Successfully Reducing Antibiotic Prescribing in Nursing Homes

Zimmerman, Sheryl; Sloane, Philip D.; Bertrand, Rosanna M.; Olsho, Lauren; Beeber, Anna; Kistler, Christine E.; Hadden, Louise; Edwards, Alrick S.; Weber, David J.; Mitchell, C. Madeline

doi:10.1111/jgs.12784

Cited by 72 publications

(135 citation statements)

References 24 publications

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“…Four out of 12 studies targeted only physicians [42,44,46] or nurses [43]. Six studies involved some feedback to physicians and/or nurses [29,41,42,44,46,48], and five studies performed repeated interactions with physicians and/or nurses [29,42,44,46,48]. Jump et al described the positive impact of an Infectious Diseases (ID) on-site consultation service in a hospital-based American LTCF [2,44], in line with several studies demonstrating the value of ID specialists in acute-care hospitals [49].…”

Section: Interventional Studies Aiming At Improving Antibiotic Use Inmentioning

confidence: 74%

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Strategies and challenges of antimicrobial stewardship in long-term care facilities

Dyar

Pagani

Pulcini

2015

Clinical Microbiology and Infection

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As people are living longer the demand for long-term care facilities (LTCFs) continues to rise. For many reasons, antimicrobials are used intensively in LTCFs, with up to a half of this use considered inappropriate or unnecessary. Over-use of antimicrobials can have direct adverse consequences for LTCF residents and promotes the development and spread of resistant bacteria. It is therefore critical that LTCFs are able to engage in antimicrobial stewardship programmes, which have the potential to minimize the antibiotic selective pressure, while improving the quality of care received by LTCF residents. To date, no antimicrobial stewardship guidelines specific to LTCF settings have been published. Here we outline the scale of antimicrobial use in LTCFs and the underlying drivers for antibiotic over-use. We further describe the particular challenges of antimicrobial stewardship in LTCFs, and review the interventional studies that have aimed to improve antibiotic use in these settings. Practical recommendations are then drawn from this research to help guide the development and implementation of antimicrobial stewardship programmes.

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Section: Interventional Studies Aiming At Improving Antibiotic Use Inmentioning

confidence: 74%

“…Table 2 summarizes all 12 published interventional studies that aimed to improve antibiotic use in LTCFs, of which all but one [43] had an educational component [29,32,[39][40][41][42][44][45][46][47][48].…”

Section: Interventional Studies Aiming At Improving Antibiotic Use Inmentioning

confidence: 99%

Strategies and challenges of antimicrobial stewardship in long-term care facilities

Dyar

Pagani

Pulcini

2015

Clinical Microbiology and Infection

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“…However, efforts to curb antibiotic use in older adults have primarily targeted physicians and have had limited impact [12, 13]. A possible reason for this lack of antibiotic stewardship in NHs may be a lack of involvement of nursing staff and patient/family in prescribing decisions.…”

Section: Introductionmentioning

confidence: 99%

Nursing home nurses’ and community-dwelling older adults’ reported knowledge, attitudes, and behavior toward antibiotic use

et al. 2017

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BackgroundAntibiotic overuse causes antibiotic resistance, one of the most important threats to human health. Older adults, particularly those in nursing homes, often receive antibiotics when they are not indicated.MethodsTo understand knowledge, attitudes, and behaviors of nursing home (NH) nurses and community-dwelling older adults towards antibiotic use, especially in clinical situations consistent with antibiotic overuse, we conducted a mixed-method survey in two NHs and one Family Medicine clinic in North Carolina, among English-speaking nurses and community-dwelling, cognitively intact adults aged 65 years or older. Based on the Knowledge-Attitude-Practice model, the survey assessed knowledge, attitudes, and behavior towards antibiotic use, including three vignettes designed to elicit possible antibiotic overuse: asymptomatic bacteriuria (ASB), a viral upper respiratory illness (URI), and a wound from a fall.ResultsOf 31 NH nurses and 66 community-dwelling older adults, 70% reported knowledge of the dangers of taking antibiotics. Nurses more often reported evidence-based attitudes towards antibiotics than older adults, except 39% agreed with the statement “by the time I am sick enough to go to the doctor with a cold, I expect an antibiotic”, while only 28% of older adults agreed with it. A majority of nurses did not see the need for antibiotics in any of the three vignettes: 77% for the ASB vignette, 87% for the URI vignette, and 97% for the wound vignette. Among older adults, 50% did not perceive a need for antibiotics in the ASB vignette, 58% in the URI vignette, and 74% in the wound vignette.ConclusionsWhile a substantial minority had no knowledge of the dangers of antibiotic use, non-evidence-based attitudes towards antibiotics, and behaviors indicating inappropriate management of suspected infections, most NH nurses and community-dwelling older adults know the harms of antibiotic use and demonstrate evidence-based attitudes and behaviors. However, more work is needed to improve the knowledge, attitudes and behaviors that may contribute to antibiotic overuse.

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“…8–13 A majority of those educational interventions have generally focused on one aspect of infection prevention, such as hand hygiene, 9–11 antibiotic usage, 7, 14–16 or evidence-based strategies to prevent a specific type of infection. 8 …”

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confidence: 99%

Making infection prevention education interactive can enhance knowledge and improve outcomes: Results from the Targeted Infection Prevention (TIP) Study

Koo

McNamara

Lansing

et al. 2016

American Journal of Infection Control

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Objectives To assess effectiveness of an interactive educational program in increasing knowledge of key infection prevention and control (IPC) principles with emphasis on indwelling device care, hand hygiene and multi-drug resistant organisms (MDROs) among nursing home (NH) healthcare personnel (HCP). Methods We conducted a multi-modal randomized-controlled study involving HCP at 12 NHs. Ten comprehensive and interactive modules covered common IPC topics. We compared: a) intervention and control scores to assess differences in pre-test scores as a result of field interventions; b) pre- and post-test scores to assess knowledge gain and c) magnitude of knowledge gain based on job categories. Results 4,962 tests were returned over the course of the intervention with 389–633 HCP/module. Participants were mostly female certified nursing assistants (CNAs). Score improvement was highest for modules emphasizing hand hygiene, urinary catheter care and MDROs (15.6%, 15.95%, and 22.0%, respectively). After adjusting for cluster study design, knowledge scores were significantly higher after each educational module, suggesting the education delivery method was effective. When compared to CNAs, nursing and rehabilitation personnel scored significantly higher in their knowledge tests. Conclusion Our intervention significantly improved IPC knowledge in HCP, especially for those involved in direct patient care. This increase in knowledge along with preemptive barrier precautions and active surveillance has enhanced resident safety by reducing MDROs and infections in high-risk NH residents.

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Successfully Reducing Antibiotic Prescribing in Nursing Homes

Cited by 72 publications

References 24 publications

Strategies and challenges of antimicrobial stewardship in long-term care facilities

Strategies and challenges of antimicrobial stewardship in long-term care facilities

Nursing home nurses’ and community-dwelling older adults’ reported knowledge, attitudes, and behavior toward antibiotic use

Making infection prevention education interactive can enhance knowledge and improve outcomes: Results from the Targeted Infection Prevention (TIP) Study

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