Implementing an antimicrobial stewardship program in the intensive care unit by engaging critical care nurses
Abstract
The continuing rise in the incidence of multidrug-resistant organism infections has made combating this grave threat a national imperative. One of the most potent weapons in our arsenal against such organisms is the prudent use of antibiotics. Antimicrobial stewardship (AMS) programs aim to slow the development of antimicrobial resistance through judicious, monitored use of antibiotics. Traditionally, AMS programs have included pharmacists and physicians with training in AWS, infectious disease physicians, hospital leadership, microbiologists, and infection prevention professionals. Nurses are missing from AMS programs, especially intensive care nurses. Critical care nurses provide the majority of patient care to ICU patients and monitor the progress of the patient's condition. The ICU nurse is an obvious asset to the AMS programs. ICU nurses are well-educated autonomous professionals with a unique role in coordinating with the critical care team. Critical care nurses already perform numerous nursing tasks with AWS functions. This, together with their unique perspective makes them a valuable asset that has often been overlooked. Traditionally, perceived barriers have kept ICU nurses from joining AMS teams. By removing these barriers and engaging critical care nurses in the important work of AWS, we can strengthen our AMS team and achieve optimal outcomes for our patients.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
While the composition of the IPC and AMS teams varies across different settings, emerging studies from LMICs support multidisciplinary AMS teams in general, as well as being specific to paediatric departments.
“While the composition of the IPC and AMS teams varies across different settings, emerging studies from LMICs support multidisciplinary AMS teams in general, as well as being specific to paediatric departments.5,28,30–33”
From Rationalizing irrational prescribing—infection-related attitudes and practices across paediatric surgery specialties in a hospital in South India (2024) · cites this paper as [33]
Cites
An Intervention to Decrease Catheter-Related Bloodstream Infections in the ICU
Pronovost, P., Needham, D., Berenholtz, S., Sinopoli, D., Chu, H., Cosgrove, S., Sexton, B., Hyzy, R., Welsh, R., Roth, G., et al. (2006) · New England Journal of Medicine · doi:10.1056/nejmoa061115 · Cited by 4,387 · see citing works
Multistate point-prevalence survey of health care-associated infections
Magill, S. S., Edwards, J. R., Bamberg, W., Beldavs, Z. G., Dumyati, G., Kainer, M. A., Lynfield, R., Maloney, M., McAllister-Hollod, L., Nadle, J., et al. (2014) · New England Journal of Medicine · doi:10.1056/nejmoa1306801 · Cited by 3,931 · see citing works
Barlam, T. F., Cosgrove, S. E., Abbo, L. M., MacDougall, C., Schuetz, A. N., Septimus, E. J., Srinivasan, A., Dellit, T. H., Falck-Ytter, Y. T., Fishman, N. O., et al. (2016) · Clinical Infectious Diseases · doi:10.1093/cid/ciw118 · Cited by 3,147 · see citing works
Bouadma, L., Luyt, C.-E., Tubach, F., Cracco, C., Alvarez, A., Schwebel, C., Schortgen, F., Lasocki, S., Veber, B., Dehoux, M., et al. (2010) · The Lancet · doi:10.1016/s0140-6736(09)61879-1 · Cited by 1,183 · see citing works
