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
The percent of population in the US that are labelled as penicillin allergic
What is 10% or more (higher in elderly patients)
This core element addresses the processes in place improve antibiotic use. Skilled nursing facilities need to do at least one.
What are Actions
The CDPH AS Honor Roll is a three year designation. There are three tiers (bronze, silver, gold) that can be achieved during a designation period. The silver tier requires the facility to show this.
What is demonstration of ways the antibiotic stewardship program improved facility outcomes such as decreased bacterial resistance rates or improved prescribing behavior.
Use of this facility- specific document can help assure the selection of appropriate empiric treatment of common infections.
What is a facility-specific treatment guideline
Common routine empiric treatment for uncomplicated UTI in a patient without a recent history of an MDRO includes these two antibiotics
What is nitrofurantoin and cephalexin
The percent of the population in the US that are truly allergic to penicillin
What is less than 1%
Starting in 2022 the CDC issued these 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 document is needed to create a facility-specific treatment guideline.
What is an antibiogram
What is the best use of ciprofloxacin for urinary tract infections
What is treatment of Pseudomonas aeruginosa in a patient with UTI symptoms
These are the two explanations for the disparity between the percent of patients labelled as penicillin allergic (>10%) and the percent of patients truly 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 Priorities
The practice of reviewing antibiotic treatment courses 48-72 hours after therapy initiation to decide whether antibiotics can be discontinued or de-escalated.
What is a Time Out (if done by the prescriber) or Prospective Audit and Feedback (if done by the AS team)
When other treatment options are available, 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 reports
What is 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
What is prevention of 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 in a "low-risk" patient.
What is an oral amoxicillin challenge.