Introduction

Methods and sources

Results

Discussion

References

Abstract

Scope: Antimicrobial stewardship teams are responsible for implementing antimicrobial stewardship programmes (ASP). However, in many countries, lack of funding challenges this obligation. A consensus procedure was performed to investigate which structural activities need to be performed by Dutch stewardship teams and how much time (and thus full-time equivalent (FTE) labor) is needed to perform these activities.
Methods: In 2015, an electronic survey, based on a nonsystematic literature search and interviews with seven experienced stewardship teams, was sent to 21 stewardship teams that performed an ASP. This was followed by a semistructured face-to-face consensus meeting. Fourteen stewardship teams completed the survey (18% of Dutch acute-care hospitals), and 13 participated in the consensus meeting.
Recommendations: The hours needed each year are dependent on hospital size and number of stewardship objectives monitored. If all activities are performed at a minimal base (one stewardship objective; minimal staffing standard), time investment was estimated to be 1393 to 2680 hours annually in the early phase, corresponding with 0.87 (300 beds) to 1.68 FTE (1200 beds), with a further increase to minimally 1.25 to 3.18 FTE in the following years with three stewardship objectives monitored (optimal staffing standards during the first few years of implementing an ASP). This consensus on required human resources provides a directive for structural financial support of stewardship teams in the Dutch context. Some stewardship activities (and related time investments) might be specific to the Dutch context and hospital setting.

Introduction

Antimicrobial stewardship may be defined as ‘a coherent set of actions designed to use antimicrobials in ways that ensure sustainable access to effective therapy for all who need them’ [۱]. Three dimensions of stewardship can be recognized [2]. Stewardship encompasses firstly structural prerequisites that should be met when implementing an antimicrobial stewardship programme (ASP), such as the presence of a multidisciplinary antimicrobials stewardship team, ensuring the presence of local practice guidelines or information technology support. Secondly, stewardship objectives describe the recommended care that should be provided at the patient level, such as prescribing empirical antimicrobial therapy according to guidelines and timely switch from intravenous to oral administration [3]. To bridge the gap between recommended care and the actual care provided, many behavioural change interventions can be used by the antimicrobial stewardship team. This third dimension of antimicrobial stewardship, the stewardship improvement interventions, relates to strategies that should be performed for achieving the stewardship objectives [2,3]. Examples include the performance of prospective audit and feedback as well as preauthorization. In Dutch hospitals, antimicrobial stewardship teams, consisting of at least an infectious disease specialist, a medical microbiologist and a hospital pharmacist, are responsible for implementing an ASP. As of 2014, all Dutch hospitals are required to have a stewardship team; the Dutch Healthcare Inspectorate supervises the establishment and performance of stewardship teams. The Dutch Working Party on Antibiotic Policy (SWAB), consisting of representatives of the professional societies involved in stewardship (infectious disease physicians, medical microbiology, hospital pharmacy, intensive care medicine and paediatrics) supports the implementation of antimicrobial stewardship in Dutch hospitals on a national level. On the basis of a systematic review and meta-analysis [3], SWAB published a stewardship guideline that includes recommendations on appropriate antimicrobial use to guide the stewardship team’s choice of potential stewardship objectives. In addition to this guideline, SWAB disseminated the ‘Antimicrobial Stewardship Practice Guide for the Netherlands’ providing practical support on how to embark on antimicrobial (antibiotic, antifungal and antiviral) stewardship. Furthermore, a yearly conference is organized to facilitate the exchange of best practices among stewardship teams [4].