STRATEGIES TO PREVENT AND CONTROL THE EMERGENCE AND SPREAD OF ANTIMICROBIAL-RESISTANT MICROORGANISMS IN HOSPITALS - A CHALLENGE TO HOSPITALLEADERSHIP

Objective-To provide hospital leaders with strategic goals or actions likely to have a significant impact on antimicrobial resistance, outli ne outcome and process measures for evaluating progress toward each go al, describe potential barriers to success, and suggest countermeasure s and novel improvement strategies. Participants.-A multidisciplinary group of experts was drawn from the following areas: hospital epidemio logy and Infection control, infectious diseases (including graduate tr aining programs), clinical practice (including nursing, surgery, inter nal medicine, and pediatrics), pharmacy, administration, quality impro vement, appropriateness evaluation, behavior modification, practice gu ideline development, medical informatics, and outcomes research, Repre sentatives from appropriate federal agencies, the Joint Commission on Accreditation of Healthcare Organizations, and the pharmaceutical indu stry also participated. Evidence.-Published literature, guidelines, ex pert opinion, and practical experience regarding efforts to improve an tibiotic utilization and prevent and control the emergence and dissemi nation of antimicrobial-resistant microorganisms in hospitals. Consens us Process.-Participants were divided into two quality improvement tea ms: one focusing on improving antimicrobial usage and the other on pre venting and controlling transmission of resistant microorganisms. The teams modeled the process a hospital might use to develop and implemen t a strategic plan to combat antimicrobial resistance. Conclusions.-Te n strategic goals and related process and outcome measures were agreed on, The five strategic goals to optimize antimicrobial use were as fo llows: optimizing antimicrobial prophylaxis for operative procedures; optimizing choice and duration of empiric therapy; improving antimicro bial prescribing by educational and administrative means, monitoring a nd providing feedback regarding antibiotic resistance; and defining an d implementing health care delivery system guidelines for important ty pes of antimicrobial use, The five strategic goals to detect, report, and prevent transmission of antimicrobial resistant organisms were as follows. to develop a system to recognize and report trends in antimic robial resistance within the institution; develop a system to rapidly detect and report resistant microorganisms in individual patients and ensure a rapid response by caregivers; increase adherence to basic inf ection control policies and procedures; incorporate the detection, pre vention, and control of antimicrobial resistance into institutional st rategic goals and provide the required resources; and develop a plan f or identifying, transferring, discharging, and readmitting patients co lonized with specific antimicrobial-resistant pathogens.