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Antimicrobial stewardship programs (ASP) promote the appropriate selection, dose, route and duration of antimicrobial therapy. These programs have proven to be effective in optimizing clinical outcomes while minimizing the unintended consequences of antimicrobial use such as
- increased microbial resistance;
- increased hospital lengths of stay; and
- increased costs to patients and hospitals.
Public Health Ontario (PHO) has partnered with the Ontario Hospital Association (OHA) to establish a province-wide, tailored, sustainable ASP for Ontario's hospitals. The program team of PHO and OHA staff will be assisted by an expert advisory committee with representation from professional disciplines across Ontario to provide authoritative advice and direction. A survey of Ontario hospitals in August 2011 demonstrated a high level of interest in ASPs.
Antimicrobial Stewardship Program Goals
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To use the best available evidence to develop tools and resources that support acute and community care organizations in evaluating and measuring antibiotic use.
- To evaluate best practices and methods that support antibiotic stewardship practices in acute settings and employ this program's evaluative results in developing a sustainable, practical and meaningful ASP that all acute care facilities in Ontario will implement.
- To assess how best to support antimicrobial stewardship principles across the spectrum of care and the linkages between acute and community settings, particularly in smaller and rural Ontario communities, and implement an ASP for those settings.
- To support the newly-developed provincial ASP for preventing and reducing antimicrobial resistance and for sustaining appropriate antimicrobial use through a knowledge exchange strategy.
The guiding principles of this project include the following:
- Recognition that hospitals are characterized by varying levels of size, incidence of antibiotic resistant organisms and infrastructure of clinical resources.
- Understanding that a community-based ASP will complement and reinforce the hospital ASP dimensions, especially in communities where the overlap between community primary care physicians and hospital physician staff is considerable.
- Involving key partners in all aspects of program planning, implementation and evaluation will strengthen and ensure relevance and feasibility of an ASP in Ontario.
To date, there have been a variety of hospital and community ASPs conducted across the province that will inform the development of the Ontario Antimicrobial Stewardship Program.
Preliminary Survey Results
An environmental scan was conducted via e-mail survey in August 2011. The purpose of this survey was to provide an updated snapshot of existing antimicrobial stewardship programs in Ontario's hospitals. The very high response rate of more than 70% demonstrated a high level of interest in ASPs. Of the respondents, 32% already had an existing ASP in place; of those who did not, 60% were considering implementing one. The survey results were reflective of varying hospital types: acute teaching hospitals, large community hospitals and small community hospitals were all represented.
These findings will be helpful to shape future antimicrobial stewardship programs in Ontario. The ASP Advisory Committee and project team will draw on this data to create a provincial stewardship initiative that is relevant and practical in its approach.
Provincial Antimicrobial Stewardship Program Advisory Committee (PASPAC)
The volunteer members of this committee will provide expert recommendations and information to advise the program team.
Anne-Marie Bombassaro, Victoria Hospital – London Health Sciences Centre
Dr. Jamie C. Brown, Peterborough Regional Health Centre
Patricia Byers, North Bay Regional Health Care Centre
Trent Fookes, Grey Bruce Health Services
Dr. Hugh Fuller, St. Joseph’s Healthcare
Lynn Keon, Pembroke Regional Hospital
Dr. Camille Lemieux, University Health Network
Leslie McArthur, Royal Victoria Hospital
Dr. Daniel Ricciuto, Lakeridge Health
Nisha Varughese, Children’s Hospital of Eastern Ontario
Sandra Walker, Sunnybrook Health Science Centre
Resources
National efforts continue to promote good antimicrobial stewardship across the country. Information and educational tools are available at www.antibioticawareness.ca.
For more information or to be added to our mailing list, contact asp@oahpp.ca.
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