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Implementation of core elements of antibiotic stewardship in nursing homes—National Healthcare Safety Network, 2016–2018

Published online by Cambridge University Press:  26 May 2021

Katryna A. Gouin Open the ORCID record for Katryna A. Gouin [Opens in a new window] ,
Sarah Kabbani Open the ORCID record for Sarah Kabbani [Opens in a new window] ,
Angela Anttila ,
Josephine Mak ,
Elisabeth Mungai ,
Ti Tanissha McCray ,
Jeneita Bell ,
Lauri A. Hicks  and
Nimalie D. Stone
Katryna A. Gouin*
Affiliation:
Chenega Corporation, on assignment to the Centers for Disease Control and Prevention, Atlanta, Georgia
Sarah Kabbani*
Affiliation:
Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, US Centers for Disease Control and Prevention, Atlanta, Georgia
Angela Anttila
Affiliation:
CACI (subcontractor to Leidos), on assignment to the Centers for Disease Control and Prevention, Reston, Virginia
Josephine Mak
Affiliation:
Leidos, on assignment to the Centers for Disease Control and Prevention, Reston, Virginia
Elisabeth Mungai
Affiliation:
Leidos, on assignment to the Centers for Disease Control and Prevention, Reston, Virginia
Ti Tanissha McCray
Affiliation:
Leidos, on assignment to the Centers for Disease Control and Prevention, Reston, Virginia
Jeneita Bell
Affiliation:
Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, US Centers for Disease Control and Prevention, Atlanta, Georgia
Lauri A. Hicks
Affiliation:
Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, US Centers for Disease Control and Prevention, Atlanta, Georgia
Nimalie D. Stone
Affiliation:
Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, US Centers for Disease Control and Prevention, Atlanta, Georgia
*
Author for correspondence: Sarah Kabbani, E-mail: [email protected]. or Katryna A. Gouin, E-mail: [email protected]
Author for correspondence: Sarah Kabbani, E-mail: [email protected]. or Katryna A. Gouin, E-mail: [email protected]
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Abstract

Objective:

To assess the national uptake of the Centers for Disease Control and Prevention’s (CDC) core elements of antibiotic stewardship in nursing homes from 2016 to 2018 and the effect of infection prevention and control (IPC) hours on the implementation of the core elements.

Design:

Retrospective, repeated cross-sectional analysis.

Setting:

US nursing homes.

Methods:

We used the National Healthcare Safety Network (NHSN) Long-Term Care Facility Component annual surveys from 2016 to 2018 to assess nursing home characteristics and percent implementation of the core elements. We used log-binomial regression models to estimate the association between weekly IPC hours and the implementation of all 7 core elements while controlling for confounding by facility characteristics.

Results:

We included 7,506 surveys from 2016 to 2018. In 2018, 71% of nursing homes reported implementation of all 7 core elements, a 28% increase from 2016. The greatest increases in implementation from 2016 to 2018 were in education (19%), reporting (18%), and drug expertise (15%). In 2018, 71% of nursing homes reported pharmacist involvement in improving antibiotic use, an increase of 27% since 2016. Nursing homes that reported at least 20 hours of IPC activity per week were 14% (95% confidence interval, 7%–20%) more likely to implement all 7 core elements when controlling for facility ownership and affiliation.

Conclusions:

Nursing homes reported substantial progress in antibiotic stewardship implementation from 2016 to 2018. Improvements in access to drug expertise, education, and reporting antibiotic use may reflect increased stewardship awareness and resource use among nursing home providers under new regulatory requirements. Nursing home stewardship programs may benefit from increased IPC staff hours.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 43 , Issue 6 , June 2022 , pp. 752 - 756
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Copyright
© The Author(s), 2021. Published by Cambridge University Press on behalf of The Society for Healthcare Epidemiology of America

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Footnotes

PREVIOUS PRESENTATION: These findings were previously presented in an abstract at the IDWeek 2020 conference, October 22–25, 2020, held virtually.

