An estimated 30-80% of antimicrobials used in hospitals are unnecessary. Antimicrobial overuse promotes the development of superbugs like C. Difficile, Methicillin Resistant Staphylococcus Aureus (MRSA), Vancomycin Resistant Enterococcus (VRE), and Extended Spectrum B-lactamase producing bacteria (ESBL). Prior attempts to reduce antimicrobial use with antimicrobial guidelines or formulary restrictions (i.e., limiting which antimicrobials can be used) have demonstrated little success in reducing unnecessary antimicrobial use. A model of prospective audit and feedback was utilized as the basis for the TEGH Antimicrobial Stewardship Program (ASP) quality improvement intervention. The selection of this model was based on available evidence and the feedback elicited from the health care team. During the process of prospective audit and feedback an individual patient’s antimicrobials are reviewed by the ASP with feedback and education provided directly to care providers. Since the implementation of the TEGH ASP there has been a 30% reduction in antimicrobial costs and significant reductions in the use of broad spectrum antimicrobial agents. Patient outcome data has demonstrated stability in mortality rates and average length of stay, with some wards demonstrating a reduction in seven-day readmission rates. Institutional rates of hospital acquired C. Difficile have also significantly decreased from an average monthly rate of 0.67/1000 patient-days to 0.42/1000 patient days since ASP implementation (p < 0.003).
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