Question

"Nursing Home Antimicrobial Stewardship"

• Identification of problem and impact on nursing practice.

Answer 1

Infections caused by organisms resistant to multiple drugs are associated with morbidity and mortality, prolonged hospital stay and increased costs. Since antibiotic use is the main factor in the development of resistance, it is hoped that the judicious use of antibiotics will reduce the emergence of antimicrobial resistance.

• Nursing home antibiotic stewardship programs are moderately or highly comprehensive.

• •

  Antibiotic stewardship implementation increased following regulation changes.

• •

  More infection preventionists trained in infection control, however, gaps remain.

• •

  Trained staff are needed for comprehensive antibiotic stewardship.

• •

  Quality Innovation Networks-Quality Improvements Organizations are valuable.

Background

Antibiotic stewardship in nursing homes (NHs) is a high priority owing to intense antibiotic use and increased risk of adverse events. Updated Centers for Medicare and Medicaid Services regulations required NHs to establish antibiotic stewardship programs (ASPs). This study describes the current state of NH ASPs.

Methods

A nationally representative survey of NHs was conducted in 2018. ASP comprehensiveness, infection preventionist (IP) training, participation in Quality Innovation Network-Quality Improvement Organization (QIN-QIO) activities, and facility and staff characteristics were analyzed using weighted descriptive statistics and multinomial regression models.

Results

Of 861 NHs, 33.2% (6-7) had “comprehensive” ASP policies, 41.1% (4-5) had “moderately comprehensive” ASP policies, and 25.6% (≤ 3) had “not comprehensive” ASP policies. Data collection on antibiotic use was most reported (91.4%), and restricting use of specific antibiotics was least reported (19.0%). Comprehensive ASPs were associated with QIN-QIO involvement; moderate and comprehensive ASPs were associated with IP training and high occupancy.

Immediately following Centers for Medicare and Medicaid Services regulation changes, a majority of NHs had moderately comprehensive or comprehensive ASPs. Rates for each policy and infection control-trained IPs increased from previous studies.

Conclusions

NH ASPs are becoming more comprehensive. Infection control training and partnerships with QIN-QIOs can support NHs to increase ASP comprehensiveness.