SHEA/SIDP/PIDS/IDSA Guidance for the Knowledge and Skills Required for Antimicrobial Stewardship Leaders

Introduction

Antimicrobial stewardship refers to coordinated interventions to improve appropriate use of antimicrobials in all healthcare settings (acute care, outpatient care, and long-term care). This is achieved through optimizing antimicrobial regimen, dose, duration of therapy, and route of administration. The objectives of antimicrobial stewardship are to (1) achieve the best clinical outcomes related to antimicrobial use while, (2) minimizing the emergence of antibiotic-resistant organisms, Clostridioides difficile infection and other adverse events and (3) reducing excessive costs attributable to suboptimal antimicrobial use.¹

The Centers for Diseases Control and Prevention endorse antimicrobial stewardship program (ASP) co-leadership from a physician and a pharmacist with subspecialty training in infectious diseases.² Although the in-depth understanding of diagnosis, management, and therapy of infectious diseases afforded by subspecialty training is advantageous, it is not always practical in settings like long-term care, outpatient care, critical access hospitals, and low-and-middle income countries. Fortunately, several high-quality online resources and certificate programs are available for attainment of requisite knowledge and skills.^1–3 Increasingly, physicians and pharmacists without specialized infectious disease training and infection preventionists are engaged in successful stewardship activities across settings.⁴ Further, expertise beyond clinical infectious diseases, pharmacology, and microbiology is critical to initiate, maintain, and expand an ASP, including fundamentals of quality improvement and change management, effective communication, data presentation, and methods to measure programmatic success.

Recognizing the need for an update to the original guidance,⁵ which continues to be accessed regularly, the Society for Healthcare Epidemiology of America (SHEA) has partnered with the Infectious Diseases Society of America (IDSA), the Pediatric Infectious Diseases Society (PIDS), and the Society of Infectious Diseases Pharmacists (SIDP) to convene a multidisciplinary writing group of experts from academic and non-academic settings and public health departments engaged in advancing antimicrobial stewardship.

The purpose of this update is to reinforce the knowledge and skills outlined in the original document, now organized by basic, intermediate, and advanced skills applicable to acute care, outpatient care, and long-term care settings (Tables 1–3). Core knowledge and skills include understanding and effectively articulating the rationale for antimicrobial stewardship, performing various ASP interventions and activities a program needs for optimal effectiveness, and measuring processes and outcomes associated with an ASP. Collaboration with infection prevention and control (IPC), microbiology, information technology (IT), and institutional leadership to achieve ASP goals are detailed. Finally, skills focused on leadership, program building, and advocacy are enumerated. Collectively, knowledge and skills described in this document intend to help “raise the bar” for ASPs, like the recent guidance document for IPC programs in which Talbot et al. describe “active” (ie, meeting requirements) versus “effective” IPC programs (ie, those which achieve broader patient safety goals and implement proactive rather than reactive measures).⁶ Similarly, this document delineates skills on a spectrum from basic to advanced skills which serve to augment success of ASPs as they evolve over time. It does not specifically address healthcare resources, staffing models, reporting structures, or percentage of full-time equivalents needed to conduct this work, which will be addressed by future multi-society publications.

This document can be used by the individuals overseeing an ASP, by stewardship teams collectively in their evaluation of current and desired program activities, or by trainees pursuing a career in antimicrobial stewardship. It will facilitate evaluation of what additional skills are needed and inform a plan to acquire additional training to effectively direct an ASP. It also serves as a tool to assess educational needs when developing local curricula related to antimicrobial stewardship and as a framework for administrators to determine what knowledge and skills are needed for overseeing an ASP. Finally, this update also includes a supplementary gap assessment tool to augment the tables (Supplementary Table 1).

For more information, please visit the Infection Control & Hospital Epidemiology Journal.