The CMS on Wednesday finalized a rule requiring all hospitals to have antibiotic stewardship programs, which experts say is a big step forward in the fight against superbugs.
The rule was first proposed in 2016 and requires all acute-care and critical access hospitals that participate in Medicare or Medicaid to develop and implement an antibiotic stewardship program as part of their infection control efforts.
Dr. David Hyun, senior officer for the Pew Charitable Trusts' Antibiotic Resistance Project, said this is the first federal policy mandating hospital antibiotic stewardship.
"It definitely creates a broader level of involvement across different hospitals across the United States," Hyun said.
Hyun said he was hopeful the rule would help sustain momentum to improve antibiotic stewardship. In 2016, the CMS finalized requirements for nursing facilities to have a stewardship program in response to widespread misuse of antibiotics in such settings. Up to 70% of the estimated 4 million patients receiving care in nursing homes received antibiotics in 2017, according to the Centers for Disease Control and Prevention, with up to 75% of those drugs prescribed incorrectly.
In 2017, the Joint Commission issued standards for acute-care hospitals, critical access hospitals and nursing homes to have an antibiotic stewardship program to maintain their accreditation. The commission expanded its requirements in June to include ambulatory care centers.
A 2018 CDC survey of more than 4,900 acute-care hospitals found more than 76% reported adhering to all seven of the agency's core elements of hospital antibiotic stewardship programs, which include standards such as leadership commitment, tracking antibiotic prescribing and resistance patterns, and educating clinicians on better prescribing practices.
But there are more opportunities for additional healthcare settings to adopt stewardship programs, Hyun said, including outpatient sites.
He predicted the focus will begin to shift from expanding the number of providers that have antibiotic stewardship programs to improving the quality of those programs.
CDC estimates about 47 million, or 30%, of antibiotic prescriptions written each year are given to treat for infections that don't need antibiotics.