Antimicrobial Stewardship Practices Reported by California Hospitals Following New Legislative Requirements: Analysis of National Healthcare Safety Network Annual Survey Data, 2014–2015

BACKGROUND: New legislation required California hospitals to adopt and implement an antimicrobial stewardship policy by July 1, 2015. The policy must be in accordance with guidelines established by the federal government and professional organizations. Hospitals were also required to establish a physician-supervised multidisciplinary antimicrobial stewardship program (ASP) committee and appoint at least one physician or pharmacist who completed stewardship training. Since 2008, hospitals were mandated to evaluate the judicious use of antibiotics and report ASP activities to hospital quality improvement committees. We analyzed California hospitals’ responses to National Healthcare Safety Network (NHSN) Annual Surveys from 2014 and 2015 to describe ASP implementation progress in the setting of the new requirements. METHODS: The NHSN Annual Surveys included 15 questions that correspond with the Centers for Disease Control and Prevention (CDC) Core Elements of Hospital ASP. The ASP guideline includes three infrastructure elements (Leadership Support, Accountability, Drug Expertise) and four implementation elements (Actions, Tracking and Monitoring, Reporting, Education). We assessed hospital implementation of the ASP core elements and evaluated progress from 2014 to 2015. RESULTS: We analyzed surveys from 386 of 388 eligible California hospitals (99.5%). The proportion of hospitals reporting implementation of all core elements increased significantly from 59.3% in 2014 to 69.2% in 2015 (P < 0.001). Hospitals that reported implementation of all ASP infrastructure elements were more likely to have instituted all implementation elements compared with hospitals without all infrastructure elements in place (unadjusted risk ratio: 2.4 [95% confidence interval: 1.5, 3.7]; P < 0.001). Educating clinicians about appropriate use of antimicrobials was the least implemented element among ASP in 2015 (N = 316; 81.9%). CONCLUSION: California hospitals demonstrated ASP implementation progress within one year following new state legislative requirements. NHSN Annual Survey data provided information to identify opportunities for public health outreach to further advance ASP adoption. DISCLOSURES: All authors: No reported disclosures.