Allegheny County Health Department Assesses Antibiotic Stewardship

By Kristen Mertz, MD, MPH, Allegheny County Health Department, Pennsylvania

This story originally ran in NACCHO’s Stories from the Field.

Overuse and misuse of antibiotics contribute to the growing problem of antibiotic resistant organisms, which are estimated to cause over 20,000 deaths each year in the United States. Bacteria that were once easy to treat are developing resistance to antibiotics, leading to more severe and more costly infections.

To assess efforts by healthcare facilities to promote judicious use of antibiotics, the Allegheny County Health Department (ACHD) conducted an online survey of stewardship programs at acute care hospitals, long-term care facilities (LTCFs), and outpatient facilities in the spring of 2017. Later that year, ACHD followed the survey with a half-day workshop for hospitals and LTCFs in June, as well as a workgroup meeting in November for selected outpatient facilities. The results were as follows:

    • Of 26 acute care hospitals contacted during the survey, 89% (n=18) completed the questionnaire. Of the 18 respondents, 16 (89%) had a formal antibiotic stewardship program (ASP). Among these, the most commonly reported antibiotic restriction methods were mandatory infectious disease consults (81%), retrospective audits of prescribed antibiotics (81%), and required pre-approval of selected antibiotics (63%). More than half of the hospitals reported staff and information technology constraints as barriers to effective stewardship./li>
    • Of 65 LTCFs contacted, 49% (n=32) competed the survey, but only 15 (47%) reported having an ASP.
    • Among outpatient facilities completing the survey, two (40%) of five urgent care centers and eight (31%) of 26 ambulatory surgery centers had an ASP.
    • None of the seven federally qualified health centers (FQHCs) or four multisite pediatric practices had an ASP.

With the support of the Pennsylvania Department of Health (PADOH), ACHD held workshops for local facilities to encourage development and refinement of ASPs. The workshop in June was attended by approximately 100 persons from hospitals and LTCFs. The focus of roundtable discussions was the implementation of the Centers for Disease Control and Prevention’s seven core ASP elements. Participants shared their successes and barriers with the help of facilitators. The workgroup meeting in November for pediatrics practices, urgent care centers, and FQHCs focused on use of evidence-based protocols for treatment of common conditions.

Our simple online survey proved useful for a quick assessment of our county’s stewardship programs. The subsequent workshops were well-received as facilities appreciated the opportunity to learn from others’ experiences. Attendance was much lower at the outpatient workshop, possibly because there is no requirement for stewardship at these facilities and it may be lower on the list of priorities. On the other hand, LTCFs are quickly developing ASP policies to comply with new regulations but they face implementation challenges. ACHD is planning another workshop for LTCFs in June 2018, again with the support of PADOH. The upcoming workshop will focus on protocols for the diagnosis and treatment of urinary tract infections and the measurement of antibiotic use and resistant organisms.