Deadline looms for Calif. hospital mandate of ASPs


Beginning in July, California hospitals are required to have an antimicrobial stewardship program (ASP) in place to evaluate the judicious use of antibiotics.

Beginning in July, California hospitals are required to have an antimicrobial stewardship program (ASP) in place to evaluate the judicious use of antibiotics.

Senate Bill 1311, which was signed by California’s Governor Edmund G. Brown Jr., last September, calls for all California health systems, including acute care hospitals, to develop a multidisciplinary committee, headed by a physician, to create an ASP and appoint a doctor or pharmacist who is knowledgeable about antimicrobial stewardship. This committee is responsible for reporting its ASP activities to other hospital committees involved in clinical quality improvement strategies.

As of last year, only half of the hospitals in California had developed ASPs because the 2006 law requiring ASPs was ambiguous. With S.B. 1311, California health systems have more precise legislation to follow.


Last year, the Centers for Disease Control and Prevention (CDC) highlighted the urgency to develop ASPs at all hospitals because antibiotic resistance is a major public health threat.

“Antibiotics save lives, but poor prescribing practices are putting patients at unnecessary risk for preventable allergic reactions, super-resistant infections, and deadly diarrhea,” according to CDC’s website. “Errors in prescribing decisions also contribute to antibiotic resistance, making these drugs less likely to work in the future.”

Inappropriate prescribing has led to Clostridium difficile-associated diarrhea in hospitalized patients, which has affected approximately 250,000 patients annually and led to 14,000 deaths, according to the CDC.


”Decreasing the use of antibiotics that most often lead to C. difficile infection by 30% (this is 5% of overall antibiotic use) could lead to 26% fewer of these deadly diarrheal infections. These antibiotics include fluoroquinolones, β-lactams with β−lactamase inhibitors, and extended-spectrum cephalosporins,” as noted on CDC’s website.

7 steps for hospitals to follow

CDC Director Thomas Frieden, MD, MPH, provided seven recommendations for hospitals that choose to start an ASP.

1. Leadership needed. Make sure that the appropriate resources (human, financial, and IT) are in place.

2. Accountability. Find a strong leader, such as a physician, to champion the antimicrobial stewardship initiative and report outcomes.

3. Drug expertise. A pharmacist leader is needed to support appropriate prescribing.

4. Action. Get started now. Implement one initiative to move the needle toward appropriate prescribing. For example, within 48 hours of antibiotic initiation, be sure to double-check drug choice, dose, and duration.

5. Track the progress. Gather and monitor antibiotic prescribing and follow and report resistance patterns.

6. Report. Regularly inform staff on antibiotic prescribing and resistance information and recommend changes to improve results.

7. Educate. Offer staff the opportunity to learn more about antibiotic resistance and best prescribing practice.

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