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Implementation of core elements of antibiotic stewardship in nursing homes—National Healthcare Safety Network, 2016–2018

Published online by Cambridge University Press:  26 May 2021

Katryna A. Gouin*
Affiliation:
Chenega Corporation, on assignment to the Centers for Disease Control and Prevention, Atlanta, Georgia
Sarah Kabbani*
Affiliation:
Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, US Centers for Disease Control and Prevention, Atlanta, Georgia
Angela Anttila
Affiliation:
CACI (subcontractor to Leidos), on assignment to the Centers for Disease Control and Prevention, Reston, Virginia
Josephine Mak
Affiliation:
Leidos, on assignment to the Centers for Disease Control and Prevention, Reston, Virginia
Elisabeth Mungai
Affiliation:
Leidos, on assignment to the Centers for Disease Control and Prevention, Reston, Virginia
Ti Tanissha McCray
Affiliation:
Leidos, on assignment to the Centers for Disease Control and Prevention, Reston, Virginia
Jeneita Bell
Affiliation:
Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, US Centers for Disease Control and Prevention, Atlanta, Georgia
Lauri A. Hicks
Affiliation:
Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, US Centers for Disease Control and Prevention, Atlanta, Georgia
Nimalie D. Stone
Affiliation:
Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, US Centers for Disease Control and Prevention, Atlanta, Georgia
*
Author for correspondence: Sarah Kabbani, E-mail: skabbani@cdc.gov. or Katryna A. Gouin, E-mail: kgouin@cdc.gov
Author for correspondence: Sarah Kabbani, E-mail: skabbani@cdc.gov. or Katryna A. Gouin, E-mail: kgouin@cdc.gov

Abstract

Objective:

To assess the national uptake of the Centers for Disease Control and Prevention’s (CDC) core elements of antibiotic stewardship in nursing homes from 2016 to 2018 and the effect of infection prevention and control (IPC) hours on the implementation of the core elements.

Design:

Retrospective, repeated cross-sectional analysis.

Setting:

US nursing homes.

Methods:

We used the National Healthcare Safety Network (NHSN) Long-Term Care Facility Component annual surveys from 2016 to 2018 to assess nursing home characteristics and percent implementation of the core elements. We used log-binomial regression models to estimate the association between weekly IPC hours and the implementation of all 7 core elements while controlling for confounding by facility characteristics.

Results:

We included 7,506 surveys from 2016 to 2018. In 2018, 71% of nursing homes reported implementation of all 7 core elements, a 28% increase from 2016. The greatest increases in implementation from 2016 to 2018 were in education (19%), reporting (18%), and drug expertise (15%). In 2018, 71% of nursing homes reported pharmacist involvement in improving antibiotic use, an increase of 27% since 2016. Nursing homes that reported at least 20 hours of IPC activity per week were 14% (95% confidence interval, 7%–20%) more likely to implement all 7 core elements when controlling for facility ownership and affiliation.

Conclusions:

Nursing homes reported substantial progress in antibiotic stewardship implementation from 2016 to 2018. Improvements in access to drug expertise, education, and reporting antibiotic use may reflect increased stewardship awareness and resource use among nursing home providers under new regulatory requirements. Nursing home stewardship programs may benefit from increased IPC staff hours.

Type
Original Article
Copyright
© The Author(s), 2021. Published by Cambridge University Press on behalf of The Society for Healthcare Epidemiology of America

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Footnotes

PREVIOUS PRESENTATION: These findings were previously presented in an abstract at the IDWeek 2020 conference, October 22–25, 2020, held virtually.

References

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