Antibiotic Stewardship

AHRQ Safety Program for Long-Term Care: HAIs/CAUTI

Slide 1: Antibiotic Stewardship

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Slide 2: Objectives

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Upon completion of this webinar, participants will be able to—

  • Describe how antibiotic stewardship is linked to infection prevention.
  • Explain how overtreating urinary tract infections (UTI) and catheter-associated urinary tract infections (CAUTI) can contribute to microbial resistance burden; and
  • List the core elements of executing an antibiotic stewardship program.

Slide 3: Antimicrobial Resistance is a Growing Problem1

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  • Every year 2 million people get sick with antibiotic-resistant infections.
  • Every year 23,000 die from antibiotic-resistant infections.
  • Costs as much as $20 billion in direct health care expenses per year.

Source: Centers for Disease Control and Prevention. Antibiotic Resistance Threats in the United States, 2013.

Image: Snapshot of the cover of the Antibiotic Resistance Threats in the United States 2013 report produced by the CDC.

1. Antibiotic Resistance Threats in the United States, 2013. Centers for Disease Control and Prevention (CDC). U.S. Department of Health and Human Services.

Slide 4: Antimicrobial Resistance in Long-Term Care (LTC)2,3

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  • A 2013 MMWR report found that carbapenem-resistant Enterobacteriaceae prevalence was higher in long-term acute-care hospitals than in acute-care hospitals (17.8% vs. 4.6%).
  • Healthcare-associated Clostridium difficile often originates in long-term care.

2. CDC. Vital Signs: Carbapenem-Resistant Enterobacteriaceae. MMWR Morb Mortal Wkly Rep. 2013; 62 (9): 165-70.
3. Lessa FC, Mu Y, Bamberg WM, et al. Burden of Clostridium difficile Infection in the United States. N Engl J Med 2015; 372: 825-834. DOI: 10.1056/NEJMoa1408913

Slide 5: Long-Term Care Is Critical in the Fight4

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Image from the CDC's Vital Signs showing how if health care facilities work together they can reduce the number of healtcare-associated infections.

Source: Centers for Disease Control and Prevention. "Making Health Care Safer: Stop Spread of Antibiotic Resistance." CDC Vital Signs. August 2015.

4. Stop Spread of Antibiotic Resistance. August 2015. Making Health Care Safer –CDC Vital Signs. Centers for Disease Control and Prevention.

Slide 6: Problem Statement5

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  • Up to 70% of residents in a nursing home receive one or more courses of antibiotics every year.
  • Between 40 and 70% of antibiotic use in nursing homes is inappropriate.
  • Inappropriate and unnecessary antibiotic use can lead to the selection of resistant pathogens.

Image: How Antibiotic Resistance Happens - 1. Lots of germs. A few are drug resistant. 2. antibiotics kill bacteria causing the illness, as well as good bacteria protecting the body from infection. 3. The drug-resistant bacteria are now allowed to grow and take over. 4. Some bacteria give their drug resistance to other bacteria, causing more problems.

Source: Centers for Disease Control and Prevention. Antibiotic Resistance Threats in the United States, 2013.

5. CDC. The Core Elements of Antibiotic Stewardship for Nursing Homes. Atlanta, GA: US Department of Health and Human Services, CDC; 2015.

Slide 7: Antibiotic Use in LTC Facilities6-9

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  • Antibiotics are frequently used in long-term care
    • They comprise about 40% of all prescriptions.
  • Antibiotics can cause harm to residents
    • High risk of side effects and adverse events.
    • Major risk factor for Clostridium difficile infection.
    • Driver of antibiotic resistance.
  • Prescribers often not on site and rely on assessments made by other staff
    • 67% of antibiotics were ordered over the phone.
  • Limited documentation of the assessments and rationale for antibiotic use
    • 43% of LTC-initiated antibiotic courses have no documentation of infection.

6. Benoit SR, Nsa W, Richards CL, et al. Factors Associate with Antimicrobial Use in Nursing Homes: A Multilevel Model. JAGS 2008; 56: 2039-44. DOI: 10.1111/j.1532-5415.2008.01967.x.
7. Daneman N, Grunir A, Bronskill SE, et al. Prolonged Antibiotic Treatment in Long-term Care. Role of the Prescriber. JAMA Intern. Med. 2013; 173: 673-82.
8. Nicolle LE, Bentley DW, Garibaldi R, et al. Antimicrobial Use in Long-Term –Care Facilities. Infect Control Hosp Epidwmiol 2000; 21 (8): 537-545.
9. Richards CL, Darrandji M, Weinberg DM, et al. Antimicrobial Use in Post-Acute Care: A Retrospective Descriptive Analysis in Seven Long-Term Care Facilities in Georgia. J Am Med Dir Assoc. 2005; 6 (2): 109-12.

Slide 8: Fighting Back Against Antibiotic Resistance1

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  • Infection prevention IS antibiotic stewardship!
  • Tracking infection prevention data has double value
    • HAI prevention.
    • Informs antibiotic stewardship programs.
  • Improving antibiotic prescribing.
  • Bacteria are constantly evolving, requiring the need for new antibiotics.

Image: Red oval highlighting Improving antibiotic prescribing/stewardship from the CDC's four core actions to prevent antibiotic resistance.

Source: Centers for Disease Control and Prevention. Antibiotic Resistance Threats in the United States, 2013.

1. Antibiotic Resistance Threats in the United States, 2013. Centers for Disease Control and Prevention (CDC). U.S. Department of Health and Human Services.

Slide 9: Goals of Antibiotic Stewardship5

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What is antibiotic stewardship?

Antibiotic stewardship refers to a set of commitments and activities designed to "optimize the treatment of infections while reducing the adverse events associated with antibiotic use."

