Antimicrobial Stewardship

User Guide

The toolkit is composed of three sections:

  • Hospital and Health System Resources - includes a readiness assessment tool, the starting point in developing or enhancing a successful Antimicrobial Stewardship Program (ASP). The tool, a checklist developed by the CDC, should be shared with senior management, a senior leader for quality, purchasing directors, clinic managers, nurse managers, key physician leaders, risk managers, pharmacy leaders, infection preventionists and hospital epidemiologists, laboratory staff and information technology staff. For ease of use, it is divided into two sections, one for those just beginning a program, the other for those who wish to enhance an existing program.
  • Clinician Resources - includes webinars, clinical evidence supporting appropriate use of antibiotics, implementation guides and related articles.
  • Patient Resources - includes frequently asked questions, pamphlets and handouts on how patients can best engage in their care and resources on appropriate use of antibiotics.

The CDC Assessment Tool

This checklist will assist hospitals in assessing key elements needed for creating a program that ensures optimal antibiotic prescribing and appropriate use. The key elements of a successful ASP include leadership commitment, accountability, drug expertise, action, tracking, reporting and education. To access the checklist, click here »

Hospital and Health System Resources


CDC Core Elements of Hospital Antibiotic Stewardship Programs
This document summarizes core elements of successful hospital ASPs. It complements existing guidelines on ASPs from organizations including the IDSA in conjunction with SHEA, ASHP and The Joint Commission. Experience demonstrates that antibiotic stewardship programs can be implemented effectively in a wide variety of hospitals and health systems and that success is dependent on defined leadership and a coordinated multidisciplinary approach. To download, click here »

Antibiotic Rx in Hospitals: Proceed with Caution
This fact sheet from CDC illustrates how antibiotics save lives, but poor prescribing practices put patients at unnecessary risk for preventable allergic reactions, super-resistant infections and deadly diarrhea. Errors in prescribing decisions also contribute to antibiotic resistance, making these drugs less likely to work in the future. To download, click here »

Guidelines for Developing an Institutional Program to Enhance Antimicrobial Stewardship
A joint SHEA/IDSA task force presents guidelines for developing institutional programs to enhance antimicrobial stewardship, an activity that includes appropriate selection, dosing, route, and duration of antimicrobial therapy. These guidelines, published in Clinical Infectious Diseases focus on the development of effective hospitalā€based stewardship programs and do not include specific outpatient recommendations. To download, click here »

Policy Statement on Antimicrobial Stewardship by SHEA, IDSA, and PIDS
This position statement recommends the mandatory implementation of antimicrobial stewardship throughout the health care continuum suggests process and outcome measures to monitor these interventions and addresses deficiencies in education and research in this field as well as the lack of accurate data on antimicrobial use in the United States. To download, click here »

ASHP Statement on the Pharmacist’s Role in Antimicrobial Stewardship and Infection Prevention and Control
Pharmacists have a responsibility to take prominent roles in ASPs and participate in the infection prevention and control programs of hospitals and health systems. Pharmacists’ responsibilities for antimicrobial stewardship and infection prevention and control include promoting the optimal use of antimicrobial agents, reducing the transmission of infections and educating health professionals, patients and the public. To download, click here »


CDC Vital Signs: Improving Antibiotic Use among Hospitalized Patients
Antibiotic prescribing for inpatients is common, and there is ample opportunity to improve use and patient safety by reducing incorrect antibiotic prescribing. Hospital administrators and health care providers can reduce potential harm and risk for antibiotic resistance by implementing formal programs to improve antibiotic prescribing in hospitals. To download, click here »

Guidelines for the Prevention of Antimicrobial Resistance in Hospitals
This joint SHEA/IDSA task force publication details how antimicrobial resistance results in increased morbidity, mortality and costs of health care. Prevention of the emergence of resistance and the dissemination of resistant microorganisms will reduce these adverse effects and their attendant costs. Appropriate antimicrobial stewardship that includes optimal selection, dose and duration of treatment, as well as control of antibiotic use, will prevent or slow the emergence of resistance among microorganisms. A comprehensively applied infection control program will interdict the dissemination of resistant strains. To download, click here »

