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Time to rethink antibiotic use in long-term care facilities

Categories: Antibiotic use, Antimicrobial Resistance

Nimalie Stone, MD

Nimalie Stone, MD

Author — Nimalie Stone, M.D.
Medical Epidemiologist
CDC’s Division of Healthcare Quality Promotion

With increasing drug-resistant bacteria and complicating conditions from antibiotic use like diarrhea from C. difficile on the rise, we must look at every opportunity available to improve how antibiotics are being used in healthcare settings. This year as part of CDC’s Get Smart About Antibiotics Week, in addition to our ongoing focus on improving antibiotic use in hospitals, we invite partners who deliver care in long-term care facilities (e.g., nursing homes and skilled nursing facilities) to also join in the Get Smart for Healthcare campaign.

Antibiotics are some of the most frequently prescribed medications in long-term care facilities. Studies estimate that between 50-70% of residents will receive at least 1 course of antibiotics every year. Over time, that adds up to a lot of medication exposure. All this antibiotic use also drives the development of resistant bacteria making future infections far more difficult and costly to treat. One of the biggest challenges facing long-term care facilities is the prevention and control of C. difficile infections and relapses. These infections are more severe in people over age 65 resulting in hospitalizations and sometimes death.

Antibiotic use across all healthcare settings must be addressed if we are going to protect our communities from these serious threats. Long-term care providers can demonstrate their commitment to improving antibiotic use by assessing their current antibiotic use, standardizing the evaluation of residents who are suspected of having an infection and improving documentation of antibiotic indications. In addition, residents and their family members should be included in the conversation about the importance of careful antibiotic use so they can be a part of the efforts to prevent unnecessary use whenever possible.

We applaud all our long-term care partners who have joined this campaign and started improving antibiotic use in their facilities. What are your ideas about how long-term care facilities can address antibiotic use? How can residents and their families get involved?

Public Comments

Comments listed below are posted by individuals not associated with CDC, unless otherwise stated. These comments do not represent the official views of CDC, and CDC does not guarantee that any information posted by individuals on this blog is correct, and disclaims any liability for any loss or damage resulting from reliance on any such information. Read more about our comment policy ».

  1. November 25, 2011 at 5:04 am ET  -   Anjana

    HOw much antibotic tablet is important, This post is very usefull to read health care about anti biotic details..Now to get develop the hospital management system they are using health care software management system.

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  2. November 20, 2011 at 6:22 pm ET  -   Michael E. Bailey

    I believe that the 3ed post above expresses it best. People who can live as independently as possible in the community are far less likely to be sick with a problem that gets prescribed antibiotics to address it. People in nursing homes and state developmental centers or schools are more likely to get sick and more likely to be given antibiotics for treatment. The CDC’s program should certainly be expanded to include independent living program staffs and the staffs of community based group homes that have 6 disabled persons in them as residents.

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  3. AUTHOR COMMENT November 16, 2011 at 10:41 am ET  -   DHQP Communications

    CDC has the Get Smart: Know When Antibiotics Work program, which aims to reduce the rate of rise of antibiotic resistance by (1) promoting adherence to appropriate prescribing guidelines among provider; (2) decreasing demand for antibiotics for viral upper respiratory infections among healthy adults and parents of young children; and (3) increasing adherence to prescribed antibiotics for upper respiratory infections. This program focuses on upper respiratory infections in the outpatient setting and targets both the general public and healthcare providers. Learn more at http://www.cdc.gov/getsmart.

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  4. November 15, 2011 at 8:14 pm ET  -   Susan Fuller

    I am an ICC RN in a LTC facility and have been for 8+ years. I have seen orders for ABT use for so many situations – way more than they should be ordered. All of our docs “do their own thing” and we are at their mercy. I have tried giving them information to consider – I’ve printed information from the CDC website. Some agree with our recommendation and we monitor – which we should be doing and treat if necessary. Others treat to be safe. I understand where they are coming from – they are given lab reports and from them they order antibiotics to be “safe”. Lawyers are all over charts and “why didn’t you..”
    So – it is a major problem. We need to quit ordering cultures – esp. UA/C&S! So many of our elderly folks will show a positive C/S without significant symptoms yet we treat the lab report – not the resident.
    Having some guidelines for all involved would be of great help. With that being said, what can we do?

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  5. November 15, 2011 at 7:04 am ET  -   Scott N

    As a person who has worked over 15 years as an in-home Personal Attendant and currently employed at an independent living center, I think an outside-the-box response is necessary. Families and individuals should support home-based services. One way to avoid the canvasing of medication is to make it based on individual needs; hard to do when a nursing facility staffer is responsible for attending to the needs of 6, 12, maybe 20 people at a time. This also puts more of the choice and responsibility on the individual (so education and training is still necessary and a very good idea). Individuals living in their community will face lesser risk for infection because they’re not centrally located and exposed to each other constantly and they’d receive the appropriate and individualized supports necessary. Finally, every health care professional worth anything would agree with the following: overall health is best sustained at home in the company of loved ones with individualized planning and care. Seek independent living and home-based supports.

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  6. November 15, 2011 at 6:56 am ET  -   Healthcare

    Its really appreciable topic. People can get the use of antibiotics in their day-to-day life. But some of us have misconception that use of more antibiotics causes sideeffect. Kindly give detail information regarding this.

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  7. November 15, 2011 at 12:02 am ET  -   Manjmark

    Interesting post. I was wondering if you all plan on including a general public awareness component to your Get Smart Week? Empowering the public to ask questions and raise concerns about the overuse of antibiotics may help. Local news stations periodically do stories about MRSA outbreaks – perhaps there is a way to tie the two areas together and start a conversation without starting a panic. This from a layman’s perspective – so take with a grain of salt.

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  8. November 14, 2011 at 7:42 pm ET  -   jacob queenan

    as a citizen of the US i think i should be able to comment here. i keep an eye on independent studies by professionals and they are blowing right past you guys. restore the trust we once had please

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