Studies indicate that 30-50% of antibiotics prescribed in hospitals are unnecessary or inappropriate. There is no doubt that overprescribing and misprescribing is contributing to the growing challenges posed by Clostridium difficile and antibiotic-resistant bacteria. Studies demonstrate that improving prescribing practices in hospitals can not only help reduce rates of Clostridium difficile infection and antibiotic resistance, but can also improve individual patient outcomes, all while reducing healthcare costs.
Acute Care Facilities
Core Elements of Hospital Antibiotic Stewardship Programs
- Leadership Commitment: Dedicating necessary human, financial and information technology resources
- Accountability: Appointing a single leader responsible for program outcomes. Experience with successful programs show that a physician leader is effective.
- Drug Expertise: Appointing a single pharmacist leader responsible for working to improve antibiotic use
- Action: Implementing at least one recommended action, such as systemic evaluation of ongoing treatment need after a set period of initial treatment (i.e. “antibiotic time out” after 48 hours)
- Tracking: Monitoring antibiotic prescribing and resistance patterns
- Reporting: Regular reporting information on antibiotic use and resistance to doctors, nurses and relevant staff
- Education: Educating clinicians about resistance and optimal prescribing
Additional Resources for
Long Term Care Facilities
Improving the use of antibiotics in healthcare to protect patients and reduce the threat of antibiotic resistance is a national priority. Antibiotic stewardship refers to a set of commitments and actions designed to “optimize the treatment of infections while reducing the adverse events associated with antibiotic use.” The Centers for Disease Control and Prevention (CDC) recommends that all acute care hospitals implement an antibiotic stewardship program (ASP) and outlined the seven core elements which are necessary for implementing successful ASPs. CDC also recommends that all nursing homes take steps to improve antibiotic prescribing practices and reduce inappropriate use.
Antibiotics are among the most frequently prescribed medications in nursing homes, with up to 70% of residents in a nursing home receiving one or more courses of systemic antibiotics when followed over a year. Similar to the findings in hospitals, studies have shown that 40–75% of antibiotics prescribed in nursing homes may be unnecessary or inappropriate. Harms from antibiotic overuse are significant for the frail and older adults receiving care in nursing homes. These harms include risk of serious diarrheal infections from Clostridium difficile, increased adverse drug events and drug interactions, and colonization and/or infection with antibiotic-resistant organisms.
The CDC Core Elements of Antibiotic Stewardship for Nursing Homes adapts the CDC Core Elements of Hospital Antibiotic Stewardship into practical ways to initiate or expand antibiotic stewardship activities in nursing homes. While the elements are the same for both hospitals and nursing homes, the implementation of these elements may vary based on facility staffing and resources. Nursing homes are encouraged to work in a step-wise fashion, implementing one or two activities to start and gradually adding new strategies from each element over time. Any action taken to improve antibiotic use is expected to reduce adverse events, prevent emergence of resistance, and lead to better outcomes for residents in this setting.
Additional Resources for
Antibiotic Stewardship fact sheets for nursing home residents and families
The Long-Term Care Office Hours series is hosted by BU Population Health Exchange in partnership with the Massachusetts Department of Public Health and features presentations by infectious disease and antimicrobial stewardship experts from Tufts Medical Center.