The Society for Healthcare Epidemiology of America defines antibiotic stewardship as a set of coordinated strategies to improve the use of antimicrobial medications with the goal of enhancing patient health outcomes, reducing resistance to antibiotics, and decreasing unnecessary costs. Resistance to antimicrobial treatment is a critical issue, contributing to a rapid spread of multiple organisms for which few treatments are available.

New final rules were issued by CMS in September of 2019 that make changes to the Medicare Conditions of Participation for Critical Access Hospitals regarding infection prevention and control and antibiotic stewardship programs and must be implemented by March 30, 2020. Under the new requirement, CAHs must have active facility-wide programs for the surveillance, prevention, and control of HAIs and other infectious diseases and for the optimization of antibiotic use through stewardship. The programs must demonstrate adherence to nationally recognized infection prevention and control guidelines, as well as to best practices for improving antibiotic use where applicable, and for reducing the development and transmission of HAIs and antibiotic-resistant organisms.

CMS encourages CAH collaboration with other hospitals in their network for pharmaceutical support as feasible, to work with their respective quality improvement network(s)/organization(s) and health departments for additional support and resources, and to use the technical assistance available from their State Flex Program.

The new regulatory text that will appear in the Code of Federal Regulations at 42 CFR Part 485.640 requires coordination with the CAH’s newly required quality assessment and performance improvement (QAPI) program. The new regulatory text outlines the standards for infection control and prevention and antibiotic stewardship, including standards for program organization and policies and leadership responsibilities.

Click here to read the full text of the Federal Register. 

Implementation of Antibiotic Stewardship Core Elements at Small and Critical Access Hospitals

This document provides guidance on practical strategies to implement antibiotic stewardship programs in small and Critical Access Hospitals. It was developed as a collaboration between The Centers for Disease Control and Prevention, The American Hospital Association, The Federal Office of Rural Health Policy and The Pew Charitable Trusts.

Project ECHO Antibiotic Stewardship Clinic

The Project ECHO Antibiotic Stewardship clinic focuses on helping providers manage their infectious disease patients, as well as providing evidence-based antibiotic stewardship through optimizing antibiotic usage thus reducing resistance and improving pharmacy bottom line. During these clinics, providers will interact with an infectious disease physician and clinical pharmacologists specializing in infectious diseases.

For more information, including clinic dates/times, materials from past clinics, and the case presentation template, please visit: httpss://

Recordings of past clinics can be found here: httpss://