The goal is…

  • to have the RIGHT DRUG
  • for the RIGHT PERSON
  • over the RIGHT TIME FRAME

5. CDC. The Core Elements of Antibiotic Stewardship for Nursing Homes. Atlanta, GA: US Department of Health and Human Services, CDC; 2015.

Slide 10: CDC's Core Elements of Antibiotic Stewardship for Nursing Homes5

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  • Leadership Commitment: Dedicate resources
  • Accountability: Appoint a leader responsible for implementation
  • Drug Expertise: Appoint a pharmacist leader
  • Actions To Improve Use: Implement at least one recommended action
  • Tracking: Monitor antibiotic prescribing and resistance patterns
  • Reporting: Regular report on antibiotic use and resistance
  • Education: Train staff, residents, and families about resistance and optimal prescribing

Source: Centers for Disease Control and Prevention. The Core Elements of Antibiotic Stewardship for Nursing Homes. 2015.

Image: Snap shot of the CDC's Core Elements of antibiotic Stewardship for Nursing Homes brochure/handbook.

5. CDC. The Core Elements of Antibiotic Stewardship for Nursing Homes. Atlanta, GA: US Department of Health and Human Services, CDC; 2015.

Slide 11: CDC Core Elements: Education10

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  • Engage and educate residents and families on antibiotic stewardship efforts
    • Interactive, face-to-face education has the strongest evidence for improving antibiotic stewardship knowledge.
  • Effective communication is
    • Complete
    • Clear
    • Brief
    • Timely

Image: When do you need an antibiotic? brochure

10. TeamSTEPPS® Long-Term Care Version. Content last reviewed September 2015. Agency for Healthcare Research and Quality, Rockville, MD. Accessed on August 22, 2016.

Slide 12: Communication to Enhance Antibiotic Stewardship10-12

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Consider using TeamSTEPPS communication strategies to standardize communication about antibiotic use

S – Situation

B – Background

A – Assessment

R – Recommendation

Image: Screen shot of a brochure for residents and family's that is part of Choosing Wisely. It outlines "Test & treatments for urinary tract infections (UTIs) in older people, when you need them -and when you don't."

Source: Choosing Wisely

Source: Consumer Voice

10. TeamSTEPPS® Long-Term Care Version. Content last reviewed September 2015. Agency for Healthcare Research and Quality, Rockville, MD. Accessed on August 22, 2016.
11. Choosing Wisely. Antibiotics for Urinary Tract Infections in Older People (AGS). 2013 Consumer Reports. Developed in cooperation with the American Geriatric Society. Accessed on August 22, 2016.
12. Consumer Voice. CAUTI Informational Brochure. 2016. National Consumer Voice for Quality Long-Term Care.

Slide 13: Personal Protective Equipment

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  1. TeamSTEPPS® for Long-term Care.
  2. CDC's Antibiotic Resistance Threats in the United States, 2013.
  3. CDC's The Core Elements of Antibiotic Stewardship for Nursing Homes.
  4. Consumer Voice's CAUTI Informational Brochure.

Slide 14: References

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  1. Antibiotic Resistance Threats in the United States, 2013. Centers for Disease Control and Prevention (CDC). U.S. Department of Health and Human Services.
  2. CDC. Vital Signs: Carbapenem-Resistant Enterobacteriaceae. MMWR Morb Mortal Wkly Rep. 2013; 62 (9): 165-70.
  3. Lessa FC, Mu Y, Bamberg WM, et al. Burden of Clostridium difficile Infection in the United States. N Engl J Med 2015; 372: 825-834. DOI: 10.1056/NEJMoa1408913
  4. Stop Spread of Antibiotic Resistance. August 2015. Making Health Care Safer –CDC Vital Signs. Centers for Disease Control and Prevention.
  5. CDC. The Core Elements of Antibiotic Stewardship for Nursing Homes. Atlanta, GA: US Department of Health and Human Services, CDC; 2015.
  6. Benoit SR, Nsa W, Richards CL, et al. Factors Associate with Antimicrobial Use in Nursing Homes: A Multilevel Model. JAGS 2008; 56: 2039-44. DOI: 10.1111/j.1532-5415.2008.01967.x.
  7. Daneman N, Grunir A, Bronskill SE, et al. Prolonged Antibiotic Treatment in Long-term Care. Role of the Prescriber. JAMA Intern. Med. 2013; 173: 673-82.
  8. Nicolle LE, Bentley DW, Garibaldi R, et al. Antimicrobial Use in Long-Term –Care Facilities. Infect Control Hosp Epidwmiol 2000; 21 (8): 537-545.
  9. Richards CL, Darrandji M, Weinberg DM, et al. Antimicrobial Use in Post-Acute Care: A Retrospective Descriptive Analysis in Seven Long-Term Care Facilities in Georgia. J Am Med Dir Assoc. 2005; 6 (2): 109-12.
  10. TeamSTEPPS® Long-Term Care Version. Content last reviewed September 2015. Agency for Healthcare Research and Quality, Rockville, MD. Accessed on August 22, 2016.
  11. Choosing Wisely. Antibiotics for Urinary Tract Infections in Older People (AGS). 2013 Consumer Reports. Developed in cooperation with the American Geriatric Society. Accessed on August 22, 2016.
  12. Consumer Voice. CAUTI Informational Brochure. 2016. National Consumer Voice for Quality Long-Term Care.
Page last reviewed March 2017
Page originally created March 2017
Internet Citation: Antibiotic Stewardship. Content last reviewed March 2017. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/professionals/quality-patient-safety/quality-resources/tools/cauti-ltc/modules/implementaion/education-bundles/urine-culturing/antibiotic-stewardship/part2-slides.html