“On the CUSP: Stop CAUTI Supplement” from APIC
This supplement features success stories from facilities that have joined the On the CUSP: Stop CAUTI program, strategies for engaging others in CAUTI prevention, insight from experts on the program’s core national faculty, ways for health care organization to be part of the program and frequently asked questions. To download, click here »

Clinician Resources


Assessment of Appropriateness of Antibiotics
The primary goal of antibiotic stewardship efforts is to optimize the use of antibiotics. However, assessing “optimal” or “appropriate” antibiotic use remains a challenge. To begin addressing the challenge, CDC, in consultation with a variety of external experts, has developed assessment tools that can help facilities explore potential opportunities for improving antibiotic use. These forms draw heavily from existing treatment guidelines to identify variations in diagnostic evaluation and antibiotic use that deviate from general recommendations, such as:

Tools and Sample Forms
This resource, from SHEA's Antimicrobial Stewardship task force, includes tools such as an adult inpatient antibiotic approval form, a blank order set for antifungal therapy, a sample checklist, a drug use evaluation form and others. To view the materials and forms, click here »

Clinical Practice Guidelines for Antimicrobial Prophylaxis in Surgery
Authored by ASHP, IDSA, the Surgical Infection Society (SIS) and SHEA these guidelines are intended to provide practitioners with a standardized approach to the rational, safe and effective use of antimicrobial agents for the prevention of surgical-site infections based on currently available clinical evidence and emerging issues. To download, click here »


“Antimicrobial Stewardship: A Collaborative Partnership between Infection Preventionists and Health Care Epidemiologists” from APIC
Infection preventionists and health care epidemiologists play key roles in promoting effective antimicrobial stewardship in collaboration with other health professionals, according to a joint position paper published by APIC and SHEA in their respective peer-review journals, the American Journal of Infection Control and Infection Control and Hospital Epidemiology. To download, click here »

Infection Prevention + Antimicrobial Stewardship = Synergy
In the APIC quarterly member magazine, Prevention Strategist, Julia Moody, MS, SM (ASCP), shares a case study and explains the infection preventionist’s and health care epidemiologist’s role in antimicrobial stewardship. To download, click here »

Clinical and Economic Outcomes of a Prospective Antimicrobial Stewardship Program
In ASHP’s American Journal of Health-System Pharmacy, the authors found antimicrobial expenditures, which had increased by an average of 14.4 percent annually in the years preceding ASP implementation, decreased by 9.75 percent in the first year of the program and remained relatively stable in subsequent years, with overall cumulative cost savings estimated at $1.7 million. Rates of nosocomial infections involving Clostridium difficile, methicillin-resistant Staphylococcus aureus and vancomycin-resistant enterococci all decreased after ASP implementation. To download, click here »

Antimicrobials and Resistance
This chapter from the 4th edition of APIC Text of Infection Control and Epidemiology discusses that although infection prevention traditionally has approached the problem of resistance primarily from the aspect of preventing transmission, more needs to be done to control how antimicrobials are commonly used. To download, click here » and then click on the blue bar that reads, “Download a free chapter of the APIC Text on ‘Antimicrobials and Resistance.’”

ASHP Guidelines on Pharmacist-Conducted Patient Education and Counseling
A coordinated effort among health care team members will enhance patients’ adherence to pharmacotherapeutic regimens, monitoring of drug effects, and feedback to the health system. ASHP believes these patient education and counseling guidelines are applicable in all practice settings—including acute inpatient care, ambulatory care, home care and long-term care—whether these settings are associated with integrated health systems, managed care organizations or are freestanding. To download, click here »

Antimicrobial Stewardship and Clostridium difficile Infection: A Primer for the Infection Preventionist
This chapter, in Guide to Preventing Clostridium difficile Infections (CDI), an APIC Implementation Guide, discusses antimicrobial use and its impact on patients in all healthcare settings and ASPs within the context of CDI. To download, click here »

