News-Newsletter Vol. 29 No. 1

California’s Model for Antimicrobial Stewardship: Legislation, Consultation, and Accountability

Kavita Trivedi, M.D.,
Public Health Medical Officer
California Department of Public Health

The Healthcare Associated Infections (HAI) Program of the California Department of Public Health (CDPH) has developed a statewide Antimicrobial Stewardship Program (ASP) Initiative in order to strengthen and promote optimization of antimicrobial utilization in California health care facilities. The purpose of an ASP is to promote the appropriate use of antimicrobials by selecting the appropriate agent, dose, duration and route of administration in order to improve patient outcomes, while minimizing toxicity and the emergence of antimicrobial resistance. Although guidelines exist for developing ASPs, there is limited information on practical implementation of these guidelines, particularly in resource limited settings.

   California Senate Bill 739 (Health & Safety Code §§ 1288.5 to 1288.9 [2006]) mandated that, by January 1, 2008, CDPH require general acute care hospitals to monitor and evaluate the utilization of antibiotics and assemble a quality improvement committee to oversee the judicious use of these medications. While hospitals were aware of this mandate, they were left to implement programs on their own. In December 2009, the HAI Program was staffed, and by February 2010, a physician was identified to spearhead this initiative. The Licensing and Certification Program at CDPH now assesses hospitals for compliance with this mandate on routine patient licensing surveys.

   Current program activities include assessing ASPs in California facilities. With information on specifics of ASPs throughout the state, CDPH is developing evidence-based recommendations on how to implement and strengthen ASPs, given available resources and facility attributes. As of March 2011, preliminary information from 229 acute care hospitals indicates that 48% have a current ASP in place and 28% are planning one. Furthermore, 10% of the 229 hospitals developed an ASP because of SB 739, underscoring the positive effect of statewide legislation. Of hospitals assessed, 177 self-identified community hospitals indicate that 45% currently have an ASP and 29% have one forthcoming. Many community hospitals, previously thought to have limited programs regarding the prudent use of antimicrobials, in fact represent best practices regarding antimicrobial use optimization since ASPs help utilize existing resources efficiently.

   Other program activities include providing consultative advice and practical evidence to facilities in order to gain administrative and pharmacy buy-in. CDPH is also developing regional and special setting collaborations among hospitals with similar difficulties, such as long-term acute care hospitals, and/or healthcare systems so that facilities can learn from one another and develop system-wide ASPs. CDPH is developing statewide recommendations regarding internal and external outcome measures for ASPs. CDPH is also committed to educating long-term care facilities on the benefits of antimicrobial use optimization and is collaborating on research proposals to better study the efficacy of antimicrobial oversight in the long-term care setting. Finally, CDPH is working to expand current statewide legislation/regulation to specify characteristics of ASPs required in California acute care hospitals.

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