By Tami Rodriguez, PharmD, BCPS

A new position statement from the National Commission on Correctional Health Care highlights an urgent and growing priority in correctional health care: antimicrobial stewardship. As antimicrobial resistance (AMR) continues to threaten the effectiveness of modern medicine, correctional facilities are critical partners in addressing this public health challenge.

Correctional facilities face distinct challenges that increase the risk of inappropriate antimicrobial use and the spread of resistant organisms. Close living quarters, high rates of chronic illness, and frequent movement of individuals into and out of facilities create conditions where infections can spread rapidly.

The new position statement outlines six core elements of an effective antimicrobial stewardship program (ASP), aligning with broader national stewardship efforts while adapting them to the correctional setting. It acknowledges the unique risks within correctional environments while outlining clear, achievable steps to improve care and protect broader community health.

• Leadership commitment. Sustainable stewardship efforts require visible support from both administrative and clinical leadership, including alignment with public health partners.
• Accountability. Facilities are encouraged to designate leaders responsible for stewardship activities, often through a collaborative model involving physicians and pharmacists.
• Targeted interventions. Facilities should implement at least one stewardship strategy to improve antimicrobial use. Examples include prospective audit and feedback, formulary management strategies, or development of local treatment guidelines.
• Multidisciplinary approach. Effective stewardship relies on collaboration across disciplines. Physicians, pharmacists, nurses, dentists, and laboratory personnel all contribute to optimizing antimicrobial use and ensuring appropriate care.
• Tracking and reporting. Monitoring antimicrobial prescribing patterns and resistance trends allows facilities to evaluate the impact of interventions and refine their approach over time. The statement also highlights the importance of sharing data with local and state public health agencies to support coordinated response efforts.
• Education and training. Ongoing training helps clinicians understand best practices, reinforces guideline-based prescribing, and improves communication with patients about appropriate antimicrobial use.

This position statement acknowledges the operational realities of correctional health care including competing priorities, limited staffing, and resource constraints, which can make implementation difficult. However, the statement emphasizes that these barriers should not prevent action. Even small, focused interventions can lead to meaningful improvements when supported by leadership and informed by data.

Ultimately, the message is clear: improving antimicrobial use in correctional health care is achievable, necessary, and impactful. By taking deliberate steps, whether large or small, facilities can enhance patient care, reduce harm, and contribute to the global effort to preserve the effectiveness of antimicrobial therapies.

Read the Antimicrobial Stewardship position statement here. See all NCCHC position statements here.

Tami Rodriguez, PharmD, BCPS, is the American Pharmacists Association liaison to the NCCHC Board of Representatives.