Antimicrobial stewardship in Victorian hospitals: a statewide survey to identify current gaps.
OBJECTIVE
To determine antimicrobial stewardship (AMS) activities currently being undertaken at Victorian hospitals, identifying gaps when assessed against the Australian Commission on Safety and Quality in Health Care criteria for effective AMS.


METHODS
A survey open to all Victorian health services, conducted between January and March 2012.


METHODS
Availability of the endorsed prescribing guidelines, antimicrobial prescribing policies, formularies, approval systems for restricted antimicrobials, procedures for postprescription review, auditing and selective reporting of sensitivities.


RESULTS
Response rates were 96.4% for public health services and 67.7% for private hospitals. Guidelines were available at all public and 88.1% of private hospitals, and 90.6% of public metropolitan, 45.7% of public regional and 21.4% of private hospitals had antimicrobial prescribing policies. Antimicrobial approval systems were used in 93.8% of public metropolitan, 17.3% of public regional and 4.8% of private hospitals. Prescribing audits were conducted by 62.5% of public metropolitan, 35.8% public regional and 52.4% of private hospitals. Nearly all hospitals had selective laboratory reporting of antimicrobial sensitivities. Few hospitals had dedicated funding for AMS personnel.


CONCLUSIONS
We identified wide differences between hospital AMS activities. Additional support for AMS is particularly required in the public regional and private hospital sectors, principally in the key areas of policy development, antimicrobial approval systems, prescription review and auditing. Further research is required to develop recommendations for implementation of AMS within the regional and private hospital settings.
Department of Medicine, University of Melbourne, Melbourne, VIC, Australia. Rod.James@mh.org.au.
Rodney S
RS
James
Kylie A
KA
McIntosh
Susan B
SB
Luu
Menino O
MO
Cotta
Caroline
C
Marshall
Karin A
KA
Thursky
Kirsty L
KL
Buising
D000890:Anti-Infective Agents; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D019538:Health Care Surveys; D016304:Hospitals, Private / Q000458:organization & administration / Q000592:standards* / Q000706:statistics & numerical data; D006779:Hospitals, Public / Q000458:organization & administration / Q000592:standards* / Q000706:statistics & numerical data; D057970:Inappropriate Prescribing / Q000517:prevention & control*; D017410:Practice Guidelines as Topic; D011785:Quality Assurance, Health Care / Q000379:methods / Q000458:organization & administration / Q000706:statistics & numerical data; D057566:Self Report; D014739:Victoria
D000890:Anti-Infective Agents