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Improving Hospital-Based Antimicrobial Use to Prevent Antimicrobial Resistant Healthcare-Associated Infections


Background: Healthcare-associated infections have been estimated to occur in about one of every 20 hospitalized persons; an increasing proportion (about 20%) of HAIs are caused by pathogens demonstrating increased resistance to traditional antimicrobials, leaving clinicians with fewer treatment choices and putting other patients at risk for infections through transmission between patients. Over the past decade, researchers have demonstrated that use of a comparative measure of inpatient-antimicrobial use by pharmacists and providers improves the appropriateness of antimicrobial prescribing by providers in hospitals that use these measures. To facilitate this prevention strategy, CDC?s National Healthcare Safety Network (NHSN) (HYPERLINK "" is launching an Antimicrobial Use Surveillance Option in January, 2011 to allow facilities to report such data and compare facility-specific usage rates to a national risk-adjusted comparative benchmark; however, facilities are required to submit these data electronically using specifications consistent with the NHSN electronic reporting standards. Complying with these standards will require vendors of ?Electronic Medication Administration Records? (eMAR) used in acute-care facilities to modify the applicable software to allow such reporting. After initial modification and piloting of the reporting from a few facilities to NHSN, expansion of such reporting as a tool for reducing antimicrobial-resistant HAIs within acute-care facilities nationally can occur. As more vendors enable their products to report these data electronically to CDC?s NHSN, CDC will be able to provide the comparative data to drive practice change locally at each reporting facility and to reduce unnecessary antimicrobial use through this enhancement of antimicrobial stewardship activities. Research has suggested that facilities can reduce unnecessary antimicrobial use through activities such as these within 6 months, and observe reductions in antimicrobial-resistant infections within 2 years.

Public Health Impact: ? Successful piloting of submission of data from eMAR systems to NHSN would provide facilities utilizing the vendor?s software to report and receive comparative antimicrobial use data as a tool to drive local HAI prevention activity. HAIs are reportable in over 22 States, and antimicrobial use stewardship is mandated in California. Commercialization potential for antimicrobial use reporting is going to increase as mandates become more common.?

Examples of specific research areas of interest include, but are not limited to:

1. Develop a technical prototype for aggregating antimicrobial use metrics (as outlined in NHSN ?website) using eMAR systems and reporting to NHSN within the CDC clinical document architecture specifications (HYPERLINK ""

2. Evaluate (1) the validity (i.e., accuracy) of the data reported to NHSN and (2) the usability by hospital-based pharmacists.?

3. Define a scalable solution and business plan to enhance utilization of the reporting capabilities by all acute-care facilities using electronic medical administration record systems.?

For NCEZID programmatic information, contact:

Ms. Barbara Stewart

Deputy Director

Center for Disease Control and Prevention

Extramural Research Program Office

National center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention

1600 Clifton Road

Mail Stop E-60

Atlanta, Georgia 30333


Email:? HYPERLINK ""

For grants specific information, contact:

Ms. Sharron Orum

Centers for Diseases Control and Prevention

Procurement and Grants Office

1600 Clifton Road

Mail Stop E-15

Atlanta, Georgia 30333


Email:? HYPERLINK ""

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