**9. Importance of antimicrobial stewardship programs, outcomes, and new regulatory mandate from the Joint Commission (7 CDC elements)**

According to the World Health Organization (WHO), "Antimicrobial resistance threatens the effective prevention and treatment of an ever-increasing range of infections caused by bacteria, parasites, viruses, and fungi." The Centers for Disease Control and Prevention (CDC) has identified that 20–50% of all antibiotics prescribed in the U.S. acute care hospitals are either inappropriate or unnecessary. The CDC has also stated that "Antibiotics are among the most commonly prescribed medications in nursing homes. Up to 70% of long-term care facilities' residents receive an antibiotic every year [76]."

White House held the antibiotic stewardship program in June, 2015, in which the Joint Commission participated along with more than 150 major healthcare organizations and other relevant organizations for helping to implement changes over the next 5 years to decrease the rate of emergence of antibiotic-resistant bacteria, to help detect the resistant strains, help preserve the efficacy of existing antibiotics, and also more importantly regulate to prevent the spread of resistant infections [76].

The Joint Commission has also developed the antimicrobial stewardship standard for hospitals, critical access hospitals, nursing care centers, ambulatory care organizations, and Official Publication of Joint Commission Requirements New Antimicrobial Stewardship Standard Applicable to Hospitals and Critical Access Hospitals Effective January 1, 2017 Medication Management (MM) Standard MM.09.01.01 The critical access hospital has an antimicrobial stewardship program based on current scientific literature.

**1**. Leaders establish antimicrobial stewardship as an organizational priority. (*See also* LD.01.03.01, EP 5) **Note:** *Examples of leadership commitment to an antimicrobial stewardship program are as follows:*


activity against imipenem-resistant *A. baumannii* and MDR *A. baumannii* clinical isolates [75]. Combinations of minocycline plus meropenem and minocycline plus colistin were found to be synergistic *in vitro* against XDR *A. baumannii*. The package insert (PI) has an initial dose of 200 mg, with subsequent doses of 100 mg administered over 60 min every 12 h. Minocycline is very lipophilic compared to other tetracyclines. It has a very unique pharmacokinetic/phar-

a) Peak concentrations following 200-mg load (mean) = 4.18 μg/mL (range, 2.52–6.63 μg/mL).

c) These achievable peak and trough serum concentrations with standard human doses of minocycline intravenous exceed the mutant prevention concentration of 1 μg/mL, which

e) The mean concentration of minocycline in lung parenchyma has been reported to be 378%

g) Renal dysfunction does not appear to alter the maximum serum concentrations of mino

h) Bactericidal activity in combination with carbapenems or colistin against *A. baumannii*.

**9. Importance of antimicrobial stewardship programs, outcomes, and new regulatory mandate from the Joint Commission (7 CDC elements)**

According to the World Health Organization (WHO), "Antimicrobial resistance threatens the effective prevention and treatment of an ever-increasing range of infections caused by bacteria, parasites, viruses, and fungi." The Centers for Disease Control and Prevention (CDC) has identified that 20–50% of all antibiotics prescribed in the U.S. acute care hospitals are either inappropriate or unnecessary. The CDC has also stated that "Antibiotics are among the most commonly prescribed medications in nursing homes. Up to 70% of long-term care facilities'

White House held the antibiotic stewardship program in June, 2015, in which the Joint Commission participated along with more than 150 major healthcare organizations and other relevant organizations for helping to implement changes over the next 5 years to decrease the rate of emergence of antibiotic-resistant bacteria, to help detect the resistant strains, help preserve the efficacy of existing antibiotics, and also more importantly regulate to prevent the

The Joint Commission has also developed the antimicrobial stewardship standard for hospitals, critical access hospitals, nursing care centers, ambulatory care organizations, and

b) Trough concentration of (1.4–1.8 μg/mL) with 100-mg dosing every 12 h.

macodynamic profile (PK/PD) [67]:

92 Contemporary Topics of Pneumonia

has been reported with *Acinetobacter*.

residents receive an antibiotic every year [76]."

spread of resistant infections [76].

d) Half-life of 15–23 h.

of that in plasma.

cycline.

f) Urinary excretion 11%.


**3**. The critical access hospital educates patients, and their families as needed, regarding the appropriate use of antimicrobial medications, including antibiotics. (For more information on patient education, refer to Standard PC.02.03.01)

**Note:** *An example of an educational tool that can be used for patients and families includes the Centers for Disease Control and Prevention's Get Smart document, "Viruses or Bacteria— What's got you sick? At https://www.cdc.gov/antibiotic-use/ community/pdfs/Viruses-or-Bacteria-Factsheet-Eng.pdf*

**2**. The critical access hospital educates staff and licensed independent practitioners involved in antimicrobial ordering, dispensing, administration, and monitoring about antimicrobial resistance and antimicrobial stewardship practices. Education occurs upon hire or granting of initial privileges and periodically thereafter, based on organizational need

**4**. The critical access hospital has an antimicrobial stewardship

multidisciplinary team that includes the following members, when available in the setting:


**Note 1:** *Part-time or consultant staff are acceptable as members of the antimicrobial stewardship multidisciplinary team*

**Note 2:** *Telehealth staffs are acceptable as members of the antimicrobial stewardship multidisciplinary team*

#### **5. The critical access hospital's antimicrobial stewardship program includes the following CDC core elements:**


**Note:** *These core elements were cited from the Centers for Disease Control and Prevention's Core Elements of Hospital Antibiotic Stewardship Programs (https://www.cdc.gov/antibiotic-use/healthcare/pdfs/core-elements.pdf)*

**6**. The critical access hospital's antimicrobial stewardship program uses organization-approved multidisciplinary protocols (for example, policies and procedures). **Note:** *Examples of protocols are as follows:*


**8**. The critical access hospital takes action on improvement opportunities identified in its antimicrobial stewardship program. (*See also* MM.08.01.01, EP 6)

Adopted from https://www.jointcommission.org/assets/1/6/New\_Antimicrobial\_Stewardship\_Standard.pdf.

**Table 6.** The New Joint Commission antimicrobial stewardship standard: MM.09.01.01.

office-based surgery practices in standard with the following governmental and professional organizations: Centers for Medicare & Medicaid Services (CMS), the CDC, and the Society for Healthcare Epidemiology of America (SHEA) (**Table 6**).
