While there's no single model of stewardship, he suggests hospitals adopt programs that best fit their unique needs. One model that has worked in many settings is a physician leader running the program working closely with a pharmacist. A full stewardship checklist is here. At minimum, the CDC recommends these elements:
- Leadership commitment: Dedicate necessary human, financial, and IT resources.
- Accountability: Appoint a single leader responsible for program outcomes. Physicians have proven successful in this role.
- Drug expertise: Appoint a single pharmacist leader to support improved prescribing.
- Action: Take at least one prescribing improvement action, such as requiring reassessment within 48 hours to check drug choice, dose, and duration.
- Tracking: Monitor prescribing and antibiotic resistance patterns.
- Reporting: Regularly report to staff prescribing and resistance patterns, and steps to improve.
- Education: Offer education about antibiotic resistance and improving prescribing practices.
Ideally, both the physician and the pharmacist would have some background in infectious diseases, although that's not always the case—some hospitals are very small and don't have infectious disease specialists on staff. "It doesn't have to be infectious disease physician," said Srinivasan. "Others have stepped forward—but this is what we recommend."