CoE Logo Antimicrobial Stewardship
 Center of Excellence 
 Application & Designation Terms & Conditions

Part I: Demographic Data








































Part II:
ASP alignment with CDC Core Elements of Hospital Antibiotic Stewardship Programs
















CDC CORE ELEMENT: Action
Provide evidence of antibiotic stewardship interventions that improve patient outcomes, current DAILY stewardship activities and the strategies utilized (i.e., written attestation, electronic messages (e-mail), presentations, education material, and order sets).

Possible Supporting Documentation 
  • Prior authorization (List antimicrobials)
  • Prospective audits with feedback (List antimicrobials)
  • Institutional guidance for specific infections (List guidelines)
  • Formulary restrictions for specific antimicrobials (List antimicrobials) 
  • Active daily review of patients with targeted infections (List targeted infections)
  • Diagnostic stewardship activities (please describe) 
  • Evidence that the impact of actions is being monitored for success 
  • Required dose and indication for all antibiotic orders
  • Evaluation for opportunities to convert IV to PO antibiotics. 
  • Criteria for restricted use for broad-spectrum antimicrobial agents. 
  • Copy of hospital stewardship policy in place of supporting documents if the policy includes the specific activities outlined above.














CDC CORE ELEMENT: Education

Provide examples that reflect well-established and ongoing education efforts with different healthcare groups (clinicians, prescribers, pharmacists, nursing, etc.). Examples should be within the last 3 years.

Possible Supporting Documentation (Provide up to three examples).
  • Presentation given within the past 12 months to physicians and/or pharmacists and/or nurses and/or other relevant staff relating to antibiotic usage/optimization (if a PowerPoint presentation, please convert to a document showing 2-3 slides per page)
  • Patient education materials given to patients/caregivers regarding antimicrobials
  • Information provided to patients/caregivers on discharge when discharged to complete an antibiotic regimen
  • Educational material developed in collaboration with nursing representative
  • Communication provided to patients/caregivers as part of an ongoing patient education effort (e.g., newsletter)
  • Post-test or knowledge assessment.




Part III: Optional 
Provide any additional information on regional or national stewardship collaborations, publications, and presentation. 


Possible Supporting Documentation
  • List of stewardship-related publications within the last 3 years (citations only). 
  • Description of stewardship collaborations your hospital has participated in the last 3 years (i.e., how your hospital engages in ongoing, formal collaboration beyond your facility to advance antibiotic stewardship, whether informal or on an as-needed basis). 
  • List of stewardship regional and national presentations within the last 3 years.  
  • List of stewardship-related research grants within the last 3 years.


For internal purpose only


Terms & Conditions

By signing below, I acknowledge and agree that I am authorized as a representative of the Hospital submitting this application to accept the following terms and conditions, on behalf of the Hospital, for participation in the Antimicrobial Stewardship Centers of Excellence ("Program"):