Antibiotics are a powerful tool for fighting and preventing infections. However, widespread use of antibiotics has resulted in an alarming increase in antibiotic-resistant infections and a need to rely on broad-spectrum antibiotics that might be more toxic and expensive than those usually used for treatment. Since antibiotics are often unnecessarily or inappropriately prescribed, a concerted effort to decrease or eliminate inappropriate use can have a big impact on patient safety and the problem of AMR.
This handbook is intended for use by veterinary hospitals interested in implementing the AVMA’s core principles of AS in veterinary medicine.1 These core principles are based on the Centers for Disease Control and Prevention (CDC) core elements of AS programs, which have been used successfully to improve AU in healthcare settings.2 This guide provides a collection of concrete implementation strategies, suggestions, and tools to implement the core principles and is intended to be complementary to literature reviews and other evidence-based tools and resources.
Basic Antimicrobial Stewardship Interventions
Core Principle 1: Commit to stewardship
- Form your AS committee.
- Identify an AS Champion.
- Make a public commitment to your clients.
- Define (and redefine) your hospital AS priorities.
For specific details on these interventions and implementation strategies, download our Handbook PDF.
Core Principle 2: Advocate for a system of care to prevent common diseases
- Educate clients on the importance of preventative care.
- Prevent healthcare-associated infections in your hospital.
For specific details on these interventions and implementation strategies, download our Handbook PDF.
Core Principle 3: Select and use antimicrobial drugs judiciously
- Provide clinical guidance for responsible antibiotic use.
- Develop protocols for use of clinical diagnostics.
For specific details on these interventions and implementation strategies, download our Handbook PDF.
Core Principle 4: Evaluate antimicrobial drug use practices
- Inventory antimicrobials in your facility.
For specific details on these interventions and implementation strategies, download our Handbook PDF.
Core Principle 5: Educate and build expertise
- Require all clinic staff to take part in training on AMR and AS.
- Communicate with pet owners about AMR and other potential harms of AU.
- Provide information to clients about safe medication disposal.
For specific details on these interventions and implementation strategies, download our Handbook PDF.
Basic Core Principle Checklist
Intermediate Antimicrobial Stewardship Interventions
Core Principle 1: Commit to stewardship
- Draft an AS policy.
- Formalize the AS Champion Role.
- Actively promote responsible AU to your clients and the public.
- Define (and redefine) your hospital AS priorities.
For specific details on these interventions and implementation strategies, download our Handbook PDF.
Core Principle 2: Advocate for a system of care to prevent common diseases
- Develop prevention protocols for high-priority conditions.
For specific details on these interventions and implementation strategies, download our Handbook PDF.
Core Principle 3: Select and use antimicrobial drugs judiciously
- Provide clinical guidance for responsible antibiotic use.
- Implement AS actions to prevent inappropriate prescribing.
- Review hospital antimicrobials, and identify opportunities for formulary-level AS action.
- Develop protocols for use of clinical diagnostics.
For specific details on these interventions and implementation strategies, download our Handbook PDF.
Core Principle 4: Evaluate antimicrobial drug use practices
- Participate in continuing education activities to learn about tracking AU.
For specific details on these interventions and implementation strategies, download our Handbook PDF.
Core Principle 5: Educate and build expertise
- Conduct all-staff training on hospital AS practice and policy.
For specific details on these interventions and implementation strategies, download our Handbook PDF.
Intermediate Core Principle Checklist
Advanced Antimicrobial Stewardship Interventions
Core Principle 1: Commit to stewardship
- Ensure implementation of commitment strategies from basic and intermediate AS interventions are met.
For specific details on these interventions and implementation strategies, download our Handbook PDF.
Core Principle 2: Advocate for a system of care to prevent common diseases
- Align infection prevention and quality improvement priorities with AS actions.
For specific details on these interventions and implementation strategies, download our Handbook PDF.
Core Principle 3: Select and use antimicrobial drugs judiciously
- Implement AS actions to identify and prevent unnecessary prescribing.
- Identify additional opportunities for formulary-level AS action.
- Develop protocols for use of clinical diagnostics.
For specific details on these interventions and implementation strategies, download our Handbook PDF.
Core Principle 4: Evaluate antimicrobial drug use practices
- Assess compliance with AS actions.
- Track and report overall AU and prescribing for priority conditions.
- Review appropriateness of prescribing for priority conditions.
For specific details on these interventions and implementation strategies, download our Handbook PDF.
Core Principle 5: Educate and build expertise
- Engage with other health disciplines working on AMR and AS.
For specific details on these interventions and implementation strategies, download our Handbook PDF.
Advanced Core Principle Checklist
Citations
1. AVMA Antimicrobial Stewardship Definition and Core Principles. https://www.avma.org/KB/Policies/Pages/Antimicrobial-Stewardship-Definition-and-Core-Principles.aspx
2. CDC Core Elements of Antibiotic Stewardship. https://www.cdc.gov/antibiotic-use/core-elements/