It’s no exaggeration to say that antibiotic stewardship programs in nursing homes will literally save lives. Broad spectrum antibiotics in particular can wipe out commensal gut flora and set the stage for Clostridium difficile infection (CDI) in this frail, elderly population. C. diff caused some 115,400 infections with onset in nursing homes in the United States in 2012, comprising nearly one-quarter of all U.S. CDI cases. Of those, some 8,700 (8%) residents died within 30 days of diagnosis, researchers report.1
To attack the problem, new recommendations from the CDC advise all nursing homes to improve antibiotic prescribing practices and reduce their inappropriate use to protect residents from the consequences of antibiotic-resistant infections, such as CDI. Complementing a similar publication for hospitals last year, the CDC has issued Core Elements of Antibiotic Stewardship for Nursing Homes (http://www.cdc.gov/longtermcare/prevention/antibiotic-stewardship.html). Key tenets of the guidelines stress leadership involvement, accountability, tracking, and reporting antibiotic use.
The CDC effort follows similar action by CMS, which recently proposed a rule that would require long-term care facilities to incorporate an antibiotic stewardship program— including antibiotic use protocols and antibiotic monitoring — into their infection prevention and control programs. (SeeHospital Infection Control & Prevention, September 2015.)
Approximately 4 million Americans are nursing home residents. Antibiotics are the most frequently prescribed medications in nursing homes, as up to 70% of residents receive one or more courses of the drugs each year. Unfortunately, some 75% of antibiotics prescribed in nursing homes are given incorrectly, meaning either the drug is unnecessary or the prescription is for the wrong drug, dose, or duration, the CDC reports.
The Core Elements guide provides practical ways for nursing homes to initiate or expand antibiotic stewardship activities. The CDC includes examples of how antibiotic use can be monitored and improved by nursing home leadership and staff. A checklist is included to assess policies and practices already in place and to review progress in expanding stewardship activities on a regular basis. Ultimately, the CDC recommends that nursing home antibiotic stewardship activities should include, at a minimum, the following:
Leadership commitment: Demonstrate support and commitment to safe and appropriate antibiotic use.
Accountability: Identify leaders who are responsible for promoting and overseeing antibiotic stewardship activities at the nursing home.
Drug expertise: Establish access to experts with experience or training in improving antibiotic use.
Action: Take at least one new action to improve the way antibiotics are used in the facility.
Tracking: Measure how antibiotics are used and the complications (e.g., C. difficile infections) from antibiotics in the facility.
Reporting: Share information with healthcare providers and staff about how antibiotics are used in the facility.
Education: Provide resources to healthcare providers, nursing staff, residents, and families to learn about antibiotic resistance and opportunities for improving antibiotic use.
- Hunter J, Mu Y, Dumyati, M., et al. National Estimates of Incidence, Recurrence, Hospitalization, and Death of Nursing Home-Onset of Clostridium difficile Infections — United States, 2012. CDC 64th Annual EIS Conference. Atlanta: April 20 – 23, 2015
