Antibiotic Use Reporting Is Critical, Kentucky Health Care-Associated Infection Manager Says

Data collection is crucial to helping health care stakeholders—including medical providers and public health experts—to evaluate antibiotic prescribing practices, ensure their appropriate use, and slow the emergence of deadly antibiotic-resistant pathogens, or “superbugs.”

The Centers for Disease Control and Prevention’s National Healthcare Safety Network (NHSN) gathers data on a range of health care-associated infections that patients acquire during hospitalization, long-term care facility stays, outpatient surgery center visits, or medical procedures such as dialysis. This surveillance system also collects data specific to antibiotic-resistant infections and antibiotic prescribing from inpatient facilities through the Antimicrobial Use and Resistance (AUR) Module—allowing these facilities to better understand their prescribing practices and improve antibiotic stewardship efforts—with the goal of reducing antibiotic-resistant infections.

This interview with Andrea Flinchum, the Healthcare-Associated Infection/Antimicrobial Resistance Prevention Program manager at the Kentucky Department for Public Health, is one in a Pew series of interviews with five state health department officials to learn about antibiotic stewardship efforts to encourage data reporting. This interview has been edited for clarity and length.

Q: How would you describe your role in the Kentucky Department for Public Health?

A: Among other things, I manage the day-to-day activities of the Healthcare-Associated Infection/Antimicrobial Resistance Prevention Program, including grant submissions and work related to antimicrobial stewardship. Part of our program’s mission is to decrease health care-associated infections, or HAIs, as well as antibiotic resistance, in health care settings. I spend time working on stewardship, because antibiotic use is the main driver in the development of antibiotic resistance.

Q: What made you interested in working on antibiotic stewardship?

A: Around 2013 or 2014, I wanted to understand the breadth of antibiotic use in Kentucky, so we looked at prescribing data. I was astonished to see that Kentucky was number two in the country in antibiotic prescribing in outpatient settings. This analysis really increased awareness in the Kentucky Department for Public Health; suddenly people understood that antibiotic prescribing was a problem, and our department started having more conversations with our physicians about antibiotic awareness and stewardship. We knew something had to be done, but our program was very small with very few resources. It was challenging to know where to begin.

Q: So how did you begin?

A: We were able to use grant dollars from CDC to help hospitals acquire the IT resources they needed to begin reporting their data into the AUR Module, which allows users to access data from electronic health records to reduce inappropriate antibiotic prescribing and use in hospitals. We convinced 36 facilities to start using the module.

Then, in December of last year, the Kentucky Legislature passed a mandate that requires acute-care hospitals to report antimicrobial use. The facilities that had invested the time to report data into the AUR Module felt a sense of relief because they were well positioned to comply with the mandate. We’re still working to educate our partners across the state so that everyone understands that antimicrobial use reporting is now a requirement. My hope is that we can continue to build on this momentum and really make an impact.

Q: Have any facilities run into issues with reporting their data to the CDC’s National Healthcare Safety Network, or NHSN?

A: Yes. Many facilities, especially the smaller, more rural hospitals, have limited financial resources, so they don’t have the IT infrastructure and personnel to prioritize reporting data. Grant money helps with that, but since we have a lot of rural hospitals, it’s still not enough.

Before Kentucky’s reporting mandate, we spoke to people at one hospital about using grant money for reporting. They were completely terrified that once their team started reporting into the AUR Module, they would somehow be penalized if they missed a month. Even though we got the CDC to intervene and tell the hospital that if they missed a month, the hospital could just change its reporting plan without any penalty, the hospital still turned down the funds.

We’re also trying to develop a good way to analyze the data that comes out of NHSN and feed it back to the facilities so that they can understand how they compare to other facilities in their region. But COVID-19 really slowed down that work; we’re hoping to pick it back up as we get back into a regular routine.

Q: Has the COVID-19 pandemic affected your work in other ways?

A: It changed our work drastically: Pretty much everything not related to the pandemic response was put on hold. The governor mandated COVID-19 tests for every resident and staff member in long-term care facilities in the state, so that testing initiative took up a lot of our time and energy. That meant there were certain projects we’ve done in previous years related to antibiotic stewardship that we couldn’t get to this year. For example, due to time constraints on our part, I wasn’t able to get a gubernatorial proclamation during Antibiotic Awareness Week last year to align with the CDC’s annual initiative, which is something we’ve done before.

Prior to the pandemic, we were working to involve students throughout Kentucky on the issue of antibiotic use by doing a poster contest for Antibiotic Awareness Week. But when schools went remote, that didn’t happen either.

Q: Do you have tips for other states looking to improve stewardship and increase reporting into NHSN?

A: You have to engage health care stakeholders—including medical providers and leadership in health care facilities­—to take antibiotic resistance and stewardship seriously. We had to show them that there was a problem before they considered accepting assistance from the Department for Public Health, for example, to increase stewardship and reporting efforts. We’re now having more and more conversations with our physicians about antibiotic awareness and stewardship. Here in Kentucky we can say, “We’re one of the top two prescribers of antibiotics in the outpatient setting, and that matters because that will lead to resistance. Here’s what you can do.”

We’ve also found it’s really helpful to identify someone on the staff of a facility who has a significant interest in antibiotic resistance and can be a champion for stewardship. Even if the facility as a whole has concerns about doing the work of reporting, having an individual who is ready to push the cause forward is really helpful.

We also saw a lot of success when we brought various stakeholders—like the acute-care hospitals, the hospital association, and others—together to discuss the importance of antibiotic use data. Based on my experience trying to get reporting mandates through, at least in Kentucky, if you don’t have the buy-in of those groups, then getting reporting mandates in place will be an uphill battle.