Roberts, J. A., Paul, S. K., Akova, M., Bassetti, M., De Waele, J. J., Dimopoulos, G., Kaukonen, K.-M., Koulenti, D., Martin, C., Montravers, P., et al. (2014) · Clinical Infectious Diseases · doi:10.1093/cid/ciu027 · Cited by 1,090 · see citing works
Targeted versus universal decolonization to prevent ICU infection
Huang, S. S., Septimus, E., Kleinman, K., Moody, J., Hickok, J., Avery, T. R., Lankiewicz, J., Gombosev, A., Terpstra, L., Hartford, F., et al. (2013) · New England Journal of Medicine · doi:10.1056/nejmoa1207290 · Cited by 795 · see citing works
Coia, J. E., Duckworth, G., Edwards, D., Farrington, M. M., Fry, C., Humphreys, H., Mallaghan, C., & Tucker, D. R. (2006) · Journal of Hospital Infection · doi:10.1016/j.jhin.2006.01.001 · Cited by 545 · see citing works
Antibiotic stewardship in the intensive care unit
Luyt, C. E., Bréchot, N., Trouillet, J., & Chastre, J. E. (2014) · Critical Care · doi:10.1186/s13054-014-0480-6 · Cited by 391 · see citing works
Fishman, N. O. (2006) · The American Journal of Medicine · doi:10.1016/j.amjmed.2006.04.003 · Cited by 239 · see citing works
Central Line Bundle Implementation in US Intensive Care Units and Impact on Bloodstream Infections
Furuya, E. Y., Dick, A. W., Perencevich, E. N., Pogorzelska‐Maziarz, M., Goldmann, D. A., & Stone, P. W. (2011) · PLoS ONE · doi:10.1371/journal.pone.0015452 · Cited by 218 · see citing works
Zingg, W., Hopkins, S., Gayet‐Ageron, A., Holmes, A. H., Sharland, M., Suetens, C., Almeida, M. D. L. G., Ašembergienė, J., Borg, M., Budimir, A., et al. (2017) · The Lancet Infectious Diseases · doi:10.1016/s1473-3099(16)30517-5 · Cited by 200 · see citing works
Olans, R. N., Olans, R. D., & DeMaria, A. (2015) · Clinical Infectious Diseases · doi:10.1093/cid/civ697 · Cited by 190 · see citing works
Self-citationKollef, M. H., Bassetti, M., François, B., Burnham, J. P., Dimοpoulos, G., Garnacho‐Montero, J., Lipman, J., Luyt, C. E., Nicolau, D. P., Postma, M. J., et al. (2017) · Intensive Care Medicine · doi:10.1007/s00134-017-4682-7 · Cited by 146 · see citing works
Medication errors and drug knowledge gaps among critical-care nurses: a mixed multi-method study
Gracia, J. E., Serrano, R. B., & Garrido, J. F. (2019) · BMC Health Services Research · doi:10.1186/s12913-019-4481-7 · Cited by 143 · see citing works
Using antibiotics responsibly: right drug, right time, right dose, right duration
Dryden, M., Johnson, A. P., Ashiru-Oredope, D. A. I., & Sharland, M. (2011) · Journal of Antimicrobial Chemotherapy · doi:10.1093/jac/dkr370 · Cited by 141 · see citing works
Slatore, C. G., Hansen, L., Ganzini, L. K., Press, N. A., Osborne, M. L., Chesnutt, M. S., & Mularski, R. A. (2012) · American Journal of Critical Care · doi:10.4037/ajcc2012124 · Cited by 131 · see citing works
Covering more territory to fight resistance: considering nurses’ role in antimicrobial stewardship
Edwards, R., Drumright, L. N., Kiernan, M. A., & Holmes, A. H. (2011) · Journal of Infection Prevention · doi:10.1177/1757177410389627 · Cited by 119 · see citing works
Re-estimating annual deaths due to multidrug-resistant organism infections
Burnham, J. P., Olsen, M. A. A., & Kollef, M. H. (2018) · Infection Control and Hospital Epidemiology · doi:10.1017/ice.2018.304 · Cited by 117 · see citing works
Preventing Transmission of Multidrug-Resistant Pathogens in the Intensive Care Unit
Strich, J. R., & Palmore, T. N. (2017) · Infectious Disease Clinics of North America · doi:10.1016/j.idc.2017.05.010 · Cited by 84 · see citing works
