BACKGROUND: Antimicrobial resistance (AR) is ever increasing, with over two million people in the United States acquiring antibiotic-resistant infections each year. Up to 75% of all antibiotics prescribed are unnecessary or inappropriately prescribed in long-term care facilities (LTCFs). An antibiotic stewardship program (ASP) is one method shown to curtail rising AR. ASP implementation in LTCFs has not been measured in Hawaii. Our objective was to evaluate the status of ASPs in LTCFs in Hawaii as a measure of efforts toward addressing AR.
METHODS: A web-based survey was adapted from CDC’s Core Elements of Antibiotic Stewardship for Nursing Homes and distributed to all 45 LTCFs in Hawaii. The assessment included questions on facility demographics, the seven Core Elements, and barriers to ASP implementation. The survey was intended for facilities to assess their existing ASP capacity and to help inform tool and training development. Survey analysis was done using SAS v 9.4.
RESULTS: Completed surveys were received from 21 LTFCs (47% response rate). Among responding facilities, four (19%) reported implementing all core elements. Facilities with leadership support for antibiotic stewardship (63%) differed significantly from those lacking such in several areas, including: monitoring one or more measures of antibiotic use (100% vs 57%; p=.04; overall: 83%), implementing practices to improve antibiotic use (92% vs 29%; p=.01; overall: 72%), and provision of educational resources on AR and stewardship (82% vs 14%; p=.01; overall: 56%). Among all respondents, most (79%) could identify an ASP lead, but fewer (63%) reported having access to individuals with antibiotic stewardship experience. Over half (68%) reported having policies to improve antibiotic use, with 29% of those facilities implementing more than one policy. Seventy-one percent of facilities experienced at least one barrier to ASP implementation, with 20% reporting 3 or more. Staffing constraints (57%) and lack of a program proposal (38%) were identified most often as barriers to implementation.
CONCLUSIONS: Among responding LTCFs, ASP implementation varies; greatest progress has been made by facilities with leadership support for antibiotic stewardship. Overall, a majority of respondents incorporated ASP practices, policies, and education; however, a substantial portion experienced barriers, with a majority citing a lack of staffing for ASP. Response rate was a limitation of our study; it is unclear how non-respondents may impact findings, and follow-up with these facilities is needed. Next steps will include collaboration with LTCFs to strategize ways to increase ASP leadership capacity and mitigate barriers to implementation in Hawaii.