2088. Cross-sectional Analysis of Administrative Structure and Practices for Hospital Antimicrobial Stewardship Programs (ASPs) in a Large Metropolitan City

Abstract

BackgroundLos Angeles (LA) County is large and diverse urban southern California county with a population of over 10 million and a multitude of hospitals. The state of California required hospitals to implement ASPs in July 2015. This collaborative with the LA County Department of Public Health sought to characterize administrative structure and practices of hospital ASPs in the county.MethodsA survey of LA County hospital ASPs was conducted from November 2018 to April 2019. Initial telephone and email screenings were performed to confirm individuals’ involvement in hospital ASPs prior to survey participation.ResultsOverall, 40 of 87 (46%) hospitals responded. Of these, 90% (36/40) were private hospitals and 68% (27/40) were part of a multi-hospital network. All hospitals (40/40) reported an active ASP with 53% (21/40) established for 5 years or longer. Only 65% (26/40) reported meeting all seven CDC core elements of hospital ASPs and 85% (34/40) reported having an ASP committee. Of those with ASP committees, individuals who chaired or co-chaired the committee were predominantly ID physicians (33/34, 97%). Most held meetings quarterly (18/34, 53%). Committee member meeting attendance “all or most of the time” was highest for pharmacists (34/34, 100%) and ID physicians (33/34, 97%) and lowest for information technology (IT) personnel (9/34, 27%) and non-ID physicians (12/34, 35%). ASP committees reported to a mean of 2.4 other committees, most frequently to pharmacy and therapeutics (P&T) (32/34, 94%) and infection control (IC) (24/34, 71%). ASP committees received reports from a mean of 2.3 committees, most frequently from IC (22/34, 65%). Few ASP committees (<20%) reported to any of patient/medication safety, quality, sepsis, laboratory, risk management or nursing committees. Risk assessments and strategic planning were performed by only 35% (12/34) and 56% (19/34), respectively.ConclusionOur study demonstrates additional need in LA County hospital ASPs to meet CDC core measures as well as enhance ASP administrative structure. Notably, ASP committees appear to be siloed with P&T and IC with minimal reporting to other committees, do not frequently perform risk assessments or strategic planning, and have low meeting attendance by IT personnel and non-ID physicians.Disclosures All authors: No reported disclosures.