The obvious distinction between hospitals and nursing homes is we are regulated to develop and implement an antibiotic stewardship program . Even with the regulation , creating an environment that will encourage and sustain an antibiotic stewardship program takes much effort and continuous support .
As time went on , there came a stronger push to use antibiotics appropriately . In 2012 ,
SHEA , IDSA and Pediatric
Infectious
Diseases ( PIDS ) published a joint policy statement on antibiotic stewardship . In 2014 , the CDC recommended that all U . S . hospitals have an antibiotic stewardship program .”
Although we have known for almost 77 years that inappropriate use of antibiotics can cause resistance , we still haven ’ t embraced the idea wholeheartedly . Even today , an article was written stating 70 percent of primary physicians would order antibiotics for patients who are asymptomatic when there is bacteriuria present . 10 ( Not meeting the standard criteria for a UTI .) If this occurs and the facility isn ’ t focused on the principles of antibiotic stewardship ( meeting the infection criteria ; Loeb ’ s or McGeer ’ s ) the program is not very successful in its goal of utilizing antibiotics only when appropriate in order to stem the occurrence of antibiotic resistance .
The leadership in a facility is key to creating and sustaining the climate of antibiotic stewardship by holding its staff accountable . This includes the physicians and physician extenders . This takes buy-in , passion , support , resources and recognition of the value that antibiotic stewardship can bring to the residents , staff and the community .
According to the survey deficiencies issued over the past two years , long-term care must show increased progress before we can state we are committed to antibiotic stewardship . However , I do believe we have started and are inching our way along given all the other hurdles we are currently facing , such as staffing , resources and the pandemic / post-pandemic era .
We will get past these hurdles . Our residents are depending on us , as are the communities in which we reside . This is not just about long-term care but about all of us . Antibiotics used inappropriately will affect everyone not just the person receiving it .
Cindy Fronning , RN , GERO-BC , IP-BC , AS-BC , RAC-CT , CDONA , FACDONA , ELFA , is a master trainer and the director of education for NADONA .
References :
1 . https :// www . reactgroup . org / antibiotic-resistance / courseantibiotic-resistance-the-silent-tsunami / part-1 / the-discovery-ofantibiotics /
2 . Ruedy , J . ( 1966 ). A method of determining patterns of use of antibacterial drugs . Can Med Assoc J . 95 ( 16 ): 807 – 12 . PMC 1935763 . PMID 5928520 .
3 . Reimann ; D ’ Ambola ( 1968 ). Cost of antimicrobial drugs in a hospital . JAMA . 205 ( 7 ): 537 . doi : 10.1001 / jama . 205.7.537 . PMID 5695313
4 . Schollenberg , E .; Albritton WL ( 1980 ). Antibiotic misuse in a pediatric teaching hospital . Can Med Assoc J . 122 ( 1 ): 49 – 52 . PMC 1801611 . PMID 7363195 .
5 . McGowan , JE Jr ; Gerding , DN ( August 1996 ). Does antibiotic restriction prevent resistance ? New Horizon . 4 ( 3 ): 370 – 6 . PMID 8856755 .
6 . Shlaes , D ; et al . ( April 1997 ). Guidelines for the prevention of antimicrobial resistance in hospitals . Infect Control Hosp Epidemiol . 18 ( 4 ): 275 – 91 . doi : 10.2307 / 30141215 . JSTOR 30141215 . PMID 9131374 .
7 . Society for Healthcare Epidemiology of America ; Infectious Diseases Society of America ; Pediatric Infectious Diseases Society ( April 2012 ). Policy statement on antimicrobial stewardship by the Society for Healthcare Epidemiology of America ( SHEA ), the Infectious Diseases Society of America ( IDSA ), and the Pediatric Infectious Diseases Society ( PIDS ). Infect Control Hosp Epidemiol . 33 ( 4 ): 322 – 7 . doi : 10.1086 / 665010 . PMID 22418625 .
8 . Loria A . Pollack , Arjun Srinivasan ( 2014 ). Core Elements of Hospital Antibiotic Stewardship Programs From the Centers for Disease Control and Prevention . Clin Infect Dis . 59 ( suppl 3 ): S97 – S100 . doi : 10.1093 / cid / ciu542 . PMC 6521960 . PMID 25261548 .
9 . https :// www . cms . gov / Medicare / Provider-Enrollmentand-Certification / GuidanceforLawsAndRegulations / Downloads / Appendix-PP-State-Operations-Manual . pdf
10 . https :// www . mcknights . com / news / clinical-news / mostprimary-care-docs-would-treat-asymptomatic-utis-with-antibioticssurvey-finds /
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