Infectious Disease & Hospital

Epidemiology
Alessandra Felix, America Zavala, Annie Rittenhouse, 
Joshua Casas, Luis Chavez, & Yamilet Hernandez
Learning Objectives
Objective 1 Objective 2 Objective 3

Describe the methods Analyze the findings that the
that were used by the Division of Healthcare
Division of Healthcare Quality Promotion team
Quality Promotion team found using the 2014
used in order to find National Healthcare Safety
what steps acute care Network Annual Hospital
hospitals were taking to Survey for Antibiotic
help with Antibiotic Stewardship Programs in
stewardship. U.S. for Acute Care
Hospitals.
Detail how the journal,
Antibiotic Stewardship
Programs in U.S. Acute
Care Hospitals: Findings
From the 2014 National
Healthcare Safety
Network Annual Hospital
Survey relates to
Epidemiology.
Article Citation
● Antibiotic Stewardship Programs in U.S Acute Care Hospitals: Findings
from 2014 National Healthcare Safety Network Annual Hospital Survey

● Division of Healthcare Quality Promotion, Centers for Disease Control and

Prevention, Atlanta, Georgia

● Pollack, L. A., van Santen, K. L., Weiner, L. M., Dudeck, M. A., Edwards,

J.R., & Srinivasan, A. (2016). Antibiotic Stewardship Programs in

U.S. Acute Care Hospitals: Findings From the 2014 National
Healthcare Safety Network Annual Hospital Survey. Clinical
Infectious Diseases : An Official Publication of the Infectious Diseases
Society of America, 63(4), 443–449.
https://doi.org/10.1093/cid/ciw323
 Introduction
● Objective:
“To understand the variation of Antibiotic Stewardship Program (ASP’S) by
hospital characteristics and state and to explore the association between
infrastructure (support, staffing) and ASP implementation (actions, tracking,
reporting, and education)”. (Pollack et al, 2015, p.444)

● Hypothesis:

ASP infrastructure is the most effective predictor to sustain efforts against

antibiotic resistance in hospitals.
Interesting Fact!!
Clostridium difficile - a bacterium that can cause symptoms ranging from
diarrhea to life-threatening inflammation of the colon. Commonly affects older
adults in hospitals or in long-term care facilities and typically occurs after use
of antibiotic medications
Who Are They?

● People
4184 Acute Care Hospitals

● Place
National hospitals

● Time

2014 National Healthcare Safety Network Annual Hospital Survey

Method
● Design
Univariate Analysis - assess stewardship infrastructure and practices by facility
characteristics
MultiVariate Models - determined factors associated with meeting all ASP core elements
● Population Sample -4184 US hospitals, survey is usually completed by hospital
infections specialist. Encouragement was given to have pharmacist,physicians, pharmacy and
therapeutics committee.
● Quantitative data- present when determining the number and percentages of hospitals
following ASP core elements.
● Qualitative data- present when describing the different ASP core elements in connection
with facility type, bed size and medical school affiliation
● Data is reliable- survey was based on “CDC’s Core Elements for Hospital ASPs” and the
questions related to ASP were piloted by Georgia Department of Public Health as a presurvey
at a stewardship workshop.
● Secondary Data - data was collected from the Patient Safety Component Annual Hospital
Survey was administered online within the National Healthcare Safety Network (NHSN)
application.
Statistical Analysis
● Aggregated and analyzed at the state and national levels
● Inpatient rehabilitation facilities, long-term acute care hospitals, and
psychiatric hospitals were excluded
● Hospitals were stratified by bed size - <50, 51-200, >200
● Hospital facility type - General acute care, children's critical access,
Surgical.
● Each of the 7 core elements were reviewed individually.
● Univariate analyses were performed on facility characteristics
● Multivariate model was built using a forward stagewise log binomial
regression
● Likelihood ratio tests and Akaike information criterion statistics were used
to assess model fit.
 Findings
● Descriptive findings
○ Bigger hospitals (>200 beds) were more
likely to have all core elements.
○ Teaching hospitals more likely to have
successful ASP.
○ General hospitals and children’s hospitals
(low # of respondents) more likely to have
ASPs.
○ California has the highest rate of facilities
with ASPs (state policy in place that
mandates ASPs).
● Non Descriptive findings
○ 39% of all acute care hospitals had all
core elements of a successful ASP.
 Study Strengths
● Large sample size
○ 4184 hospitals
● Differentiated by hospital type and size
○ # of beds
○ teaching/ non-teaching
○ type of care
● Response rate
○ Hospitals are required to respond as it affects the funding they receive from
Medicaid/Medicare services.
● Questions specific to ASPs and the 7 core elements
Study Limitations
● Self-reported survey vs. observation or auditing body
● Implementation of ASPs in hospitals remains vague
● Standard risk-adjusting benchmarking measuring antibiotic use remains a
barrier.
Study Implications
•May lead to more research in looking at cost-effective ways to encourage
Antibiotic Stewardship Programs.
•Programs or grants may emerge to help fund smaller hospitals due to
findings
•Can lead to administrators to become more active in the creation and support
of Antibiotic Stewardship Programs
•Possible research into how laws may promote it and laws themselves being
established
•Creation of a study that is not self-reported or one that is verified by
researchers
Discussion
● One major factor was administrative support which was shown to be a
strong predictive.
● Despite that there was no evidence that shows support alone could improve
participation in smaller hospitals who struggle to implement such
programs due to limited resources
● California has the highest participation rate
● Smaller hospitals do struggle due to lack of resources and teaching
hospitals do tend to be more involved in ASP.
● Measured presence of core elements at hospitals and not the effectiveness
of them.
How Content Relates to Epidemiology
● Infectious Disease/ Hospital Epidemiology:
○Quantitative and qualitative
○Retrospective
○Univariate and multivariate analyses
○Data can inform hospitals on the current status and gaps in intervention
implementation

■ This study: antibiotic stewardship implementation and monitoring to

help prevent resistance
Data Table
● Percentage of US acute care
hospitals implementing all 7 core
elements of hospital antibiotic
stewardship programs by state

● California had the highest

percentage due to the impact of
the 2009 mandate in the state
that hospitals engage in efforts to
improve antibiotic use
Data Table Cont.

7 Core Elements of hospital ASP

Quiz
What public health issue is being discussed in the article?
How are ASP’s being used in hospitals to combat antibiotic-resistance in the
United States?
Name the 7 core elements of hospital antibiotic stewardship programs.

How many people died from Clostridium Difficile in 2017?

Conclusion
● Analysis of annual hospital survey responses to understand Antibiotic
Stewardship Program implementation across US
○ Gained baseline data to identify gaps and monitor progress
○ Implementation varies across the nation, but can be implemented in any
size facility
○ Stewardship Program implementation is best supported by hospital
leadership and funding