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Report on the modified Delphi process for common structure and process indicators for hospital antimicrobial stewardship programs
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April 10, 2015
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Description:The Transatlantic Task Force on Antimicrobial Resistance (TATFAR) fosters cooperation between the EuropeanUnion(EU) andtheUnitedStates(US)ontheissueofantimicrobialresistance.Thefirst TATFAR recommendation refers to appropriate use of antimicrobials in human medicine through hospital Antimicrobial Stewardship Programs (ASPs) and, specifically, to the development of common structure and process indicators of ASP. These indicators should allow characterization of programs and comparisons among healthcare systems in EU and US.
To this end, a multidisciplinary expert group, coordinated by the European Centre for Disease Prevention and Control (ECDC) and US Centers for Disease Control and Prevention (CDC), was formed. The group consisted of 20 experts including representation of nine EU member states and six US states. The expert group participated in a structured consensus process (modified Delphi method) to facilitate the international collaboration and ensure the equal involvement of all experts. The process was conducted between March and May 2014 and was concluded by a group consensus meeting in June 2014. Aninitiallistofindicatorswasdevelopedbasedonpreviousindicators,availableguidanceanda review of the literature, including published systematic reviews. The domains assessed were: Governance and Management; Human Resources; Laboratory; Information Technology; Education; Policies for Appropriate Use; Guidelines, Activities and Interventions; and Monitoring of Appropriate Use. The indicators were rated for feasibility, clinical importance and relevance to minimizing antimicrobial resistance. Three rounds of rating followed by the in-person meeting led to a final set of 33 indicators. Among them 17 indicators were considered essential to characterize an ASP and therefore were included in a core set of indicators. The remaining 16 indicators were considered optional indicators and included in a supplemental set.
Implementation of the TATFAR-developed core indicators in multiple nations would contribute to a comprehensive, comparative description of infrastructure, policies, and practices of ASPs internationally. These findings could, in turn, lead to an understanding of best practices of ASPs through further investigation into the relation of different ASP approaches to antimicrobial use and resistance. Current public health surveillance systems or special studies may also be candidates for the addition of ASP questions to baseline surveys. Furthermore these indicators are envisaged as drivers for improvement and alignment with adoption of best practices. Piloting, implementation and evaluation of the impact of the indicators constitute important next steps for the optimization of antimicrobial use.
tatfar_rec1-finalreport_2015.pdf
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