References

Thompson, ND, LaPlace, L, Epstein, L, et al. Prevalence of antimicrobial use and opportunities to improve prescribing practices in US nursing homes. J Am Med Dir Assoc 2016;17:1151–1153.CrossRefGoogle Scholar
van Buul, LW, van der Steen, JT, Veenursing homeuizen, RB, et al. Antibiotic use and resistance in long-term care facilities. J Am Med Dir Assoc 2012;13:568.e561.CrossRefGoogle Scholar
Lim, CJ, Kong, DCM, Stuart, RL. Reducing inappropriate antibiotic prescribing in the residential care setting: current perspectives. Clin Interv Aging 2014;9:165–177.Google ScholarPubMed
Gurwitz, JH, Field, TS, Avorn, J, et al. Incidence and preventability of adverse drug events in nursing homes. Am J Med 2000;109:87–94.CrossRefGoogle ScholarPubMed
Drinka, PJ, Crnich, CJ, Nace, DA. An antibiotic prescription induces resistance at the individual level more than the group level. J Am Med Dir Assoc 2013;14:707–708.CrossRefGoogle Scholar
Crnich, CJ, Safdar, N, Robinson, J, Zimmerman, D. Longitudinal trends in antibiotic resistance in US nursing homes, 2000–2004. Infect Control Hosp Epidemiol 2007;28:1006–1008.CrossRefGoogle ScholarPubMed
Campbell, RJ, Giljahn, L, Machesky, K, et al. Clostridium difficile infection in Ohio hospitals and nursing homes during 2006. Infect Control Hosp Epidemiol 2009;30:526–533.CrossRefGoogle Scholar
The Core Elements of Antibiotic Stewardship for Nursing Homes. Centers for Disease Control and Prevention website. https://www.cdc.gov/longtermcare/prevention/antibiotic-stewardship.html. Published 2015. Accessed January 7, 2020.Google Scholar
Tracking infections in long-term care facilities. Centers for Disease Control and Prevention website. https://www.cdc.gov/nursinghomesn/ltc/index.html. Accessed October 15, 2019.Google Scholar
Palms, DL, Kabbani, S, Bell, JM, Anttila, A, Hicks, LA, Stone, ND. Implementation of the core elements of antibiotic stewardship in nursing homes enrolled in the National Healthcare Safety Network. Clin Infect Dis 2019;69:1235–1238.CrossRefGoogle ScholarPubMed
Medicare and Medicaid programs; reform of requirements for long-term care facilities. US Government Publishing Office website. https://www.govinfo.gov/content/pkg/FR-2016-10-04/pdf/2016-23503.pdf. Published 2016. Accessed October 15, 2019.Google Scholar
Nursing facilities, staffing, residents and facility deficiencies, 2009 through 2016. Kaiser Family Foundation website. http://files.kff.org/attachment/SUPPLEMENTAL-TABLES-Nursing-Facilities-Staffing-Residents-and-Facility-Deficiencies-2009-2016. Published 2018. Accessed January 7, 2020.Google Scholar
Nursing home data compendium, 2015 edition. Centers for Medicare & Medicaid Services website. https://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/CertificationandComplianc/Downloads/nursinghomedatacompendium_508-2015.pdf. Accessed January 7, 2020.Google Scholar
O’Leary, EN, van Santen, KL, Webb, AK, Pollock, DA, Edwards, JR, Srinivasan, A. Uptake of antibiotic stewardship programs in US acute-care hospitals: findings from the 2015 National Healthcare Safety Network annual hospital survey. Clin Infect Dis 2017;65:1748–1750.CrossRefGoogle Scholar
Hospital antibiotic stewardship. Centers for Disease Control and Prevention website. https://arpsp.cdc.gov/profile/stewardship. Accessed February 27, 2020.Google Scholar
Stone, PW, Herzig, CTA, Agarwal, M, Pogorzelska-Maziarz, M, Dick, AW. Nursing home infection control program characteristics, CMS citations, and implementation of antibiotic stewardship policies: a national study. Inquiry 2018;55:46958018778636.Google ScholarPubMed
Fu, CJ, Mantell, E, Stone, PW, Agarwal, M. Characteristics of nursing homes with comprehensive antibiotic stewardship programs: results of a national survey. Am J Infect Control 2020;48:13–18.CrossRefGoogle ScholarPubMed
Stone, PW, Agarwal, M, Pogorzelska-Maziarz, M. Infection preventionist staffing in nursing homes. Am J Infect Control 2020;48:330–332.CrossRefGoogle Scholar
M’Ikanatha, NM, Boktor, SW, Seid, A, Kunselman, AR, Han, JH. Implementation of antimicrobial stewardship and infection prevention and control practices in long-term care facilities—Pennsylvania, 2017. Infect Control Hosp Epidemiol 2019;40:713–716.CrossRefGoogle ScholarPubMed
Core Elements of Hospital Antibiotic Stewardship Programs. Centers for Disease Control and Prevention website. https://www.cdc.gov/antibiotic-use/core-elements/hospital.html. Published 2019. Accessed March 23, 2020.Google Scholar
Martin, CM. Antibiotic stewardship: new frontier, familiar journey. Consult Pharm 2017;32 suppl A:27–32.CrossRefGoogle Scholar
Quigley, DD, Dick, A, Stone, PW. Quality innovation networks share varied resources for nursing homes on mostly user-friendly websites. J Am Geriatr Soc 2019;67:2376–2381.CrossRefGoogle ScholarPubMed
CDC antibiotic stewardship training series. Centers for Disease Control and Prevention Train website. https://www.train.org/cdctrain/training_plan/3697. Published 2018. Accessed January 7, 2020.Google Scholar
Nursing home infection preventionist training course. Centers for Disease Control and Prevention Train website. https://www.train.org/cdctrain/training_plan/3814. Published 2019. Accessed January 7, 2020.Google Scholar
Sloane, PD, Zimmerman, S, Ward, K, et al. A 2-year pragmatic trial of antibiotic stewardship in 27 community nursing homes. J Am Geriatr Soc 2020;68:46–54.CrossRefGoogle Scholar
Dick, AW, Bell, JM, Stone, ND, Chastain, AM, Sorbero, M, Stone, PW. Nursing home adoption of the National Healthcare Safety Network Long-term Care Facility Component. Am J Infect Control 2019;47:59–64.CrossRefGoogle ScholarPubMed
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