A Systematic Review of Filtering Facepiece Respirator Reprocessing

Abstract

In Reply In their Letter to the Editor about our study, 1 Dr Omata and colleagues posit that the finding of higher antimicrobial use in nursing home residents in nonmetropolitan areas may have been due to lower participation in antimicrobial stewardship CME by prescribers in rural areas. Our prevalence survey of antimicrobial use in US nursing homes 1 was not designed or powered to be able to provide accurate or meaningful comparisons of state-level data. State-to-state differences in antimicrobial use and stewardship practices likely do exist in nursing homes, as they do in community and hospital prescribing. 2 Undoubtedly, education for physicians and other health care personnel who prescribe antimicrobials is an essential component of an antimicrobial stewardship program. However, the difference observed in antimicrobial use in nonmetropolitan vs metropolitan nursing home residents is likely multifactorial and not solely due to differences in CME requirements.We agree with Omata and colleagues that an in-depth analysis of prescriber characteristics may be important to fully understand patterns of antimicrobial use and to implement interventions that address selected prescribing behaviors in nursing homes. While the process of antimicrobial prescribing in nursing homes is complex and different from that in hospital and clinic settings, 3 the factors that influence antimicrobial use in nursing homes are not well described. 1 A retrospective analysis of data obtained from linked population-based administrative databases for long-term care residents in 630 longterm care facilities in Ontario, Canada, found that prescriber preferences were more important determinants of antibiotic treatment duration than patient characteristics. 4 While an important area of inquiry, it was not an aim of our prevalence survey to describe antimicrobial prescriber characteristics; therefore, we do not have this information available to share. Data collection on prescriber characteristics is not well suited to the prevalence survey approach, especially in nursing homes, where the process of prescribing is complex and many residents are admitted for antimicrobial therapy from other health care settings. 1 Alternative study designs, including those based on administrative data 4 or electronic health and medication administration records, may be better suited to facilitate the collection of data on prescriber characteristics.