It’s Prime Time for Nursing Homes: New AHRQ Antimicrobial Stewardship Guide Available

Antimicrobial medications, including antibiotics, are a classic double-edged sword. Used properly, antibiotics save lives, fighting life-threatening infections by killing the bacteria that cause them. But used improperly, antibiotics can be ineffective, and even harmful, and can render the drugs powerless for future use.

Antimicrobial stewardship programs (ASPs) are a proven method to improve the use of antibiotics. An ASP is a coordinated program within a health care setting that promotes the appropriate use of antimicrobials, thereby improving patient outcomes, reducing antibiotic resistance, and decreasing the spread of infections caused by antibiotic-resistant organisms.

A new guide from AHRQ addresses challenges in creating and implementing ASPs in nursing homes. This is important because it’s estimated that up to 75 percent of antibiotics used in nursing homes are prescribed unnecessarily. The Nursing Home Antimicrobial Stewardship Guide was developed to optimize the use of antimicrobials in nursing homes and decrease the harms that can be caused by inappropriate antibiotic prescribing.

The guide is based on four AHRQ-funded toolkits developed to improve use of antibiotics in nursing homes as well as additional tools to complement the existing four toolkits. The evidence-based guide was pilot-tested in nine nursing homes; so it’s ready for prime time.

Critically, all the toolkits are customizable, allowing nursing homes to pick and choose the interventions and modules within each of the four toolkits to fit their needs. In addition, the Guide is consistent with CDC’s core elements of antibiotic stewardship for nursing homes and can help staff implement many of those elements. And, it can help health care providers meet CMS’ new Infection Prevention and Control Program requirement. The Web-based toolkits offer step-by-step instructions to help nursing homes improve antibiotic use and decrease infection. The guide’s four toolkits are designed to do the following:

• Implement, monitor, and sustain an antimicrobial stewardship program.
• Determine whether it is necessary to treat a potential infection with antibiotics.
• Help prescribing clinicians use an antibiogram to choose the right antibiotic to treat a particular infection.
• Educate and engage residents and family members.

This isn’t AHRQ’s first venture into ASPs. Four years ago, we developed the Toolkit for Reduction of Clostridium difficile Infections Through Antimicrobial Stewardship. We’re committed to ASPs because they’re essential to our broad national effort to maintain the effectiveness and safety of the Nation’s antibiotics. They are an important part of the White House’s National Strategy and National Action Plan for Combating Antibiotic-Resistant Bacteria (collectively known as the CARB).

The new guide is the latest way that AHRQ is supporting CARB—and we’re doing so in several ways, including two currently active Funding Opportunity Announcements (an R01 and an R18) that speak directly to the CARB effort.

Also, this week, infection prevention specialists are assembling in New Orleans for IDWeek, the annual conference convening four infectious disease organizations. If you’re attending IDWeek, I hope you’ll visit the AHRQ exhibit at Booth 1102, where you can learn more about the Nursing Home Antimicrobial Stewardship Guide and other AHRQ projects to combat healthcare-associated infections.