If we do not have an in-house ID physician, how can we build a successful ASP?
Giulio Didiodato: Organizations without an infectious disease physician on staff can still have an effective ASP. First, it is important to identify an antimicrobial stewardship champion to lead the program. While a champion could be a physician, many organizations have pharmacists (ID or non-ID trained) or infection control practitioners (ICP) as ASP champions. When an infectious disease physician is not available, the ASP should be focused on clinical syndromes whose management is explicitly defined in evidence-based practice guidelines and antibiotic guides, such as community-acquired pneumonia or urinary tract infections. This is critical because organizations only want champions with significant clinical expertise making recommendations about complicated patients.
Having a strong relationship with the microbiology department is also important. The department can provide antibiograms which are used to guide empiric therapy and create institution-specific care pathways and protocols. Ongoing communication with the department can be incredibly important for an effective ASP, as it facilitates early identification of pathogens. This allows the team to identify potential bug-drug mismatches in a more timely fashion improving patient safety and quality of care.
What important qualities does a non-ID specialist champion need to be successful?
Giulio Didiodato: A non-ID specialist champion needs to demonstrate a significant amount of trust in the organization and good relationships with physician groups; he or she should be respected at the clinical level. It is important to have a basic working knowledge of common clinical infectious diseases syndromes and antimicrobials, but trust and good relationships are essential.
Are there examples of successful ASPs that do not have an in-house ID specialist?
Giulio Didiodato: There are many examples of successful ASPs that do not have in-house ID specialist expertise (see the exploring ASP in action webpage and the webcast “Unusual Suspects - ASP Champions from Non-Infectious Diseases/Pharmacy Backgrounds”). A large regional program is being rolled out in the North Simcoe Muskoka Local Health Integration Network involving five hospital corporations that will utilize a locally developed ASP data collection tool. The programs will be supported by an in-house pharmacist or ICP champion and remotely by an ID physician, who can help with more complicated recommendations and evaluations.
Dr. Giulio DiDiodatoGiulio DiDiodato is an infection prevention and control physician at Public Health Ontario. He is also medical consultant and lead investigator for the ASP at the Royal Victoria Regional Health Centre (RVH), where they currently have two prospective, REB- approved studies underway to assess the effectiveness of the program after a two-year period of implementation.