The mission of Expert Stewardship, Inc. is to establish, support and maintain antimicrobial stewardship and infection prevention programs in long-term care facilities. We use the latest developments in performance improvement and medical research to improve clinical outcomes, minimize development of antimicrobial resistance and reduce costs.

Centers for Medicare & Medicaid Services (CMS) regulations (§483.80 Infection Control) and individual state law (California Senate Bill 361) require that all long-term care facilities adopt and implement infection prevention and antimicrobial stewardship systems that are consistent with guidelines developed by the Centers for Disease Control and Prevention (CDC), the Centers for Medicare and Medicaid Services (CMS), the Society for Healthcare Epidemiology of America (SHEA), the Infectious Disease Society of America (IDSA) or similarly recognized professional organizations.  

Our expert team assists long-term care facilities anywhere in the nation comply with these requirements using the following strategies:


Baseline infection prevention risk assessment, antibiotic usage data, resistance patterns and patient outcomes form the foundation for effective infection prevention and antmicrobial stewardship.  Our training and expertise in infectious diseases, pharmacy and infection prevention combined allow us to rapidly develop targeted, effective interventions specific to each facility. Goals include reductions in laboratory testing costs, hospital readmission rates, antibiotic associated harm such as Clostridium difficile, antimicrobial resistance and, most importantly, improved resident health and satisfaction.


Education is one of our most important interventions.  Education is provided in person and also through this website.  As experts in our fields, we have the credibility to educate providers, change prescribing practices and implement a comprehensive suite of best practices. Facility specific Interventions may target opportunities such as low hand hygiene rates, spread of multidrug resistant organisms (Candida auris, CRE, MRSA, VRE and Clostridium difficile), unnecessary antibiotic exposure, laboratory testing, antibiotic cost and infection related outcomes.   The highest value interventions are initiated first so each facility should quickly realize a return on their investment.  Using our training in Quality Assurance and Performance Improvement (QAPI) and Six Sigma including DMAIC (Define, Measure, Analyze, Improve, Control) methodology, the effects of interventions are monitored and used to refine an intervention and/or develop new strategies and initiatives.



By following our comprehensive and data driven approach, our facilities are experiencing improved infection prevention best practices, reductions in unnecessary antibiotic prescriptions especially for Fluoroquinolones and antibiotic new starts for residents.  As a result, our facilities have had a reduction in urinary tract infections, Clostridium difficile infections and antibiotic expenditure.  Reductions in laboratory testing costs,  hospital readmission rates, antibiotic associated harm such as antimicrobial resistance and improved resident health and satisfaction may follow.  See examples of actual results here.

We work nationwide with individual facilities either in person or remotely. We have the capability to develop and support infection prevention and antimicrobial stewardship programs across an entire system of facilities which adds value and allows standardization.