Antimicrobial Stewardship in Ambulatory Care and Ambulatory Surgery Settings

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Antimicrobial stewardship (AMS) refers to coordinated interventions designed to improve and measure the appropriate use of antimicrobials by promoting the selection of the optimal antimicrobial drug regimen, dose, duration of therapy, and route of administration.

For the past few years, a major emphasis has been placed on developing and maintaining AMS programs in acute care settings as well as outpatient centers.

AMS efforts at the federal level began in September 2014 when President Obama issued an executive order to combat antibiotic resistant bacteria. The order detailed plans for reducing the risk of resistance through a number of initiatives, including introducing AMS into ambulatory care. Ambulatory settings include, but are not limited, to outpatient clinical practices, ambulatory surgery centers (ASCs) and dialysis centers.

In March 2015, the White House issued a national action plan which includes an extensive list of goals and expectations. By 2020, significant outcomes in this area will include:

  • Establishment of antimicrobial stewardship programs in all acute care hospitals and improved stewardship across all healthcare settings.
  • Reduction of inappropriate antibiotic use by 50% in outpatient settings and 20% in inpatient settings.
  • Establishment of State Antibiotic Resistance Prevention (Protect) Programs in all 50 states. 

In June 2016, The Joint Commission released a new standard relating directly to AMS: medication management (MM) standard MM.09.01.01. This standard will be enforced in January 2017 for all acute care hospitals, critical access hospitals and nursing care centers. According to The Joint Commission, "This standard was developed following the White House Forum on Antibiotic Stewardship, held on June 2, 2015. At the forum, The Joint Commission joined major health care organizations, food companies, retailers, and animal health organizations at the forum to express commitment for implementing changes over the next five years to slow the emergence of antibiotic-resistant bacteria, detect resistant strains, preserve the efficacy of existing antibiotics, and prevent the spread of resistant infections."

Infection Control Consulting Services (ICCS) stresses the need for ASCs and other outpatient facilities to develop their AMS programs without delay as the White House and accreditation agencies ramp up their efforts to implement changes in antimicrobial use. The Joint Commission will more than likely hold its outpatient facilities to the same standards as inpatient and nursing care centers, and it would not be surprising to see other accreditation agencies (e.g., AAAHC) add an AMS standard(s).

Looking for assistance with developing compliant AMS programs? Contact ICCSs, a national leader in developing compliant infection prevention programs for a wide range of facility types, including outpatient care centers, ASCs and hospitals.

Phenelle Segal, RN, CIC, FAPIC

Phenelle Segal, RN, CIC, FAPIC, is the founder and president of Infection Control Consulting Services LLC (ICCS). Phenelle has more than 30 years' experience providing customized comprehensive infection control and prevention services to healthcare facilities nationwide. Her services focus on assisting hospitals, ambulatory surgery centers, dental office and oral surgery practices, doctor's offices, nursing homes and other organizations with implementing and maintaining an infection control program that: complies with The Joint Commission, AAAHC, Centers for Medicaid and Medicare Services (CMS) and other regulatory agencies; respond to situations of noncompliance; and improve the processes for reducing risk.