Development and Validation of Measures to Assess Prevention and Control of AMR in Hospitals

Background: The rapid spread of antimicrobial resistance (AMR) in the US hospitals poses serious quality and safety problems. Expert panels, identifying strategies for optimizing antibiotic use and preventing AMR spread, have recommended hospitals undertake efforts to implement specific evidence-based practices. Objective: To develop and validate a measurement scale for assessing hospitals’ efforts to implement recommended AMR prevention and control measures. Study Design: Surveys were mailed to infection control professionals in a national sample of 670 US hospitals stratified by geographic region, bedsize, teaching status, and VA affiliation. Subjects: Four hundred forty-eight infection control professionals participated (67% response rate). Methods: Survey items measured implementation of guideline recommendations, practices for AMR monitoring and feedback, AMRrelated outcomes (methicillin-resistant Staphylococcus aureus prevalence and outbreaks MRSA), and organizational features. “Derivation” and “validation” samples were randomly selected. Exploratory factor analysis was performed to identify factors underlying AMR prevention and control efforts. Multiple methods were used for validation. Results: We identified 4 empirically distinct factors in AMR prevention and control: (1) practices for antimicrobial prescription/use, (2) information/resources for AMR control, (3) practices for isolating infected patients, and (4) organizational support for infection control policies. The Prevention and Control of Antimicrobial Resistance scale was reliable and had content and construct validity. MRSA prevalence was significantly lower in hospitals with higher resource/ information availability and broader organizational support. Conclusions: The Prevention and Control of Antimicrobial Resistance scale offers a simple yet discriminating assessment of AMR prevention and control efforts. Use should complement assessment methods based exclusively on AMR outcomes.