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A Tale of Two Assessments – How Are Virginia Hospitals Meeting the Core Elements of Antibiotic Stewardship?

Posted By Mefruz Haque and Andrea Alvarez, Friday, August 26, 2016
Updated: Friday, August 26, 2016

The emergence of antibiotic-resistant organisms has elevated antibiotic use and misuse to a national topic of conversation. In early 2015, the National Action Plan to Combat Antibiotic Resistant Bacteria was released, making antibiotic stewardship a federal priority. One goal of this plan was to have antibiotic stewardship programs (ASPs) in 100% of the nation’s hospitals by 2020. The Centers for Disease Control and Prevention (CDC) has published best practice guidelines that outline seven core elements of hospital ASPs. To evaluate hospital capacity, the CDC developed a Core Elements survey instrument, components of which are included in the National Healthcare Safety Network (NHSN) Annual Hospital Survey.


Aligning with national efforts, Virginia (VA) and Maryland (MD) formed the VA/MD Antibiotic Stewardship Affinity Group, comprised of stakeholders from public health, pharmacy, infection prevention (IP), quality improvement and clinical communities. Its first task was to characterize the current state of state antibiotic stewardship efforts according to the CDC Core Elements. In October 2015, an assessment tool developed by the Affinity Group (the VA/MD Antibiotic Stewardship Baseline Assessment) was sent to pharmacy and IP contacts at 132 acute care, critical access, and children’s hospitals in both states. Eighty-five hospitals (33 in MD, 52 in VA) responded to the assessment (response rate = 64%).


A comparative analysis was conducted among Virginia hospital respondents that evaluated differences in results between the VA/MD Baseline Assessment and the 2014 NHSN Annual Hospital Survey. Responses were matched by Virginia hospital and survey question; chi-square tests were used to determine statistical significance of percentages.



Respondents of the VA/MD Baseline Assessment reported meeting core elements more frequently. Comparisons of the two assessments yielded significant differences in specific survey questions. Hospitals responding to the VA/MD Assessment reported lower frequencies of having a formal written statement of leadership report, using an antibiotic time out, and sharing an annual antibiogram.



After matching results by hospital and specific survey question, similar percentages were observed in general. However, significant differences were seen for leadership support and education.



For the VA/MD Assessment, the total number of hospitals meeting all seven CDC core elements was stratified across key hospital characteristics: region, medical school affiliation, and hospital size. Results showed that the Northern health region had the highest percentage (71.4%) of hospitals that had ASPs.


This analysis identified gaps in Virginia hospital ASPs, particularly with respect to leadership support and educating clinicians about optimal prescribing. Differences in response rates and key variables suggest variability in responses between survey types, even among the same Virginia hospitals. Virginia plans to use the results from the assessments to develop targeted educational programs and resources to strengthen existing ASPs as well as support new ones.



Mefruz Haque, MPH, CPH is CDC/CSTE Applied Epidemiology fellow at Virginia Department of Health and Andrea Alvarez, MPH is healthcare-associated infections program manager at the Virginia Department of Health. For more information about the Applied Epidemiology Fellowship, visit the CSTE AEF webpage.

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