Each year, the Centers for Disease Control and Prevention recognizes U.S. Antibiotic Awareness Week November 18-24, highlighting the importance of appropriate antibiotic use in fighting the threat of drug resistance.
Antibiotic awareness and infection control are especially crucial in long-term care and nursing settings, where patients are vulnerable to community-acquired infections and treatment plans often include preventative antibiotic use or antibiotics are prescribed for symptoms that resemble a bacterial infection but actually may be due to viruses.
Further, treatment of COVID-19 in hospitals and other facilities can give rise to drug-resistant pathogens due to improper antibiotic use.
With Antibiotic Awareness Week upon us once again, here are a few things decision-makers and caregivers in long-term care should keep in mind to play their part in reducing inappropriate antibiotic use and lowering infection rates within facilities.
Look to non-drug solutions
In long-term care, ventilators, catheters and other medical devices can put patients at higher risk of contracting infections. Close proximity to other patients and shared care staff make transmission a serious concern. The patients themselves are also likely to have co-morbidities that make them even more susceptible. Often, the first course of action when a long-term care patient is suspected of having an infection is to administer broad-spectrum antibiotics empirically.
Up to 70% of nursing home residents receive one or more courses of systemic antibiotics each year, making antibiotics one of the most frequently prescribed medications in these facilities. Yet other studies have found that anywhere from 40-75% of nursing home antibiotic prescriptions are unnecessary.
Advancements in rapid testing technology allow for the detection of a wide range of indications including those commonly found in long-term care such as urinary tract, respiratory and bloodstream infections. These tests can simultaneously identify a broad array of microorganisms and resistance markers in a single test.
Clinicians providing long-term care should prioritize obtaining a patient’s complete test results before making a treatment decision. Available rapid molecular, multiplex PCR tests can provide comprehensive results in just a few hours, rather than days for conventional culture methods.
These tests can reduce inappropriate antibiotic use and cut down on the time a patient spends receiving unnecessary antibiotics. Rapid molecular diagnostic panels need to be made widely available in long-term care settings for use in the right patient populations where a rapid diagnosis can guide early, effective and potentially life-saving treatment decisions.
Record keeping is another challenge when treating long-term care patients. When a patient spends time at multiple facilities and is treated by multiple clinicians during their treatment journey, it can be difficult to create a consistent record of their condition and treatments received.
Digital health databases that gather and analyze treatment outcomes, pathogen data and test results are being piloted as cloud-based surveillance tools for healthcare facilities. Access to these records in long-term care settings as well as across regional health systems will enable greater collaboration on antibiotic use practices and can facilitate more comprehensive, rapid response to outbreak threats by tracking transmission patterns.
Establish consistent stewardship & infection control practices
Even with stringent testing and data collection policies in place, there will still be instances where long-term care patients require antibiotics. Alongside adopting non-drug solutions to use these therapeutics more strategically, all long-term care facilities should closely examine their antibiotic stewardship and infection control policies. COVID has been a devastating reminder of how easily infectious diseases can spread in these facilities. Audit your practices and hold staff accountable for responsible antibiotic use, reporting and infection control practices at all times, not just during a pandemic.
Oftentimes, infections can be brought into a facility by an unknowing staff member. This is particularly dangerous within a long-term care facility where patients are at high-risk for adverse reactions and caregivers interact with multiple patients each day. A testing and/or contact tracing policy for all staff members is essential to ensure patients are protected from outside infection threats.
Travel is a known spreader of multidrug-resistant organisms! So, with borders reopening and travel becoming more frequent, enforcing frequent staff testing is even more important. Regular COVID-19 testing has become common practice in many facilities. With multiplex antimicrobial resistance (AMR) panels for genotypic detection of drug resistance becoming more widely available, such diagnostic tools enable testing for resistance in a broad array of infectious disease threats. In addition to detecting AMR, innovative AI-powered and Machine Learning (ML) driven approaches that deploy an extensive and curated database can shed light on the prevalence of AMR and predict how pathogens will likely respond to antibiotic therapy.
Long-term care facilities should also use these technologies to establish frequent patient testing policies. Illness and other conditions may leave long-term care patients unable to communicate effectively with their care team so it’s essential to rely on frequent testing to consistently monitor for threats, such as drug-resistant infections, that might go unnoticed or be mistaken for other issues. When infections are detected, act fast to isolate the patient from others, if possible, and ramp up use of protective equipment, disinfection and handwashing to limit potential transmission from the initial patient to others in the same area.
Infection control has long been a challenge for long-term care facilities. However, lessons learned from the COVID-19 response and the global focus on antibiotic awareness create an opportunity for administrators and staff to examine and further refine their best practices. With knowledge of the latest in testing and data management tools, facilities can better arm themselves against all public health threats and use resources like antibiotics more responsibly.
Oliver Schacht is the CEO of OpGen, Inc., a pioneering precision medicine, bioinformatics and genomic analysis company providing complete solutions for patients, hospitals, and network-wide infection prevention and treatment decisions.
The opinions expressed in McKnight’s Long-Term Care News guest submissions are the author’s and are not necessarily those of McKnight’s Long-Term Care News or its editors.