Fortifying the LTC system against antibiotic-resistant bacteria

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Dolly Greene
Dolly Greene

As we begin the Centers for Disease Control and Prevention's annual November “Get Smart About Antibiotics Week,” we are thankful for the invaluable work the CDC and its partners have done in raising awareness about the growing crisis of antibiotic-resistant bacteria.

Awareness alone, however, is not enough.

Across tens of thousands of facilities and millions of residents, the long-term care network is one of the most important lines of defense we have in the battle against antibiotic-resistant bacteria. As executives, leaders, employees, consultants and partners to the LTC system, we each have a duty to our patients and the healthcare system as a whole to confront this issue now to extend the useful lifetime of effective antibiotics.

Our industry is now in a golden window to slow the rise of antibiotic-resistant bacteria, but that window is quickly closing. The CDC estimates that each year at least two million illnesses and 23,000 deaths are caused by antibiotic resistant bacteria in the U.S. alone. And even with fast and decisive action, these numbers will only increase.

Antibiotic resistance limits our ability to quickly and reliably treat bacterial infections, and could hamper our ability to perform modern medical procedures. In addition, resistant infections account for $20 to $35 billion in excess direct healthcare costs and up to $35 billion in lost productivity due to hospitalizations and sick days each year.

Long-term care professionals can play an important role in stopping the rise of antibiotic-resistant bacteria through the careful, prudent and medically-appropriate use of antibiotics. As LTC administrators, we serve vulnerable patient populations must have the courage to recognize that not all infections need antibiotics.

According to the Agency for Healthcare Research and Quality, 50-70% of residents will receive a systemic antimicrobial agent during a calendar year and anywhere from 20-30% of residents may receive multiple courses of antibiotics. Unfortunately, unnecessary use of antibiotics in nursing home residents ranges from 17-89%.

Antibiotic-resistant bacteria impair our ability to fight bacterial infections, which are among the most frequent causes of hospital transfers from nursing homes. These hospitalizations result not only in excess cost compared to management in the nursing home, but also lead to morbidity from hospital transfers or cause poor resident outcomes.

In its role as the leading provider of clinical laboratory services to post-acute care facilities, TridentUSA — through its subsidiaries Diagnostic Laboratories and Radiology, US Laboratories, MobilexUSA, and Trident Mobile Clinical Services — has been deeply involved in infection control since 2004 and has strived to raise awareness and to support and improve clinical practices at skilled nursing facilities with the effective use of its diagnostic tests.

According to the Infectious Diseases Society of America, stewardship programs have been shown to reduce the percentage of antibiotic‐resistant organisms in a facility, reduce the occurrence of Clostridium difficile (or “C. diff.”) infections, improve patient outcomes, decrease toxicity, and reduce pharmacy costs.

This spring TridentUSA joined major food companies, retailers, and health stakeholders at the White House's “One Health Forum on Antibiotic Stewardship” to discuss and plan for the emergence of antibiotic-resistant bacteria. Together with these key health stakeholders, TridentUSA committed to implementing changes over the next five years to create meaningful impact on antibiotic stewardship, slow the emergence of resistant bacteria, and prevent the spread of resistant infections.

We are now proud to partner with the CDC for “Get Smart About Antibiotics Week” and hope readers will take advantage of this opportunity to learn more about this issue.

We encourage all McKnight's readers to carefully consider steps they can take today. An antibiotic stewardship program is not an all-or-nothing proposition. Even minor improvements in policy, practice and staff education can make a significant difference over time. And your facility can build on this foundation over time.

Work to provide opportunities for education for your staff on newer approaches like empowering nurses to ask questions and dialogue with physicians. Encourage nurses to do careful assessments of residents and give thorough and detailed reports to physicians when reporting any change in conditions. And collaborate with diagnostic providers to ensure the right diagnostic tests are ordered, understand the capabilities and limitations of each test, and ensure results are delivered to the treating clinicians accurately for appropriate treatment decisions.

The scope of the problem may seem overwhelming. But working together as a system across the payer, provider, and services spectrum we must succeed in safeguarding these invaluable tools in the fight against disease for generations to come.

Lorelei Schmidt, MT (ASCP), is TridentUSA's Director of Training, and Dolly Greene, RN, CIC is TridentUSA's Director of Clinical Services & Education. Together with TridentUSA's Antiobiotic Stewardship program they have helped hundreds of post-acute and long-term care facilities make significant strides in reducing or controlling the spread of infectious disease within their vulnerable patient populations.


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