Antimicrobial Stewardship in Acute-Care Hospitals: A Report of the California Healthcare-Associated Infections Honor Roll

Background: Antimicrobial stewardship has been demonstrated to improve patient outcomes and reduce unwanted consequences, such as antimicrobial resistance and Clostridioides difficile infection. The California Department of Public Health (CDPH) Healthcare-Associated Infection (HAI) Program developed an honor roll to recognize facilities with the goal of promoting antimicrobial stewardship programs and encouraging collaboration and research. Methods: The first open enrollment period in California was from August 1 to September 1, 2020, and was only open to acute-care hospitals (ACHs). Enrollment occurs every 6 months. Applicants completed an application and provided supporting documentation for bronze, silver, or gold designations. The criteria for the bronze designation were at least 1 item from each of CDC’s 7 core elements for ACHs. The criteria for silver were bronze criteria plus 9 HAI program prioritized items (based on published literature) from the CDC Core Elements and demonstration of outcomes from an intervention. The criteria for gold designation were silver criteria plus community engagement (ie, local work or collaboration with healthcare partners). Applications were evaluated in 3 phases: (1) CDPH reviewed core elements and documentation, (2) CDPH and external blinded antimicrobial stewardship experts reviewed outcomes as scientific abstracts, and (3) CDPH reviewed each program for overall effectiveness in antimicrobial stewardship and final designation determination. Designations expire after 2 years. Results: In total, 119 applications were submitted (30% of all ACHs in California), of which 100 were complete and thus were included for review. Moverover, 33 facilities were from northern California and 67 were from southern California. Also, 85 facilities were part of a health system or network, 14 were freestanding, and 1 was a district facility. Facility types included 68 community hospitals, 17 long-term acute-care (LTAC) facilities, 17 academic or teaching hospitals, 4 critical-access hospitals, and 4 pediatric hospitals. There was an even distribution of hospital bed size: 35 facilities had <250 beds. The final designations included 19 gold, 35 silver and 43 bronze designations. There was 44% incongruency in applicants not receiving the designation for which they applied. Community hospitals were 63%–74% of all designations, and no LTACs received a gold designation. Moreover, 63% of hospitals with gold designations had >250 beds, and 47% of hospitals with bronze designations had <1 25 beds. Conclusions: The number of applicants was higher than expected because the open enrollment period occurred during the COVID-19 pandemic. This finding demonstrates the high importance placed on antimicrobial stewardship among ACHs. It also provides insight into how facilities are performing and collaborating and how CDPH can support facilities to improve their ASP.Funding: NoDisclosures: None

Employees’ Refusals to Participate in an Employer-Sponsored Wellness Program: Barriers and Benefits to Engagement

While worksite wellness programs are generally designed to help employees realize better overall health, some employees may not see them in that light. The current study sought to better understand why employees refuse to participate in a new employer-sponsored wellness program. This study also investigated how participation in the program is related to employees’ self-perceived health, efficacy to be healthier and their perceptions toward their organization providing useful resources to engage in a healthy lifestyle. A survey of more than 1,500 employees at a large Midwest organization was conducted after their annual open-enrollment period. Open-ended responses from participants refusing to participate in the wellness program ( n = 297) indicated privacy considerations as their primary concern. They also thought participation would take too much time, conceptually thought the program was unfair or not useful and felt they were already healthy and not in need of the program. Both participants and nonparticipants had no differences in self-perceived overall health. However, participants had greater self-efficacy, and perceptions that their employer offered useful resources to engage in a healthy lifestyle, than nonparticipants. Recommendations for communicating new wellness programs to employees are discussed.

From Open Enrollment to Controlled Choice: How Choice-Based Assignment Replaced the Neighborhood School in Cambridge, Massachusetts

In 1981, Cambridge, Massachusetts, became the first school district in America to replace its neighborhood schools with a “controlled choice” assignment plan, which considered parental preference and racial balance. This article considers the history preceding this decision to explore how and why some Americans became enamored with choice-based assignment at the expense of the neighborhood school in the late twentieth century. It argues that Cambridge's problematic experience with open enrollment in the 1960s and 1970s created a vocal, consumer-oriented, and politically active class of parents who became accustomed to choice and, by the early 1980s, dependent on its benefits. Moreover, controlled choice proved especially attractive in this university community because Cambridge had a constituency of well-educated, middle-income parents who possessed the social capital to identify the best educational opportunities for their children, but lacked the economic capital to use real estate to gain access to their preferred schools.