APIC 2013 Clostridium difficile infection “Pace of Progress” survey
Activities to stop the spread of the intestinal superbug Clostridium difficile (C. diff) are on the rise, but they are not yielding large improvements, according to a nationwide survey. According to the survey, 70 percent of infection preventionists have adopted additional interventions in their health care facilities to address CDI since March 2010, but only 42 percent have seen a decline in facility-associated CDI rates; 43 percent have not seen a decline. While CDI rates have climbed to all-time highs in recent years, few facilities (21 percent of respondents) have added more infection prevention staff to address the problem. To download, click here »

Pediatric Stewardship Resources
Resources are available from SHEA that are specific to pediatric antimicrobial stewardship. To view, click here »

Research Articles
For a bibliography on antimicrobial stewardship published in the Infection Control and Hospital Epidemiology journal, available from SHEA, click here »


Antimicrobial Stewardship: The Hospital Opportunity
The webinar features Dr. Arjun Srinivasan, of the CDC’s and Dr. Howard Gold, Medical Director of Antimicrobial Stewardship, Silverman Institute for Health Care Quality and Safety, and Division of Infectious Diseases, Beth Israel Deaconess Medical Center sharing compelling evidence for antimicrobial stewardship to improve care and lower cost. To view the recording or download the slides, click here »

Antimicrobial Stewardship: What the Infection Preventionist Needs to Know
Provided by APIC, this webinar features Keith S. Kaye, MD, MPH who defines antimicrobial stewardship, discusses goals and components of an ASP, as well as details the role and collaboration of the infection preventionist with an antimicrobial stewardship team. To view, click here »

From Tragedy to Triumph to Trepidation: Antibiotics at Age 70
Provided by APIC, this webinar features Stephen M. Brecher, PhD, who explains how the war in England, then in the US, a famous fire in Boston and a football game all played a role in making penicillin the "Miracle Drug." With many new antibiotics, the war against infectious diseases seemed won. The problem, however, was that the bacteria did not read the press clippings. Antibiotics at Age 70 is the story of tragedy then triumph and now trepidation. To view, click here »

Patient Resources

ABC’s of Antibiotics
This infographic from APIC helps patients and families better understand their role in preventing infections and includes a list of questions to ask their healthcare provider about antibiotics. To download, click here »

Antibiotics Aren’t Always the Answer
This fact sheet from the CDC briefly explains six simple facts about antibiotic use and when they can help treat your child’s illness. To download, click here »

Cold or Flu. Antibiotics Don’t Work For You.
This tri-fold brochure from the CDC briefly explains the difference between bacteria and viruses and how bacteria become resistant. It also answers some common questions about when it is and is not appropriate to use an antibiotic. To download, click here »

Ask Questions about Your Medicines
This guide from APIC explains to patients when antibiotics work, when they don’t and when prescribed why it’s important to finish the course of antibiotics as the prescriber recommends. To view, click here »

FAQs about Clostridium difficile
A list of common patient questions about CDI, such as who is most likely to get it, how it is treated and how contraction can be prevented are included in this handout co-sponsored by SHEA, IDSA, AHA, APIC, CDC and The Joint Commission. To download, click here »

What You Need to Know about Clostridium difficile
This article from APIC explains what Clostridium difficile is, the symptoms, who is at risk, how it’s diagnosed, treated and can be prevented. To view, click here »

AHA Town Hall Webcast

The webcast features a discussion with the Centers for Disease Control and Prevention (CDC) about the clinical evidence supporting antimicrobial stewardship programs and the core elements in developing a hospital program. Speakers also review AHA's new Antimicrobial Stewardship Toolkit and provide a hospital perspective on implementing a stewardship program.

Featured speakers include:

  • John R. Combes, MD - senior vice president, American Hospital Association and president, Center for Healthcare Governance
  • Arjun Srinivasan, MD - associate director for healthcare associated infection prevention programs, and medical director, Get Smart for Healthcare, division of healthcare quality promotion, Centers for Disease Control and Prevention
  • Scott Malaney - president and CEO, Blanchard Valley Health System, Findlay, OH