Action Plan — The Focus Areas:
II. Prevention (Issues B-C)

B.	Issue: Improved diagnostic practices can enhance antimicrobial use and patient care.
	1.	Goal: Identify and promote the widespread use of diagnostic testing and reporting strategies that effectively facilitate appropriate use of antimicrobial drugs in routine practice.
		a.	Action Items
			33.	Evaluate the potential impact of improved diagnostic tests, including rapid point-of-care tests on antimicrobial drug use and patient care, and assess their financial implications. Take into account tests that distinguish between bacterial and viral infections, tests that identify resistant pathogens, and tests that distinguish common clinical entities such as bacterial sinusitis and acute bacterial otitis media from illnesses with similar manifestations for which antimicrobials are not beneficial. (Related Action Item: Research #76) Coordinators: CDC, FDA, NIH Collaborators: DVA, DoD Timeline: Begin within one to two years
			34	Identify economic and other barriers in the health care system (e.g., reimbursement policies by third-party payers, managed care practices, cost considerations, empiric treatment recommendations, etc.) to diagnostic testing that promotes appropriate use of antimicrobials. Develop recommendations that remove disincentives or promote incentives to such testing. Coordinator: HCFA Collaborators: CDC, HRSA; AHRQ Timeline: Begin within three to five years
			35.	In collaboration with professional societies, industry, health departments, and other stakeholders and partners (b), develop guidelines for clinicians and clinical microbiology laboratories that address:
					Appropriate specimen collection;
					Performance, interpretation, and reporting of antimicrobial (including antibacterial, antifungal, antiviral, and antiparasitic) susceptibility tests performed on clinical specimens; and
					Use of in-office (point-of-care) tests for infection, including AR infections. Coordinator: CDC Collaborators: FDA, DoD, DVA, HCFA, HRSA Timeline: Begin within three to five years
			36.	In collaboration with professional societies, industry, health departments, and other stakeholders and partners (b), develop guidelines that address the use of clinical microbiology laboratories for use by health care delivery organizations. The guidelines will:
					Promote access to clinical microbiology services by clinicians;
					Promote access to appropriate on-site microbiology services in acute care facilities;
					Allow physicians to submit specimens to clinical laboratories other than those designated by their health care delivery organization or the patient's insurance company, with appropriate justifications; and
					Facilitate direct consultation between clinicians and laboratory personnel with appropriate expertise and authority. Coordinator: CDC; Collaborator: HCFA for bullet 2. Timeline: Begin within one to two years
			37.	Promote the increased performance of direct examination of microbiological specimens (e.g., by Gram stain or other rapid method), in circumstances where appropriate, clinically relevant, and reliable information can be garnered, as a readily available point-of-care diagnostic test. This step will require working within the framework of the Clinical Laboratory Improvement Amendment (CLIA) regulations and involving medical education and health care delivery organizations. Coordinator: CDC Collaborator: HCFA Timeline: Begin within one to two years
C.	Issue: Preventing infection transmission through improved infection control, behaviors that prevent infection (e.g., safe sexual practices), and use of vaccines can help prevent the spread of antimicrobial resistance.
	1.	Goal: Identify ways to reduce disease transmission in health care settings and in the community.
		a.	Action Items
			38.	Identify factors that promote transmission of drug-resistant pathogens in health care facilities, in extended care facilities, and in community settings including daycare centers and in the community at large. These may include characteristics of the facilities and of the populations that they serve. Coordinator: CDC Collaborators: DVA, DoD Timeline: Initiated
			39.	TOP PRIORITY ACTION ITEM — Evaluate the effectiveness (including cost-effectiveness) of current and novel infection-control practices for health care and extended care settings and in the community. Promote adherence to practices proven to be effective. Coordinator: CDC Collaborators: DoD, DVA, HCFA, HRSA Timeline: Initiated
			40.	Evaluate the cost-effectiveness and impact on patient care and drug resistance of medical devices that incorporate anti-infective compounds to prevent infection (e.g., anti-infective urinary catheters and prosthetic heart valves). Where appropriate (e.g., shown to be effective and not induce resistance), encourage the clinical use of these devices. (Related Action Item: Product Development #82) Coordinator: CDC Collaborators: AHRQ, DoD, DVA, FDA, HRSA, HCFA Timeline: Begin within three to five years
			41.	Encourage the development and implementation of clinical alternatives to those invasive medical procedures and devices that increase the risk of infection in hospitals and other health care settings, e.g., substitution of transcutaneous monitoring of blood oxygen levels of indwelling catheters. Coordinator: CDC Collaborators: FDA, DVA Timeline: Begin within three to five years
			42.	Evaluate the benefits and risks of incorporating antimicrobial, disinfectant, or antiseptic chemicals into consumer products (e.g., soap, toys, kitchen utensils, clothes, paints, plastics, and film preservatives) and of applying disinfectants and sanitizers to hard, non-porous surfaces such as food-contact surfaces, hospital premises, bathrooms, etc. Consider whether they have any efficacy in reducing infection and/or may play a role in promoting drug resistance. Coordinators: CDC, EPA Collaborator: FDA Timeline: Initiated
	2.	Goal: Promote infection control through behavioral and educational interventions
		a.	Action Items
			43.	Conduct a public health campaign to promote hand hygiene and other hygienic practices, as well as other behaviors that prevent the transmission of infectious organisms, in collaboration with professional societies and stakeholders. This campaign may be coordinated with the public health education strategy to promote appropriate antimicrobial use described in Action Item #25: Prevention and Control. Components will include developing, evaluating, and facilitating the implementation of school-based and other programs that promote hand hygiene and other behaviors that prevent infection, building on previous campaigns (e.g., American Society of Microbiology's Operation Clean Hands) (27). Coordinator: CDC Timeline: Begin within one to two years
			44.	Facilitate and support the activities of infection control programs in health care settings as a component of medical care. Promote infection control education at all stages of training and practice for all health care workers who have contact with patients. Coordinator: CDC Collaborators: DVA, HCFA, DoD, HRSA Timeline: Initiated
			45.	Support ongoing public health education campaigns on food safety, such as FDA and USDA's Fight Bac program (28), whose aims are to educate food producers, suppliers, retailers, and consumers about food safety practices that reduce foodborne infections (including AR infections) (29). Coordinators: USDA, CDC, FDA Timeline: Initiated
			46.	Educate the public about the merits and safety of irradiation as one tool to reduce bacterial contamination of food. Coordinator: CDC Timeline: Begin within one to two years
	3.	Goal: Optimize the use of vaccines to prevent drug-resistant infections and reduce antibiotic use.
		a.	Action Items
			47.	Support community-based programs that promote and facilitate availability of recommended vaccinations for adults and children. Coordinator: CDC Timeline: Initiated
			48.	Identify vaccines useful in preventing drug-resistant infections and reducing antimicrobial drug use, and evaluate novel methods for improving coverage with these vaccines. For example:
					Evaluate the risks and benefits of allowing certain vaccines for adults (e.g., for pneumococci and influenza virus) to be dispensed by pharmacists without prescription and
					Review and evaluate methods to promote administration of pneumococcal vaccines (e.g., offering vaccination when patients are discharged from the hospital), and encourage the use of methods found to be effective. Coordinator: CDC Collaborators: DVA, FDA, HCFA Timeline: Begin within three to five years

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