Developing and expanding hospital antimicrobial stewardship: The Ontario experience

: Mount Sinai Hospital and University Health Network, two academic health science centres in Toronto, Ontario, jointly established a robust, well-resourced antimicrobial stewardship program (ASP). Over the course of four years, we spread our program to five intensive care units (ICUs), learned which change management practices worked and which did not, and leveraged our ICU successes to other areas of our hospitals. We identified the following two factors as critical to establishing ASPs in hospitals: strong leadership with clear accountability; and valid, reliable data to monitor progress. Subsequently we have led the spread of our program to 14 academic hospital ICUs, and more recently we leveraged to help community hospitals implement ASPs without in-house infectious diseases specialists. We introduced three new data fields into the provincial critical care information system: days of antibacterial therapy, days of antifungal therapy, and ICU-onset C. difficile, which will help standardize data collection moving forward. This model-starting with academic health sciences centres, and antimicrobial stewardship experts and leaders who are then supported to mentor and develop new experts and leaders-could be copied in other jurisdictions both within and outside of Canada.