Review of antibiotic usage needed in long-term care facilities, expert urges

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Long-term care administrators and directors should have an antibiotic stewardship program that takes the entire facility into account, an infection control expert said Thursday.

“If you don't look, you don't know,” warned Gail Bennett, MSN, RN, CIC, co-founder of ICP Associates.

Use of antibiotics has resulted in new strains of multi–drug resistant organisms (MDROs) affecting long-term care. These include Methicillin-resistant Staphylococcus aureus (MRSA) and Carbapenem-resistant Enterobacteriaceae (CRE).

Residents who are more likely to shed MRSA include those with heavy draining wounds, incontinence or poor hygiene, Bennett said at the Life Services Network of Illinois Annual Meeting. Those who have antibiotic therapy, who are male, who have urinary incontinence or who have been hospitalized in the past six months are at higher risk for MRSA. Vancomycin is considered the drug of choice.

Occasionally in an outbreak of MRSA, there will be cultures of staff to determine whether they have nasal colonization. But that's a big “if,” Bennett cautioned.

“CDC tells us not to routinely culture,” she said. “It's a dangerous place to go.”

In the rare occurrence of a suspected epidemiological link to transmissions, facilities need to have an expert consultation and an action plan to put in place, she said.

The CDC has warned providers about the emergence of CRE. As it is resistant to most drugs, “tigecycline is the only thing left,” Bennett noted.

Contact precautions for MDROs include hand hygiene and donning gloves and gowns upon entering the room. Strong environmental cleaning is needed, with special attention given to areas like handrails, Bennett recommended.

Facilities should have an antibiotic stewardship program and broader view of antibiotic use among residents, she said.

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