Combating antibiotic resistance: The role of nursing in antibiotic stewardship
Manning, M. L., Pfeiffer, J., & Larson, E. (2016) · American Journal of Infection Control · doi:10.1016/j.ajic.2016.06.023 · Cited by 82 · see citing works
Integrating staff nurses in antibiotic stewardship: Opportunities and barriers
Monsees, E., Popejoy, L., Jackson, M. A., Lee, B. R., & Goldman, J. L. (2018) · American Journal of Infection Control · doi:10.1016/j.ajic.2018.03.028 · Cited by 74 · see citing works
Defining a Role for Nursing Education in Staff Nurse Participation in Antimicrobial Stewardship
Olans, R. D., Nicholas, P. K., Hanley, D., & DeMaria, A. (2015) · The Journal of Continuing Education in Nursing · doi:10.3928/00220124-20150619-03 · Cited by 52 · see citing works
Self-citationGut Check: Clostridium difficile Testing and Treatment in the Molecular Testing Era
Buckel, W. R., Avdic, E., Carroll, K. C., Gunaseelan, V., Hadhazy, E., & Cosgrove, S. E. (2014) · Infection Control and Hospital Epidemiology · doi:10.1017/ice.2014.19 · Cited by 50 · see citing works
Research needs in antibiotic stewardship
Morris, A. M., Calderwood, M. S., Fridkin, S. K., Livorsi, D. J., McGregor, J. C., Mody, L., Moehring, R. W., Pakyz, A. L., Stenehjem, E. A., Szymczak, J. E., et al. (2019) · Infection Control and Hospital Epidemiology · doi:10.1017/ice.2019.276 · Cited by 42 · see citing works
Antimicrobial stewardship programs: mandatory for all ICUs
Kollef, M. H., & Micek, S. T. (2012) · Critical Care · doi:10.1186/cc11853 · Cited by 40 · see citing works
Good Nursing Is Good Antibiotic Stewardship
Olans, R. D., Olans, R. N., & Witt, D. J. (2017) · AJN American Journal of Nursing · doi:10.1097/01.naj.0000521974.76835.e0 · Cited by 40 · see citing works
Self-citationHa, D. R., Forte, M. B., Olans, R. D., OYong, K., Olans, R. N., Gluckstein, D. P., Kullar, R., Desai, M., Catipon, N., Ancheta, V., et al. (2019) · The Joint Commission Journal on Quality and Patient Safety · doi:10.1016/j.jcjq.2019.03.003 · Cited by 39 · see citing works
Self-citationNurses and Antimicrobial Stewardship
Olans, R. D., Hausman, N. B., & Olans, R. N. (2020) · Infectious Disease Clinics of North America · doi:10.1016/j.idc.2019.10.008 · Cited by 37 · see citing works
Self-citationPadigos, J., Reid, S. A., Kirby, E. R., & Broom, J. K. (2020) · Journal of Hospital Infection · doi:10.1016/j.jhin.2020.12.003 · Cited by 33 · see citing works
Antimicrobial stewardship: the role of the nurse
Ladenheim, D., Rosembert, D., Hallam, C., & Micallef, C. (2013) · Nursing Standard · doi:10.7748/ns2013.10.28.6.46.e7802 · Cited by 31 · see citing works
Manning, M. L., & Giannuzzi, D. (2015) · JONA The Journal of Nursing Administration · doi:10.1097/nna.0000000000000159 · Cited by 29 · see citing works
Engaging Nurses in Optimizing Antimicrobial Use in ICUs
Jeffs, L. P., Law, M. P., Zahradnik, M., Steinberg, M., Maione, M., Jorgoni, L., Bell, C. M., & Morris, A. M. (2017) · Journal of Nursing Care Quality · doi:10.1097/ncq.0000000000000281 · Cited by 20 · see citing works
Rout, J., & Brysiewicz, P. (2017) · Southern African Journal of Critical Care · doi:10.7196/331 · Cited by 18 · see citing works
Antimicrobial Stewardship: The Need to Cover All Bases
Friedman, N. D. (2013) · Antibiotics · doi:10.3390/antibiotics2030400 · Cited by 15 · see citing works
Kullar, R., Nagel, J. L., Bleasdale, S. C., Sutton, S. H., Naumovski, S., Rodriguez, A., Smith, C., Leggett, J., & Goldstein, E. J. C. (2018) · Clinical Infectious Diseases · doi:10.1093/cid/ciy797 · Cited by 12 · see citing works
