Antimicrobial Stewardship – Frequently Asked Questions

Below are questions and answers related to Antimicrobial Stewardship programs, including their implementation, interventions, methods of measuring outcomes and other ASP topics. If you have additional ASP related questions, please contact us at asp@oahpp.ca.

Q.1: Where can I go for ASP training?

The following associations provide education about Antimicrobial Stewardship including ASP principles and how to develop and maintain a program and/or core ID knowledge.

• Antimicrobial Stewardship - Optimization of Antibiotic Practices (Stanford University School of Medicine)
• Making a Difference in Infectious Diseases (MAD-ID)
• Society of Infectious Disease Pharmacists (SIDP)
• The Society for Healthcare Epidemiology of America (SHEA)
• CDC Training on Antimicrobial Stewardship (CDC)

Q.2: Where can I find additional resources on how to implement an ASP?

The following associations provide toolkits, resources or how-to guides on implementing and maintaining a Stewardship Program:

• American Hospitals Association: Physician Leadership Forum
• Antibiotic Awareness
• Association of Medical Microbiology and Infectious Disease Canada
• Australian Commission on Safety and Quality in Healthcare – Antimicrobial Stewardship Initiative
• California Antimicrobial Stewardship Program Initiative
• CDC Get Smart for Healthcare: Implementing and Improving Stewardship Efforts
• CDC The Core Elements for Antimicrobial Stewardship in Nursing Homes
• CDC The Core Elements for Outpatient Antimicrobial Stewardship
• Do Bugs Need Drugs
• Joint Commission International Antibiotic Stewardship Toolkit
• Sinai Health System/University Health Network: Antimicrobial Stewardship Program

Q.3: Where can I find more information on data collection and ASP metrics?

The following links provide information on the types of metrics that can be used for an ASP and some tools and resources on how to collect the data.

• Antimicrobial Stewardship Program Metric Examples (PHO). Highlights common metrics used in hospital settings, sample calculations and their benefits and disadvantages.
• Andrawis, M and Carmichael, J. A suite of inpatient and outpatient clinical measures for pharmacy accountability: Recommendations from the Pharmacy Accountability Measures Work Group. Am J Health-Syst Pharm. 2014; 71:e99-108. (Identifies 21 quality measures to demonstrate pharmacist accountability for their services.  Antimicrobial stewardship is one of the 4 clinical areas, with in-patient measures for CAP and surgery).
• Antimicrobial Consumption Tool - The AMC Tool is a simple computer tool to measure antimicrobial consumption in hospitals and hospital wards. It transforms aggregated data provided by hospital pharmacies (generally as a number of packages or vials) into meaningful antibiotic utilization rates.
• Davey, P et al. Cochrane Database of Systematic Reviews (2017) Issue 4. Interventions to improve antibiotic prescribing practices for hospital inpatients. (identifies all relevant outcome metrics and ASPs ability to impact them)
• McGregor JC and Furuno JP. Optimizing Research Methods Used for the Evaluation of Antimicrobial Stewardship Programs. Clin Infect Dis. (2014); 59 (suppl 3): S185-S192. (this review provides guidance and recommendations for the design of studies to evaluate the impact of ASP interventions on patient and microbial outcomes)
• World Health Organization (WHO): ATC/DDD Index (can be used to look up ATC codes and DDD values)

Q.4: Where can I go to for guidelines or position statements on antimicrobial stewardship?

The following are associations that provide recommendations about antimicrobial stewardship.

• American Society of Health-System Pharmacists: ASHP Statement on the Pharmacist’s Role in Antimicrobial Stewardship and Infection Prevention and Control
• Association for Professionals in Infection Control and Epidemiology (APIC) and Society for Healthcare Epidemiology of America (SHEA): Antimicrobial stewardship: a collaborative partnership between infection preventionists and health care epidemiologists
• Canadian Pediatric Society: Antimicrobial stewardship in daily practice: managing an important resource
• Infectious Diseases Society of America (IDSA) and  Society for Healthcare Epidemiology of America (SHEA): Implementing an antibiotic stewardship program
• National Institute for Health and Care Excellence (NICE): Antimicrobial stewardship: systems and processes for effective antimicrobial medicine use