Improving the use of antibiotics in healthcare to protect patients and reduce the threat of antibiotic resistance is a national priority. Antibiotics are among the most frequently prescribed medications in nursing homes, with up to 70% of residents in a nursing home receiving one or more courses of systemic antibiotics in a year (Luong & Catullo, 2019). Studies have shown that 40–75% of antibiotics prescribed in nursing homes may be unnecessary or inappropriate (Luong & Catullo, 2019). Potential harm from antibiotic overuse is significant amongst long-term care residents. These harms include risk of serious diarrheal infections from Clostridium difficile, increased adverse drug events and drug interactions, disruption of normal flora, and colonization and/or infection with antibiotic-resistant organisms.
Antibiotic Stewardship refers to a set of commitments and actions designed to “optimize the treatment of infections while reducing the adverse events associated with antibiotic use” (CDC, 2021). This can be accomplished through improving antibiotic prescribing, administration, and management practices, thus reducing inappropriate use to ensure that residents receive the right antibiotic for the right indication, dose, and duration.
Nursing facilities are required to have an infection prevention and control program that includes an antibiotic stewardship program containing antibiotic use protocols and a system to monitor antibiotic use (CMS, 2017). These antibiotic use protocols and systems for monitoring antibiotic use must include:
- System of reports related to monitoring antibiotic usage and resistance data
- The frequency of monitoring and reviewing antibiotic usage
- The frequency and mode or mechanism of feedback to prescribers regarding antibiotic resistance data, their antibiotic use, and their compliance with your facility antibiotic use protocols
- The use of standardized tools and criteria to assess residents for infections
- The mode and frequency of education for prescribers and nursing staff on antibiotic use and the facility’s antibiotic use protocols
To learn more about the importance of antibiotic stewardship in nursing facilities, the core elements of antibiotic stewardship, and strategies for implementing an effective antibiotic stewardship program in your facility, please join us on July 19 for Adept Antibiotic Stewardship for the Infection Preventionist webinar. This webinar is part of our 12-month Proficient Infection Preventionist Series. This 12-month webinar series emphasizes skill building for the Post-Acute Care Infection Preventionist and provides a framework for supporting the Infection Preventionist with solid systems for sustained infection control, resources for compliant surveillance, data collection and outbreak management, and guidance for managing evolving regulatory requirements through a monthly remote learning group with other Infection Preventionists nationwide. Have you missed earlier sessions in the Infection Preventionist series? Access them here.
- Centers for Disease Control and Prevention (2021). Core elements of antibiotic stewardship for nursing homes. Accessed on June 14, 2022 from https://www.cdc.gov/antibiotic-use/core-elements/nursing-homes.html
- CMS Appendix PP State Operations Manual (2017). Accessed on June 14, 2022 from https://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/GuidanceforLawsAndRegulations /Downloads/Appendix-PP-State-Operations-Manual.pdf
- Luong, K., & Catullo, S. (2019, March). Developing a culture of antibiotic stewardship in post-acute care setting. The Journal of Post Acute and Long-Term Care Medicine (JAMDA), 20(3), PB16-PB17. https://doi.org/10.1016/j.jamda.2019.01.074