CDC Core Elements of ASPs
This Core Element supports the ASP by assigning AS to job descriptions and annual performance reviews.
What is Leadership Commitment
In the fall of 2020 CDPH instituted the antimicrobial stewardship Honor Roll for hospitals, LTACHs and CAHs. In 2026/27 the CDPH plans to begin an Honor Roll program for this healthcare setting
What are skilled nursing facilities.
The three most common ways antibiotics are misused or overused.
1) Treatment of bacterial colonization
2) Treatment duration is too long
3) Treatment is too broad spectrum
The most common cause of UTI
What is E.coli
What percent of the population is labelled as penicillin allergic
What is 10% or more (higher in elderly patients)
This core element addresses the activities the hospital does to improve antibiotic use and prevent antimicrobial resistance. Skilled nursing facilities need at least one according to the CDC
What is Actions
The CDPH AS Honor Roll is a three year designation. There are three honor rolls tiers that can be achieved during a designation period. The highest tier is the gold designation which requires this type of project.
What is collaboration/partnership with an outside facility to improve antimicrobial stewardship at the outside facility.
Use of this facility- specific document can assure the selection of appropriate empiric treatment at the start of therapy.
What is a facility-specific treatment guideline
The most common empiric treatment selection for UTI in a patient without a recent history of an MDRO
What is nitrofurantoin and cephalexin
What percent of patients are truly allergic to penicillin
What is less than 1%
Starting in 2022 the CDC issued specific ways in which 6 of 7 core elements should be performed by hospital AS programs.
What are the core element priorities.
Hospitals can collaborate with skilled nursing facilities or dialysis units within the same RHN to strengthen facility core element implementation to earn this designation.
What is the CDPH AS Honor Roll "Gold" designation.
This important document is needed to create a facility-specific treatment guideline.
What is an antibiogram
What is the best use of ciprofloxacin for a UTI
When the culture shows Pseudomonas aeruginosa and the patient has UTI symptoms
These are the two main reasons patients are labeled as allergic to penicillin (10%) but are not actually allergic to penicillin (<1%)
What are 1) penicillin allergies go away over time and 2) most allergies are actually drug side effects
In California this core element priority has the lowest implementation rate.
What is Reporting
The practice of reviewing antibiotic treatment courses (usually by the provider) 48-72 hours after therapy initiation to decide whether antibiotics can be discontinued or de-escalated.
What is a Time Out
This antibiotic should be avoided due to the following severe side effects: agitation/confusion, cardiac arrythmias, CDAD and tendon rupture
What is a fluoroquinolone
The three reasons a penicillin allergy label is disadvantageous for the patient.
What is increased risk for 1) antibiotic failure, 2) side effects and 3) antimicrobial resistance.
The hospital core element priority for Reporting requires these two types of reports
What is provide 1) antibiotic use feedback reports to prescribers or care units at least annually and 2) monitor adherence to at least one facility-specific treatment guideline
This is THE goal of antibiotic stewardship
To prevent antimicrobial resistance
This is the only oral antibiotic that can be used to treat Pseudomonas aeruginosa.
What is ciprofloxacin (and levofloxacin)
This simple procedure can be done to determine whether a patient is truly allergic to penicillin. Any trained prescriber in any healthcare setting can do this.
What is an oral amoxicillin challenge for patients with a low risk penicillin allergy history.