´óÏóÊÓƵ

Slide 1: Antibiotic Stewardship

Slide 2: Objectives

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

• 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. . 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

• 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

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. . August 2015. Making Health Care Safer –CDC Vital Signs. Centers for Disease Control and Prevention.

Slide 6: Problem Statement⁵

• 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. . Atlanta, GA: US Department of Health and Human Services, CDC; 2015.

Slide 7: Antibiotic Use in LTC Facilities^6-9

• 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

• 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. . Centers for Disease Control and Prevention (CDC). U.S. Department of Health and Human Services.

Slide 9: Goals of Antibiotic Stewardship⁵

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. . Atlanta, GA: US Department of Health and Human Services, CDC; 2015.

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

• 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. . Atlanta, GA: US Department of Health and Human Services, CDC; 2015.

Slide 11: CDC Core Elements: Education¹⁰

• 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: HRET's brochure: When Do You Need an Antibiotic?

^10. TeamSTEPPS® Long-Term Care Version. Content last reviewed September 2015. ´óÏóÊÓƵ, Rockville, MD. Accessed on August 22, 2016.

Slide 12: Communication to Enhance Antibiotic Stewardship^10-12

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:

Source: Consumer Voice

^10. TeamSTEPPS® Long-Term Care Version. Content last reviewed September 2015. ´óÏóÊÓƵ, Rockville, MD. Accessed on August 22, 2016.
^11. Choosing Wisely. . 2013 Consumer Reports. Developed in cooperation with the American Geriatric Society. Accessed on August 22, 2016.
^12. . 2016. National Consumer Voice for Quality Long-Term Care.

Slide 13: Personal Protective Equipment

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. .

Slide 14: References

1. Antibiotic Resistance Threats in the United States, 2013. Centers for Disease Control and Prevention (CDC). U.S. Department of Health and Human Services. Accessible at: .
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. . August 2015. Making Health Care Safer–CDC Vital Signs. Centers for Disease Control and Prevention.
5. CDC. . 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 Epidemiol 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. ´óÏóÊÓƵ, Rockville, MD. Accessed on August 22, 2016.
11. Choosing Wisely. . 2013 Consumer Reports. Developed in cooperation with the American Geriatric Society. Accessed on August 22, 2016.
12. . 2016. National Consumer Voice for Quality Long-Term Care.