News, Skilled Nursing Facility

CMS’ new infection control requirements: What you need to implement a successful antibiotic stewardship program

The Centers for Disease Control (CDC) report that roughly 40–50% of antibiotics are prescribed incorrectly, with the possibility that nearly 50% of antibiotics are given for too long in nursing homes. These numbers highlight the shortfalls that may exist in long-term care staff education when it comes to antibiotic usage.

In the past two years, federal agencies have taken a hard look at infection control practices in long-term care facilities and demanded improvement. As part of Phase 3 of CMS’ new survey process, facilities are required to have a trained infection preventionist by November 2019. Even though that’s two years away, providers must start preparing now to meet the expanding requirements being rolled out before the advent of Phase 3—including the mandate that all facilities have an antibiotic stewardship program in place by November 28, 2017. Long-term care (LTC) facilities traditionally lack the specialized infection control training of hospitals, with infection control violations making up one of the most common LTC survey deficiencies. In other words, these facilities have their work cut out for them. Join infection control expert Brian Garavaglia, PhD, FACHCA on Tuesday, December 5, 1:00-2:30pm ET, as he walks providers through how to prepare for Phase 2 infection control requirements, including the impact antibiotic resistance has had on long-term care and how facilities can prevent resistance through stewardship.

Incorporate the following antibiotic stewardship approaches into your staff education programs to help lower your facility’s antibiotic use rates:

  • Practice good advance care planning and resident goals. Not every resident should or wants to be treated for every condition. For example, options such as interventions, medications, and hospitalization will be narrowed down for residents in a Palliative Care program.
  • Facilities should NOT culture or obtain specimens without actual symptomology present. McGeer’s has criteria, for example, for UTIs that include symptoms indicative of a UTI. All too often, residents are subject to urine, stool, or other cultures with minimal or vague symptomology. Many residents have bacteria in their urine, some related even to the technique used to collect the urine, particularly with women. The point being that the presence of bacteria does not equal an infection or the justification for antibiotic use/treatment.
  • Work with the medical director and physician staff to identify what results need communication and when. Teach staff to properly communicate results with a plan that emphasizes monitoring for additional symptomology first, other alternatives next (many UTIs can resolve with fluid, cranberry juice, etc.), and then follow up for antibiotic therapy if necessary.

Education also needs to be a collaborative effort. The CDC names numerous forms for communicating education to staff, including flyers, pocket guides, newsletters, or electronic communications. The agency found the most effective method for improving medication prescribing practices to be an interactive approach, such as a face-to-face workshop.

One nursing home antibiotic stewardship intervention demonstrated a sustained reduction in antibiotic use for two years after the intervention by linking education with feedback on physician prescribing practices. Another study showed a 64% reduction in inappropriate antibiotic use (i.e., prescriptions which did not adhere to guidelines), by providing feedback on individual physician prescribing practices and adherence to the guidelines over 12 months.