The role of the ‘A’ team in the hospital near you

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It is very probably that our hospital has some degree of constrained human and material resources. Implementing an antimicrobial stewardship program (ASP) in these settings is a challenge. Leadership commitment by hospital authorities is important to ensure allocation of the necessary resources to support ASPs. Establishing a multi-disciplinary antimicrobial stewardship team (AST) with full administrative support is essential .Its constitution should be adapted to currently available human resources in every each facility, and all partieś leaders might be creative despite many barriers that will necessary appear during the implementation process. The AST is usually composed by a core group (physicians, pharmacist, microbiologist) and supporter members. The coordinator might be a doctor (e.g, ID specialist or one ̈natural leader̈, respected and with knowledge in the prudent management of antimicrobials) or a clinical pharmacist. The latter has many tasks in the ASP (e.g, review requests of antimicrobials, provide feed-back during ward rounds, detect unnecessary prescriptions). Microbiologists should ideally have some training in clinical microbiology. Doctors from key units (e.g, UCI, Internal Medicine, Surgery) would facilitate the dissemination and adherence to guidelines, generate discussions on antimicrobial prescriptions in his unit and collaborate in the implementation of AMS strategies. Main supporter members could be representatives of the IPC team, nurses, patient safety and information technology. The AST should design which strategies could better fit, foreseeing the program as a step-by-step dynamic process. For example, in settings with a small AST and without previous experiences in ASP, it would be necessary to implement a pre-prescription authorization strategy for some antimicrobials, accompanying it with targeted education initiatives. Later, once the “stewardship spirit” is more disseminated along the hospital, pre-authorization will probably be not necessary, and main strategy could progressively turn to post-prescription audit and feed-back. Education initiatives in multiple forms (e.g, face to face, classes and clinical case discussions) and communication of progresses are also essential. Monitoring the ASP might give an idea of what needs to be emphasized to improve AMS in our hospital.