Handshake stewardship over a decade: refinement after successful implementation
Kira E. Frappa, Matthew J. Weber, Kelly Pearce, Sarah K. ParkerAbstract
Objective:
To assess anti-infective use after over a decade of handshake stewardship by analyzing days of therapy per thousand patient days for all anti-infectives.
Design:
Retrospective evaluation pre- and post-implementation of handshake stewardship from October 2010 to September 2025.
Setting:
A pediatric hospital in Aurora, Colorado, with a licensed bed capacity of 472 beds. Handshake stewardship at our institution began in October 2013, after two years of planning (October 2011–September 2013); prior, there was no form of stewardship (October 2010–September 2011).
Patients:
All hospitalized patients administered anti-infectives during the study period.
Methods:
Days of therapy per thousand patient days were extracted from the electronic medical record and stratified by unit, medication, and route of administration. Antibacterial agents were grouped by National Healthcare Safety Network Antimicrobial Use and Resistance Module categories for pediatric resistant Gram-positive and hospital-onset infections. Yearly medians were utilized to define a refinement phase.
Results:
During 12 years of handshake stewardship (2013–2025), anti-infective use hospital-wide declined 33%. A maintenance phase, when refinement in anti-infective use was observed though overall use plateaued numerically, began in October 2021.
Conclusions:
The goal of stewardship is judicious use, not no use. We describe the maturation of a stewardship program over 12 years, demonstrating that handshake stewardship is both effective and sustainable, and that over time the focus shifts from decreased overall days of therapy per thousand patient days towards optimal use, reflected in fine-tuned use of specific agents.