training in infectious diseases. 3. The stewardship activities that varied most across the VA facilities include yearly antibiogram development, for- mulary restrictions, antimicrobial duration stop orders and written clinical pathways for specific medical conditions. 4. Having at least one full-time infectious disease physician, an infectious disease fellowship program or a clinical phar- macist with formal infectious disease training was associated with decreased antimicrobial usage. 5. Conducting frequent, systematic patient-level reviews of antimicrobial use and having a policy in place to address antimicrobial use for Clostridium difficile infections was also linked to decreased antimicrobial usage. 6. Conversely, having stop orders for antimicrobial dura- tion was actually associated with increased antimicrobial use. n

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