Catheter-Associated Urinary Tract Infections — Turning the Tide
Huang, S. S. (2016) · New England Journal of Medicine · doi:10.1056/nejme1604647 · Cited by 11 · see citing works
Ha, D. R., Forte, M. B., Broberg, V., Olans, R. D., Olans, R. N., OYong, K., Kullar, R., Catipon, N., Ancheta, V., Desai, M., et al. (2019) · Open Forum Infectious Diseases · doi:10.1093/ofid/ofz360.1765 · Cited by 2 · see citing works
Self-citationCAUTI: A Journey of Micturition at MICU Since 2014
Dahlin, A., Kone, V., & Skandhan, A. (2020) · Infection Control and Hospital Epidemiology · doi:10.1017/ice.2020.675 · Cited by 1 · see citing works
Flagged first, then by citations
Cited by
Sorted by citations
Jiang, H., Pu, H., & Huang, N. (2023) · Scientific Reports · doi:10.1038/s41598-023-42522-2 · Cited by 14 · see citing works
Wang, L., & Zhang, Q. (2024) · BMC Nursing · doi:10.1186/s12912-024-02144-z · Cited by 8 · see citing works
Surendran, S., Nampoothiri, V., Dhar, P., Holmes, A., Singh, S., & Charani, E. (2024) · JAC-Antimicrobial Resistance · doi:10.1093/jacamr/dlae105 · Cited by 3 · see citing works
Antimicrobial Stewardship Principles for Critically Ill Patients
Santibañez, M., Rincon-Ponte, A. M., & Perez, G. S. (2025) · AACN Advanced Critical Care · doi:10.4037/aacnacc2025715 · Cited by 1 · see citing works
Le rôle infirmier dans les programmes de gestion des antimicrobiens en réanimation
Calviño-Günther, S. (2024) · Oxymag · doi:10.1016/j.oxy.2024.10.005
Dumke, V. G., Paz, I., de Assis, M. P., Pappen, M., Bender, M. S., Bienert, A. C., Hochscheidt, B. E., & Valim, A. R. D. M. (2025) · Cuadernos de Educación y Desarrollo · doi:10.55905/cuadv17n2-105
Mesa-Mesa, F. J., Cornejo-Gil, F. M., & Márquez-García, J. A. (2025) · Enfermería Intensiva · doi:10.1016/j.enfi.2025.500564
Mesa-Mesa, F. J., Cornejo-Gil, F. M., & Márquez-García, J. A. (2025) · Enfermería Intensiva (English ed ) · doi:10.1016/j.enfie.2025.500564
Antimicrobial Stewardship in the Intensive Care Unit
Lacey, Q. (2026) · Critical Care Nursing Clinics of North America · doi:10.1016/j.cnc.2026.04.001
- Authors
- Mei-Sheng Riley, M., & Olans, R.
- Affiliations
- MGH Institute of Health Professions (US)
- ORCID
- Olans, Rita
- Venue
- Critical Care Nursing Clinics of North America
- Publisher
- Elsevier BV
- Published
- 2021-12
- Volume
- 33
- Issue
- 4
- Pages
- 369-380
- ISSN
- 0899-5885 (ISSN-L)
- OpenAlex
- W3207960997
- Cited by
- 9
- References
- 38
- Citations by year
- 2026: 1 · 2025: 4 · 2024: 3 · 2023: 1
- FWCI
- 0.11
- Type
- journal article
- Language
- en
- Open access
- closed
- Licence
- Locations
- Critical Care Nursing Clinics of North America (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Life Sciences › Immunology and Microbiology › Applied Microbiology and Biotechnology › Antibiotic Use and Resistance
- Health Sciences › Medicine › Infectious Diseases › Infection Control in Healthcare
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Medicine › Antibiotic Resistance in Bacteria
- Keywords
- antimicrobial stewardship, intensive care unit, intensive care unit nurses, multidrug-resistant organisms, antimicrobial resistance, nurse engagement
- MeSH terms
- Antimicrobial Stewardship, Anti-Bacterial Agents, Critical Care, Humans, Intensive Care Units, Nurses
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
