Standard 3: Healthcare Associated Infection

Antimicrobial stewardship

Criterion: Antimicrobial stewardship

The health service organisation implements systems for the safe and appropriate prescribing and use of antimicrobials as part of an antimicrobial stewardship program.

Safe and appropriate antimicrobial prescribing is a strategic goal of the clinical governance system.

Antimicrobial stewardship (AMS) is defined as an ongoing effort by a health service organisation to optimise antimicrobial use among patients ‘to improve patient outcomes, ensure cost-effective therapy and reduce adverse sequelae of antimicrobial use (including antimicrobial resistance).1 An AMS program involves strategies and interventions that aim to reduce unnecessary antimicrobial use and promote the use of agents that are less likely to select for resistant microorganisms. This is done in line with treatment guidelines and with consideration of local susceptibility patterns.2

Effective AMS programs reduce inappropriate antimicrobial use, improve patient outcomes and reduce adverse consequences of antimicrobial use (including antimicrobial resistance, toxicity and unnecessary costs).3 Along with infection control, hand hygiene and surveillance, AMS programs are a key strategy in preventing antimicrobial resistance and decreasing preventable healthcare-associated infections.

The emergence of antimicrobial-resistant bacteria is closely linked with inappropriate antimicrobial use. Studies show that up to 50% of antimicrobial regimens prescribed for patients in hospitals, including Australian hospitals, are considered inappropriate. Comparison with data from northern Europe shows that Australian hospitals have a higher overall rate of inpatient antimicrobial use, and further work is required to optimise the use of antimicrobials in Australian hospitals.

The intent of this criterion is to ensure appropriate prescribing of antimicrobials, as part of the broader systems within a health service organisation to prevent and manage healthcare-associated infections and improve patient safety and quality of care.

This criterion, and the actions and strategies outlined in this guide should be considered in conjunction with the requirements of the Medication Safety Standard.

The content and implementation strategies for this criterion have been drawn from Antimicrobial Stewardship in Australian Hospitals3, which summarises the evidence about AMS programs, and details strategies for implementing and sustaining these programs. It is recommended that health service organisations consult this publication when planning and implementing an AMS program. The second edition was released in May 2018 and is available here.

AMS programs may need to be tailored in each organisation. The types of strategies and activities used depend on the specific organisational context, and factors such as the complexity, size and resources available for implementation, monitoring and evaluation.


Action 3.15 Action 3.16
Last updated 23rd May, 2018 at 08:44pm

MacDougall C, Polk R. Antimicrobial stewardship programs in health care systems. Clin Microbiol Rev 2005;18(4):638–56.

Cruickshank M, Ferguson J, editors. Reducing harm to patients from health care associated infection: the role of surveillance. Sydney: Australian Commission on Safety and Quality in Health Care; 2008.

Australian Commission on Safety and Quality in Health Care. Antimicrobial stewardship in Australian hospitals. Sydney: ACSQHC; 2011.