Hospital Antibiotic Stewardship Programs to Depend More on Nurses

Nurses will become leading figures in the antimicrobial stewardship fight in hospitals in the effort to curb hospital-associated infections (HAIs), according to updated prevention methods released today by the US Centers for Disease Control and Prevention (CDC). The agency’s Core Elements for Hospital Antibiotic Stewardship Programs reflects the growing realization that nurses can play a key role on any antibiotic stewardship team. 

The Centers for Medicare and Medicaid Services (CMS) next year will require all hospitals that treat Medicare and Medicaid patients to implement such stewardship programs, and the Joint Commission already requires that hospitals seeking its accreditation have them in place. 

The CDC first released its antibiotic stewardship program elements in 2014 and has updated them this year to reflect experience and evidence that’s since been collected on how to make the programs better. 

“The field of antibiotic stewardship has advanced dramatically since 2014, with much more published evidence and the release of an implementation guideline from the Infectious Diseases Society of America and the Society for Healthcare Epidemiology of America,” the CDC states in its core elements document.

When it comes to urine cultures, input from nurses will help determine whether such cultures need to be performed in the first place. They can assure that the cultures are performed correctly and join in the discussion about antibiotic treatment, indication, and duration. 

In addition, nurses can initiate interventions. The stewardship programs will rely more on the nurses’ knowledge of the proper techniques for reducing contamination. They’re also the providers who tend to be most aware of when patients can tolerate oral medications and can initiate consultations about when best to switch to oral antibiotics. In addition, the CDC says that “nurses often know how long a patient has been receiving an antibiotic and when laboratory results become available. They can play a key role in prompting reevaluations of therapy at specified times, such as after 2 days of treatment and/or when culture results are available.”

Nurses are certainly no strangers to antibiotic stewardship programs. Elizabeth Monsees, a nurse and the antimicrobial stewardship program manager at Children’s Mercy Kansas City, told American Nurse Today a couple of years ago that “the role of nurses in stewardship has been largely unrecognized… [N]urses have a desire to participate and believe we have a professional role to be involved in stewardship…”

She added: “Nurse managers/directors are key in allocating resources for education about nurses’ role in stewarding. They also empower nurses to assume their role as key collaborators or team members in this antibiotic stewardship space.”