Antibiotic Stewardship Resources
Assessment Efforts in Long-Term Care Facilities in Washington, DC
Below is a brief list of selected antibiotic stewardship resources which may be helpful for long-term care facilities. Many, but not all, of these resources are available free of charge. Inclusion in this list does not constitute a specific endorsement but rather is intended to provide a starting point of reputable tools, information, and organizations so that users can find and choose what meets their needs. If your facility finds or develops additional valuable resources, please let us know and we can add them to the list so others may benefit as well.
Guidelines, Training, and Toolkits
A CDC developed practical guide for developing antibiotic stewardship activities in nursing homes. There are also fact sheets for residents, families, medical leaders, and administrators.
Here you’ll find general information on the Be Antibiotics Aware campaign with links to educational materials and reports on antibiotic resistance, including promotional print and online materials targeted toward both providers and the public.
You’ll also find online continuing education opportunities related to antibiotic resistance and appropriate prescribing. These free training courses are primarily for prescribers, but nurses, pharmacists, and others are also eligible and may find them useful.
AHRQ has created a Nursing Home Antimicrobial Stewardship Guide and a set of toolkits that can be used to choose and implement interventions and establish the core elements in the CDC guide above.
The Quality Improvement Organization (QIO) Program Nursing Home Training Sessions
The Centers for Medicare and Medicaid Services (CMS) leads the QIO program which is aimed at improving health quality at the local level. The nursing home training sessions are approved to award nursing contact hours, and include materials intended to be customizable for in person trainings as well as online sessions accessible to staff anytime.
American Dental Association (ADA) guidance on antibiotic prophylaxis
ADA offers guidance/references on antibiotic prophylaxis prior to dental procedures.
National Associations and Campaigns
LeadingAge is an organization of not-for-profit senior service providers that, among other efforts, provides tools intended to help member facilities understand and make cahnges to meet the CMS Requirements of Participation.
The NNHQI Campaign provides free evidence-based and model-practice resources to support continuous quality improvement.
American Health Care Association (AHCA)
The AHCA is a non-profit federation of affiliate state health organizations, together representing more than 13,500 non-profit and for-profit nursing facility, assisted living, developmentally-disabled, and subacute care providers that care for approximately one million elderly and disabled individuals each day. AHCA resources on antibiotic stewardship include education for members, the AHCA quality initiative, and an infection preventionist training program.
Selected Literature
(Some may require library subscription – if assistance needed, contact us)
The White House National Strategy for Combating Antibiotic Resistant Bacteria. 2014
Jump RL, Gaur S, Katz MJ, et al. Template for an Antibiotic Stewardship Policy for Post-Acute and Long-Term Care Settings. Journal of the American Medical Directors Association, 2017 Nov; 18(11), 913-20. doi:10.1016/j.jamda.2017.07.018.
Lim CJ, Kong DCM, Stuart RL. Reducing inappropriate antibiotic prescribing in the residential care setting: current perspectives. Clin Interven Aging. 2014; 9: 165-177.
Nicolle LE. Antimicrobial stewardship in long-term care facilities: what is effective? Antimicrob Resist Infect Contr 2014; 3:6. Accessed 11/21/17. https://doi.org/10.1186/2047-2994-3-6
Nicolle LE, Bentley DW, Garibaldi R, Neuhaus EG, Smith PW. Antimicrobial use in long-term-care facilities. SHEA Long-Term-Care Committee. Infection Control and Hospital Epidemiology 2000; 21(8): 537-45. http://www.jstor.org/stable/pdf/10.1086/501798.pdf
Thompson ND, LaPlace L, Epstein L, et al. Prevalence of Antimicrobial Use and Opportunities to Improve Prescribing Practices in U.S. Nursing Homes. Journal of the American Medical Directors Association 2016; 17(12): 1151-3.
