Governance and Strategy

Draw up a local antimicrobial stewardship strategy setting out objectives, priorities and scope for the next three to five years. The strategy should build on the findings and practical experience gained during the initiation phase. 

The statement may include a general commitment to antimicrobial stewardship within the hospital and a pledge to allocate funding and IT resources for this purpose. It should also be integrated into the strategic goals of the hospital and/or quality policy. 

Establish an interdisciplinary ASP team to develop a hospital-wide ASP and to run the programme. Put together a group of 3 to 5 senior staff members covering the relevant specialist areas. This should include IPC specialists, clinicians with experience in infectious diseases or internal medicine, hospital pharmacists, and medical microbiologists from the local or affiliated microbiology laboratory. Consider involving quality management and liaison persons from other departments with specific needs (e.g. surgery and paediatrics). A dedicated IT point of contact may also be helpful. The appointed individuals should be motivated and solution-oriented.

Appoint one or two senior staff (e.g. from IPC/Infectious Diseases and the hospital pharmacy) to provide operational and technical leadership for the ASP team.

Appoint one person within the group to act as the project champion – ideally someone who is not the head of the ASP group. The project champion continuously advocates for the project at the stakeholder level and negotiates solutions to secure their support. This person also supports the team leadership.

A project champion should have good communication skills, be widely accepted and be familiar with the hospital. 

International bodies recommend between 1 and 2.5 FTEs (full-time equivalents), depending on the size of the hospital, for the planning, operation and further development of an ASP. For launching an ASP in a smaller hospital, 0.5 FTEs may be sufficient. Once the programme is fully operational, it is advisable to increase this to 1 or more FTEs. These duties should be included in the job description or terms of reference for the relevant role.

Staffing needs include the resources required from professionals in IPC/Infectious Diseases, the hospital pharmacy, medical microbiology, IT and quality management.

Make use of the handbook: the implementation tools provided help reduce the staff effort needed to develop an ASP.

Smaller hospitals without extensive ASP expertise should consider cooperating with a larger hospital or hospital group. 

Access to data and IT resources is important for many elements of an ASP. Appoint an IT contact person at an early stage as a single point of contact (SPOC) for the IT-related coordination of ASP activities. 

At the initiative of the ASP team, the IT department will

• implement access to data on antibiotic use and antibiotic resistance, as well as to other routine data from the clinical information system (e.g. lists of patients with specific antibiotic prescriptions, or information on diagnoses)
• integrate the guidelines into the clinical information system (CIS) 
• implement training resources (E-learning courses) and materials for awareness campaigns (screensavers, reminders, etc.) into the IT system
• program decision-making aids for prescribing, such as warning messages (discontinuation of the prescription, antibiotic allergy) 

Swissnoso, ANRESIS, the Swiss Personalized Health Network (SPHN), the Swiss Pathogen Surveillance Platform (SPSP) and other national stakeholders are currently developing a digitalisation strategy to capitalise on rapid advances in data science. ASP managers should actively monitor technological developments in their field – particularly with regard to process automation and integration with national platforms that offer cross-hospital benchmarking functions. 

User surveys and access statistics provide insight into the user-friendliness of the IT support tools. 

Annual reporting serves as the basis for the management and further development of the ASP. It should include the following:

• Local stewardship strategy and the programme’s annual objectives 
• Total consumption of antibiotics, as well as the proportions of broad-spectrum antibiotics and Watch- and Reserve-group antibiotics according to the AWaRe classification (e.g. as provided by ANRESIS)
• Trends and anomalies in antibiotic consumption at hospital and unit level (e.g. departments, clinics)
• Incidence of Clostridioides difficile infections
• ASP activities and outcomes across the various Action Areas (e.g. training, prescribing practices)
• Recommendations for the further development of the local ASP