Antimicrobial Stewardship

State Examples of Activities

To provide examples and encourage peer-to-peer learning, we have listed state health agencies that highlight the following antimicrobial stewardship activities. Like the recommendations in the ASTHO report, these activities demonstrate a range of options for engagement across increasing levels of capacity (states are listed in alphabetical order in each section). We encourage you to contact colleagues in these agencies for additional information.

AMR Information

Michigan: Comprehensive information on CRE, including state surveillance information and online presentations.
Washington: Evidence-based guidelines for addressing antibiotic resistant organisms focused on MRSA.
Wisconsin: Comprehensive information on CRE for both providers and patients including state-wide surveillance.

Antimicrobial Stewardship Websites

California: Resources available on website for prescribers.
South Dakota: Comprehensive information on antibiotic stewardship with presentations archived and available online.
Virginia: Comprehensive listing of resources on antimicrobial stewardship in hospitals and LTCFs.

Antimicrobial Stewardship Educational Tools/Toolkits

Arizona: Educational slide sets comprehensively address implementation of ASPs and Cumulative Antibiogram Toolkit.
Minnesota: State-focused ASP Implementation Toolkit.
North Dakota: Educational trainings and presentations.
Vermont: State-based report on antimicrobial stewardship in emergency departments.

Partnerships to Promote Stewardship

Maine: QIO, hospitals, pharmacy association, Public Health Foundation, medical association, and health facilities association (for LTCFs) and outpatient physicians.
Massachusetts: Massachusetts Coalition for the Reduction of Medical Errors has support from a large number of organizations including hospitals and hospital systems, hospital, pharmacy, and nursing associations, senior care groups, APUA, risk management foundations, insurers, and regulatory agencies.
Minnesota: Minnesota Council of Health Plans, Blue Cross and Blue Shield, HealthPartners, Medica, medical and pharmacists associations, Minute Clinic, Stratis Health, and University Care.
South Dakota: Indian Health Services, state medical association, QIO, hospital association, pharmacy association, state infection control council, hospitals, LTCFs, medical schools, and clinics.

Hospital Antimicrobial Stewardship Recognition

California: Spotlight on ASP; lists hospitals and ASP tier they have attained as well as contact person at each hospital to serve as mentor.
Georgia: Honor Roll for Antibiotic Stewardship; acknowledges ASP work being done by hospitals.

Antimicrobial Stewardship Outreach to LTCFs

Illinois: Project assessing antimicrobial stewardship in skilled nursing facilities across Illinois with online surveys and in-person interviews. (link to patient safety web page)
Florida: Demonstration project with a system of skilled nursing facilities to implement antimicrobial stewardship focusing on urinary tract infections and asymptomatic bacteriuria. (link to AMR web page)
Maine: Implementing Public Health Foundation's Public Health Antibiotic Stewardship Driver Diagram with LTCFs.
New York: Greater New York Hospital Association implemented a project with state public health funding and United Hospital Fund to build an ASP toolkit for acute care hospitals and their LTCFs.

Outpatient Antimicrobial Stewardship and Community Health Education

California: The California Medical Association Foundation's AWARE program has published concise guidelines on treatment of upper respiratory tract infections which are updated annually.
Michigan: Michigan Antibiotic Resistance Reduction (MARR) Coalition has educated healthcare providers and the community on appropriate antibiotic prescribing in outpatient settings since 1997.
Oregon: Oregon Alliance Working for Antibiotic Resistance Education (AWARE) is a statewide coalition that promotes the appropriate use of antibiotics. AWARE also provides continuing medical education for outpatient prescribers who use antibiotics judiciously.

Antimicrobial Stewardship Collaboratives

Illinois: Worked with five Chicago-area hospitals in 2011-2012 to strengthen ASPs, identify common challenges and strategies for success, and develop a framework for hospital stewardship assessment. In 2013, began working with six other hospitals to enhance stewardship efforts via pharmacy-led interventions and evaluate use of NHSN Antimicrobial Use Option. (link to patient safety web page)
Massachusetts: Created Cross-Continuum Approach to Antibiotic Stewardship to decrease inappropriate use of antibiotics in LTCFs by targeting testing and treatment of urinary tract infections; worked with teams from 30 LTCFs and nine hospital emergency departments to increase knowledge and facilitate improved decisionmaking.
Minnesota: Minnesota Antibiotic Resistance Collaborative (MARC) is a broad-based collaborative of health care organizations committed to decreasing antibiotic resistance in Minnesota and promoting the appropriate use of antibiotics.
Oregon: In 2012, QIO, SHA, and area academic facilities started partnering to work with 13 hospitals to enhancing ASPs with learning sessions and onsite physician and pharmacist assessment to implement IHI's Driver Diagram.