LTC Infection Management and Antibiotic Stewardship Programs

Mary Madison, RN, RAC-CT, CDP
Clinical Consultant – Briggs Healthcare

A study and a survey were published this week that should interest the LTC community.

A study on the Role of Post‐Acute Care in Readmissions for Preexisting Healthcare‐Associated Infections was published in the Journal of the American Geriatrics Society.  This study looked at 2013 – 2014 “national hospital discharge data to estimate the likelihood of readmissions for preexisting HAIs according to patients’ discharge disposition and whether the likelihood varies according to patient comorbidity level, across four common types of HAIs (not including respiratory infections)…(the) outcome was a 30‐day preexisting, or “linked,” HAI readmission (readmission involving the same HAI diagnosis as at the index admission). Patient discharge disposition was skilled nursing facility (SNF), home health care, and home care without home health care (“home”).”

“Although preventable, healthcare‐associated infections (HAIs) are commonly observed in post‐acute care settings for at‐risk older adults and are a leading cause of hospital readmissions. However, whether HAIs resulting in avoidable readmissions for preexisting HAIs (the same HAI as at the index admission) are more common for patients discharged to post‐acute care as opposed to home is unknown.

This data review concluded that “SNF discharges were associated with fewer avoidable readmissions for preexisting HAIs compared with home discharges. Further research to identify modifiable mechanisms that improve posthospital infection care at home is needed.”

“Being discharged to a SNF compared to home or to home health care was associated with a 1.15 percentage point (95% confidence interval = −1.29 to −1.00), or 38%, lower risk of a linked HAI readmission. This risk difference was observed to increase with greater patient comorbidity.”

(Above bolding added by this author.)

A 2018 “nationally representative survey” – Characteristics of nursing homes with comprehensive antibiotic stewardship programs: Results of a national survey – published in the American Journal of Infection Control, looked at 861 nursing homes’ “ASP comprehensiveness, infection preventionist (IP) training, participation in Quality Innovation Network-Quality Improvement Organization (QIN-QIO) activities, and facility and staff characteristics.”  Because this is a survey, the data is self-reported.  “However, probability weights were used to adjust for potential biases owing to differences between respondents and non-respondents and allow the results to be nationally generalizable.”

The highlights of this survey are:

  • Nursing home antibiotic stewardship programs are moderately or highly comprehensive.
  • Antibiotic stewardship implementation increased following regulation changes.
  • More infection preventionists trained in infection control, however, gaps remain.
  • Trained staff are needed for comprehensive antibiotic stewardship.
  • Quality Innovation Networks-Quality Improvements Organizations are valuable.

The 6-page PDF of the survey is free (the first study’s PDF identified above can be accessed by purchasing that document) and is an interesting read.

The results of this survey showed:

  • 2% had “comprehensive” ASP policies
  • 1% had “moderately comprehensive” ASP policies and
  • 6% had “not comprehensive” ASP policies.

“Data collection on antibiotic use was most reported (91.4%), and restricting use of specific antibiotics was least reported (19.0%). Comprehensive ASPs were associated with QIN-QIO involvement; moderate and comprehensive ASPs were associated with IP training and high occupancy.”

The conclusions drawn from this survey are that two-fold: “NH ASPs are becoming more comprehensive.  Infection control training and partnerships with QIN-QIOs can support NHs to increase ASP comprehensiveness.”

Specifically, overall conclusions include:

“ASPs in NHs are showing signs of increased comprehensiveness as indicated by the inclusion of more policies since the implementation of the CMS Final Rule. Certain policies may be more easily adopted, whereas others may require more intensive efforts. For example, readily available educational resources from the CDC, the Agency for Healthcare Research and Quality, and QIN-QIOs can supplement those NHs that are not yet incorporating education in their ASPs. Infection control training for IPs remains a key area for improvement, although signs of progress exist. Additionally, QINQIOs could be further utilized to support NHs in expanding their ASPs.”

This is an interesting table found in the PDF:

Picture1

I encourage you to review and share both with your team.  Where does your facility fit with your current antibiotic stewardship program?  Food for thought…