Development and validation of potential structure indicators for evaluating antimicrobial stewardship programmes in European hospitals
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This study describes the development of structure indicators for hospital antimicrobial stewardship programmes and pilot validation across European hospitals. A multi-disciplinary panel from four European countries developed structure indicators in three steps: identification and listing of indicators, remote ranking of indicators using multi-criteria scoring, selection of indicators in a face-to-face consensus meeting. Additionally, the top-ten indicators were identified as a minimal set of key indicators. A survey was sent to the directors of antimicrobial stewardship programmes in European hospitals. The yes/no answers for the indicators were transformed into numbers in order to calculate the total scores. A list of 58 indicators was selected and categorised into the following topics: antimicrobial stewardship services (12 items), tools (16 items), human resources and mandate (6 items), health care personnel development (4 items), basic diagnostic capabilities (6 items), microbiological rapid tests (2 items), evaluation of microbiological drug resistance data (3 items), antibiotic consumption control (5 items) and drug use monitoring (4 items). The indicator scores, reported by 11 pilot hospitals from five European countries, ranged from 32 to 50 (maximum score = 58) and from 5 to 10 points (maximum score = 10) for, respectively, the complete and the top-ten list. An international panel selected 58 potential structure indicators, among which was a minimal set of ten key structure indicators, that could be useful for assessment of the comprehensiveness and resource-intensity of antimicrobial stewardship programmes. There was significant heterogeneity among participating centres with regard to their score for structural components of effective antimicrobial stewardship.
KeywordsQuality Indicator Clostridium Difficile Infection Antimicrobial Stewardship Structure Indicator Stewardship Programme
We thank all the members of the ABS Quality Indicators Team: F. Allerberger, B. Byl, M. Costers, C. Ernes, A. Frank, R. Gareis, E. Hendrickx, R. Krause, A. Lechner, H. Mittermayer.
We thank our dedicated and hard-working colleagues from the antibiotic stewardship teams in the participating hospitals for contributing their data and Benedicte Delcoigne for the data analysis assistance with compiling the expert multi-criteria scores.
We thank the external reviewers from the ABS International - Work package 5: I. Gyssens, C.Suetens, H. Goossens.
None to declare.
The project was co-financed by the European Commission, Directorate General Health and Consumer Protection through the Community Action Programme for Public Health (2003–2008), contract number 2005208, and by the participating institutions through their programmes of antibiotic use improvement.
Conflict of interest
The authors declare that they have no conflict of interest.
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