Combating infectious disease:
A summary of updates

BD Institute for Medication Management Excellence

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Combating infectious disease: A summary of updates from the Centers for Medicare & Medicaid Services (CMS)

PUBLISHED: Feb 10, 2020

Sneh Ringwala, PharmD

Tim Pierce, RPh, JD
Antimicrobial Stewardship Solution Architect, BD

Kalvin Yu, MD
Medical Director, BD

The prevention and control of infectious disease threats remains one of the biggest challenges for many healthcare systems.1 Using a point prevalence estimation, approximately one out of every thirty-one hospitalized patients will have a healthcare-associated infection (HAI) resulting in increases in costs, length of hospitalization and mortality.2,3 While U.S. healthcare systems are making strides to reduce HAIs, the prevalence of drug-resistant infections remain a significant concern.2,4

Each year in the United States, at least 2.8 million people get a resistant infection resulting in over 35,000 deaths.5 Antimicrobial resistance not only affects our ability to fight infectious diseases, but also poses significant treatment challenges for a spectrum of other medical conditions. Furthermore, the misuse of antimicrobials and lack of infection prevention standards can exacerbate the spread of Clostridium difficile, a bacterium that causes diarrhea and colitis.6 It is estimated C. diff results in almost a quarter million infections and 12,000 deaths, annually.5 To protect patients from infectious disease and ensure optimal outcomes, healthcare systems are making a concerted effort to minimize the spread of drug-resistant infections and reduce the incidence of HAIs such as C. diff.

The Centers for Medicare & Medicaid Services (CMS) recently revised and elevated existing core antimicrobial stewardship guidelines as part of their Conditions of Participation (CoP).7 Under these new guidelines, all US hospitals and critical access hospitals (CAHs) will be required to have an antimicrobial stewardship program that interacts with existing infection prevention programs in order to participate in Medicare and Medicaid.7

Infection prevention and control programs aim to prevent or stop the spread of infections in healthcare settings, while antimicrobial stewardship programs promote the appropriate use of antimicrobials. To help inform improvement of these initiatives and optimize patient safety, both initiatives have a component of either regulatory, mandated reporting (e.g., certain HAIs) or recommended voluntary reporting (CDC’s National Healthcare Safety Network Antimicrobial Use Module).8,9

In these new standards:

  • Hospitals must develop antimicrobial stewardship and infection prevention and control programs, each led by qualified program leaders.7
  • Programs must document and employ methods for preventing and controlling the transmission of infections within the hospital and endeavor to mitigate transmission to other institutions—especially for multi-hospital systems. This includes surveillance, prevention and control of HAIs, including maintaining a clean and sanitary environment to avoid sources and transmission of infection and address any infection control issues identified by public health authorities.7
  • Improvement opportunities identified by infection prevention and control and antimicrobial stewardship programs must be addressed in collaboration with the hospital-wide quality assessment and performance improvement (QAPI) program.7
  • Multi-hospital systems are encouraged to have unified and integrated infection control and antimicrobial stewardship programs for all member hospitals.7
  • Systems should be in place to track infection surveillance, prevention, control and antimicrobial use activities to demonstrate the implementation, success and sustainability of programs.7

Antimicrobial stewardship and infection control are foundational clinical programs associated with improved antimicrobial usage, reduced rates of C. diff and decreased length of hospitalization.10,11,12 CMS projects that its new standards could help save hospitals hundreds of millions each year.13 Successful programs will have a strong underpinning of integrated diagnostic solutions along with complete antimicrobial and medication management. To comply with the updated CMS regulations [§ 482.42(b) and § 485.640(b)] hospitals should have these programs implemented by March 30, 2020.7


  1. Khabbaz RF, Moseley RR, Steiner RJ, et al. Challenges of infectious diseases in the USA. Lancet. 2014 Jul 5;384(9937):53-63.
  2. Centers for Disease Control and Prevention. Healthcare-associated Infections. Published November 5, 2019. Accessed November 10, 2019.
  3. Zimlichman E, Henderson D, Tamir O, et al. Health care-associated infections: a meta-analysis of costs and financial impact on the US health care system. JAMA Intern Med. 2013;173(22):2039-2046.
  4. Weiner LM, Fridkin SK, Aponte-Torres Z, et al. Vital Signs: Preventing Antibiotic-Resistant Infections in Hospitals — United States, 2014. MMWR Morb Mortal Wkly Rep 2016;65:235–241.
  5. US Department of Health and Human Services. Antibiotic resistance threats in the United States, 2019. Atlanta, Georgia: Centers for Disease Control and Prevention;2019.
  6. Tabek Y, Srinivasan A, Yu K, et al. Hospital level high-risk antibiotic use in relation to Hospital–Associated Clostridioides difficile infections: a retrospective analysis of 2016-2017. Infection Control & Hospital Epidemiology (2019). DOI: 10.1017/ice.2019.236
  7. Department of Health and Health Services. Medicare and Medicaid programs; regulatory provisions to promote program efficiency, transparency, and burden reduction; fire safety requirements for certain dialysis facilities; hospital and critical access hospital (CAH) changes to promote innovation, flexibility, and improvement in patient care. Federal Register. 2019;84(189):51732-51834.
  8. NHSN’s Stated Purposes | NHSN | CDC. Published 2017. Accessed January 21, 2020.
  9. FAQs: Antimicrobial Resistance (AR) Option | NHSN | CDC. Published 2019. Accessed January 21, 2020.
  10. Nault V, Pepin J, Beaudoin M, et al. Sustained impact of a computer-assisted antimicrobial stewardship intervention on antimicrobial use and length of stay. Antimicrob Chemother. 2017 Mar 1;72(3):933-940.
  11. Feazel LM, Malhotra A, Perencevich EN, et al. Effect of antibiotic stewardship programmes on Clostridium difficile incidence: a systematic review and meta-analysis. J Antimicrob Chemother. 2014 Jul;69(7):1748-54.
  12. Karanika S, Paudel S, Grigoras C, et al. Systematic review and meta-analysis of clinical and economic outcomes from the implementation of hospital-based antimicrobial stewardship programs. Antimicrob Agents Chemother. 2016 Jul 22;60(8):4840-52.
  13. Centers for Medicare and Medicaid Services. CMS Proposes Rule to Improve Health Equity and Care Quality in Hospitals. Published June 13, 2016. Accessed November 10, 2019.