AHRQ Safety Program Helps Hospitals Decrease Antibiotic Use and Reduce Infections, Study Finds

A new study found that hospitals using the Agency for Healthcare Research and Quality (AHRQ) Safety Program decreased their use of antibiotic medications and reduced C. difficile infections—a potentially deadly condition of the colon and digestive system.

The study, published today in JAMA Network Open, found that the AHRQ Safety Program for Improving Antibiotic Use helped a large and diverse set of hospitals use an Antibiotic Stewardship Program (ASP) to refine and successfully implement their antibiotic use policies. ASPs are internal programs coordinated by hospitals, nursing homes and physician practices that promote the appropriate use of antibiotic medicines through good stewardship. However, they are often structured using a "top-down" approach. By contrast, the AHRQ Safety Program encourages front-line clinicians to be stewards of their own antibiotic prescribing.

"Giving clinicians tools to prescribe antibiotics appropriately can make care safer by ensuring that patients get the treatment they need while minimizing unintended harm," said Melissa Miller, M.D., a critical care physician in AHRQ's Center for Quality Improvement and Patient Safety who co-authored the study. "Antibiotics can be lifesaving, but they must be used thoughtfully in order to preserve their effectiveness."

Antibiotics are a cornerstone of modern medicine, with more than 150 million antibiotic prescriptions written annually in the United States; however, if antibiotics are overused, they can become less powerful over time as some bacteria grow resistant. The Centers for Disease Control and Prevention estimates that at least 2.8 million infections and 35,000 deaths a year are caused by antibiotic-resistant bacteria in the United States.

In just one year, this study in 402 hospitals demonstrated improvements in four key components of ASPs: prior approval, review and feedback of antibiotic prescriptions; availability of local antibiotic guidelines; having at least one paid, dedicated staffer leading the ASP; and quarterly reporting of antibiotic use. Total antibiotic use in the study was reduced by an average of 30.3 days of antibiotic therapy per 1,000 patient days. The program also demonstrated a 19.5 percent reduction in C. difficile infections over the one-year period.

The AHRQ Safety Program applies methods from the Agency's signature Comprehensive Unit-based Safety Program and the newly developed Four Moments of Antibiotic Decision Making.

"This work is part of the AHRQ Healthcare-Associated Infections Program's work in combating antibiotic-resistant bacteria, which focuses on improving antibiotic use, reducing transmission of resistant organisms and preventing healthcare-associated infections in the first place, a foundational step toward combating antibiotic resistance," said AHRQ Acting Director David Meyers, M.D. "Every infection prevented reduces the need for antibiotics, and using fewer antibiotics significantly reduces the risk of resistant infections."
 
AHRQ, part of the U.S. Department of Health and Human Services (HHS), is the nation’s lead health services research and patient safety agency. Its mission is to produce evidence to make healthcare safer, higher quality, more accessible, equitable and affordable, and to work within HHS and with other partners to make sure that the evidence is understood and used. 

The study was conducted by researchers from the Johns Hopkins University School of Medicine, NORC at the University of Chicago and AHRQ. It was published today in JAMA Network Open and can be found here.

More information about the AHRQ Safety Program for Improving Antibiotic Use, including a toolkit that can help hospitals replicate these results, can be found at www.ahrq.gov/antibiotic-use/acute-care/index.html.
 

Contact:

Shelby Venson-Smith, AHRQ Office of Communications
Shelby.Venson-smith@ahrq.hhs.gov or 240-478-3758