Stone N et al. Surveillance Definitions of Infections in Long-Term Care Facilities: Revisiting the McGeer Criteria. Infection Control and Hospital Epidemiology, Vol. 33, No. 10 (October 2012), pp.965-977. http://www.jstor.org/stable/pdf/10.1086/667743.pdf
Dyar OJ, Pagani L, Pulcini C.Strategies and challenges of antimicrobial stewardship in long-term care facilities. Clin Microbiol Infect. 2015 Jan;21(1):10-9. doi: 10.1016/j.cmi.2014.09.005.
Morrill HJ, Caffrey AR, Jump RL, Dosa D, LaPlante KL. Antimicrobial Stewardship in Long-Term Care Facilities: A Call to Action. J Am Med Dir Assoc. 2016 Feb;17(2):183.e1-16. doi: 10.1016/j.jamda.2015.11.013.
Mylotte JM. Antimicrobial Stewardship in Long-Term Care: Metrics and Risk Adjustment. J Am Med Dir Assoc. 2016 Jul 1;17(7):672.e13-8. doi: 10.1016/j.jamda.2016.04.014
Kullar R, Yang H, Grein J, Murthy R.A Roadmap to Implementing Antimicrobial Stewardship Principles in Long-Term Care Facilities (LTCFs): Collaboration Between an Acute-Care Hospital and LTCFs. Clin Infect Dis. 2017 Nov 22. doi: 10.1093/cid/cix1041
Suda KJ, Henschel H, Patel U, Fitzpatrick MA, Evans CT. Use of Antibiotic Prophylaxis for Tooth Extractions, Dental Implants, and Periodontal Surgical Procedures. Open Forum Infectious Diseases. 2018;5(1):ofx250. doi:10.1093/ofid/ofx250
Area Partners
D.C. Department of Health Healthcare-associated infections (HAI) program
The HAI program coordinates HAI prevention activities across the District. It is non-regulatory and serves as a resource for healthcare facilities in developing and implementing prevention activities to drive quality improvement. The ICAR long term care (LTC) survey process is one collaborative step in gaining a better understanding of area needs and priorities and determining how to best develop and target resources to meet those needs. The HAI program convenes an HAI committee that addresses antimicrobial resistance. LTC facilities are represented on this committee by the D.C. Health Care Association. Contact: doh.hai@dc.gov
The National Capital ROAR Coalition (Region Organized Against Resistance)
The ROAR coalition is a grassroots group of healthcare providers who work day-to-day in their facilities to combat antimicrobial resistance. ROAR members have a wide range of expertise and experience in infectious disease, infection prevention and control, microbiology and pharmacy, in many cases leading or supporting antibiotic stewardship programs. The coalition is a forum to share information and experience, including best practices, and to develop joint actions to be undertaken as a community. ROAR welcomes the participation of regional acute care and LTC facility professionals who are working or plan to work in stewardship. Also, if you have specific questions or needs in designing or implementing your antibiotic stewardship program, contact ROAR and we will work to help answer your questions and identify and connect you with local experts.
Delmarva
Delmarva Foundation is a national, not-for-profit organization—established in 1973—dedicated to creating solutions to transform health. Delmarva Foundation, the Quality Improvement Organization for the District of Columbia for greater than 30 years, partnered with the District of Columbia Hospital Association, the District of Columbia Healthcare-Associated Infections (HAI) Coordinator from the DC Health Care Department and multiple Hospital Improvement Innovation Networks (formerly named Hospital Engagement Networks) to reduce HAIs in the District. In addition, Delmarva Foundation works with these partners and stakeholders in hospitals, nursing homes, home health agencies, hospices, pharmacies, providers offices/clinics to improve care transitions, reduce readmissions and adverse drug events and increase the level of preventive care services (diabetes exams/monitoring, immunizations, cardiovascular health, smoking cessation). An additional initiative underway in 2017 includes Outpatient Antibiotic Stewardship, working with providers to improve outpatient antibiotic use by implementing the 4 Core Elements, to mitigate antibiotic resistance and harmful adverse events. Contact: Jennifer Thomas, PharmD, thomasj@delmarvafoundation.org.