Long-term care providers constantly being cited for lapses in antibiotic stewardship should adopt antibiotic-use protocols to improve adherence to federal infection control guidelines, according to a new study from the Centers for Disease Control and Prevention. 

The findings were detailed during a national conference last week by Katrina Gouin, a scientific data analyst with the CDC’s Office of Antibiotic Stewardship.

The study found the most common citations for nursing homes were related to antibiotic prescribing and involved missing antibiotic prescribing protocols, missing documentation on the facility’s criteria for antibiotic initiation, and reassessment or review for new resident admissions or readmissions. Those mistakes accounted for 67% of penalties. 

Additionally, antibiotic tracking and reporting errors were involved in 40% of citations with providers most commonly being cited for either missing or incomplete antibiotic or infection surveillance logs, Gouin said. 

Other common problems surveyors found included a lack of appropriate antibiotic stewardship training and the absence of an antibiotic stewardship policy at the facility. 

“All facilities should have an antibiotic stewardship policy available that highlights the commitment to program goals, accountable roles, and action steps taken to implement antibiotic stewardship,” Gouin explained. 

“Facilities should implement antibiotic use protocols, which was one of the most common reasons for antibiotic stewardship citations,” she added. “Protocols requiring documentation of criteria for antibiotic initiation and reassessment should be integrated into nursing home workflows to improve adherence.”

Gouin said there are several barriers that may cause providers to lapse in this area, such as a lack of expertise and high staff turnover. She stressed that providers should use several resources to support and monitor their antibiotic use. 

“Ideally, tracking antibiotic use at the facility level should be automated using either electronic health records or long-term care pharmacy dispensing data because manual tracking of antibiotics is time intensive,” she said.