New Antibiotic Stewardship: Core Elements Guide From CDC

Arjun Srinivasan, MD (CAPT, USPHS)


October 24, 2017

Editorial Collaboration

Medscape &

Hi. My name is Dr Arjun Srinivasan. I'm an infectious disease physician and the associate director for Healthcare Associated Infection Prevention Programs in CDC's Division of Healthcare Quality Promotion. I am pleased to join you today as part of the CDC Expert Commentary Series on Medscape.

CDC recently released a new resource, The Implementation of Antimicrobial Stewardship Core Elements in Small and Critical Access Hospitals. It is intended to help small and critical access hospitals in their important efforts to improve patient safety through better antibiotic use.

Research shows that core elements implementation varies by facility size, in terms of number of beds. For example, more than 50% of hospitals with more than 50 beds report having all seven of CDC's "Core Elements of Antibiotic Stewardship," compared with 26% of hospitals with 25 or fewer beds. At the same time, we know that small and critical access hospitals face challenges with antibiotic resistance and Clostridium difficile, which can be addressed by improving antibiotic use. To support antibiotic stewardship in smaller hospitals, CDC and partners met with experts who work in these settings to get their feedback, gain a more in-depth understanding of the challenges, and develop resources specifically tailored to smaller hospitals. In addition to staff in small and critical access hospitals, CDC partnered with The Pew Charitable Trusts, The American Hospital Association, and the Federal Office of Rural Health Policy to develop this new resource.

The core elements make up a framework designed to support and expand antibiotic stewardship efforts by focusing on seven key areas: leadership commitment, accountability, drug expertise, action, tracking, reporting, and education. Experience has shown that each of these core elements can be adapted and implemented to meet the unique needs of critical access hospitals. For example, some small and critical access hospitals have found it useful to join collaborations with other hospitals, state hospital associations, and state and local health departments to gain access to expertise and ideas for interventions. Critical access hospitals may also consider accessing antibiotic stewardship expertise via telemedicine or remote consultation with infectious disease physicians and pharmacists. Critical access hospitals have also found it useful to expand the role of nurses in stewardship efforts. For example, nurses can review culture techniques and results, monitor ongoing antibiotic therapy, provide patient education about antibiotic-associated adverse events, and initiate antibiotic "time-outs."

The new resource is the fourth addition to the core elements series that provides recommendations for antibiotic stewardship programs and practices in hospitals, nursing homes, and outpatient facilities. In 2015, more than 200 small and critical access hospitals successfully implemented all seven core elements of antibiotic stewardship, showing that it can be done. We hope that this document will help other small and critical access hospitals follow suit. To learn more about using the new core elements strategies in your facility, visit Thank you for watching.

Web Resources

Core Elements for Small & Critical Access Hospitals

U.S. Antibiotic Awareness Week

Core Elements for Hospitals

Hospital Antibiotic Stewardship Medscape Commentary

NQF Antibiotic Stewardship Playbook