BACKGROUND: The CDC estimates that antibiotic resistance is responsible for more than 2 million infections and 23,000 deaths each year in the United States. Studies have shown that 40 – 75% of antibiotics prescribed in nursing homes may be unnecessary or inappropriate. Recently, the Centers for Medicare & Medicaid Services (CMS) passed a rule requiring all long-term care facilities to establish an antibiotic stewardship program (ASP) by November 28, 2017. Despite the recent impetus for expanding ASPs in long-term care facilities (LTCF), there is little information available about the state of current programs in Arizona. The Arizona Department of Health Services’ Healthcare-Associated Infection (HAI) Program identified survey information to provide baseline data and inform next steps in assisting LTCFs in establishing ASPs.
METHODS: In early 2016, Arizona LTCFs were surveyed to assess infection control practices, infrastructure and outbreak reporting as part of ELC Ebola Supplement Activity A. The survey consisted of 11 sections with 5-15 questions under each section. The antibiotic stewardship section included ten questions that addressed each of the seven core elements of ASPs. We used those questions as the focus for this analysis, and divided Arizona by the 4 Emergency Management System regions to provide a geographical representation while maintaining simplicity and anonymity.
RESULTS: 56 of 146 (38%) LTCFs completed the survey. Of those responding facilities, 18% met all seven core elements of ASPs based on responses to questions from the survey, 71% met at least three core elements, and 98% met at least one core element. Overall, the Northern Region had the highest scores, while the Western Region scored the lowest. Those elements that had the highest percentage of LTCF participation were tracking (77%), leadership commitment (73%), and drug expertise (71%). Those elements with the lowest percentage of LTCF participation were reporting (41%) and education (50%). The remaining two elements, accountability and action, had 62% and 63% compliance, respectably.
CONCLUSIONS: This survey provided the HAI Program with a first look at the ASPs in LTCFs in Arizona. While most LTCFs in Arizona demonstrate some elements of ASPs, very few met all seven core elements. The HAI Program has targeted ASPs as an area of high priority to improve patient outcomes and reduce adverse events due to multidrug resistant organisms and Clostridium difficile infections. Furthermore, as the CMS rule requiring antibiotic stewardship programs in LTCFs looms in the very near future, LTCFs in Arizona have major challenges in front of them.