BACKGROUND: Approximately 4.1 million Americans receive healthcare in skilled nursing homes (SNF) each year. Up to 70% of SNF residents receive an antibiotic each year, and up to 75% of these antibiotics are prescribed incorrectly. Antibiotic use in SNFs varies considerably, suggesting an opportunity for improvement. Clostridium difficile and antibiotic resistant infections are more common in SNFs with high antibiotic use. Centers for Medicare and Medicaid Services (CMS) recently updated conditions of participation mandating that all long term care facilities establish an antimicrobial stewardship program (ASP). Currently, most SNFs lack formal ASPs.
METHODS: A subcommittee to the Washington State Department of Health HAI Advisory Committee was formed to strategize how to assist SNFs to meet the new CMS requirements for stewardship. This group included representatives from Washington and Idaho State and local public health, the states’ quality improvement organization, Washington State SNF survey agency, local chapters of Association for Professionals in Infection Control, SNF trade associations, SNF providers, and stewardship experts. EQuIP—Education, Quality, Infection Prevention—for Long Term Care (LTC) is modeled after a similar program for critical access hospitals, and was conceived to provide webinar-based education focused on critical knowledge for establishing an ASP and for strengthening infection prevention (IP); web-based tools, templates and resources; mentors experienced in IP and stewardship available to field questions from SNF staff; and collaborative learning. A gap survey based on the CDC Core Elements of Stewardship for Nursing Homes was developed and disseminated to all SNFs in Washington and Idaho. Results from the survey will be used to develop the curriculum for webinars.
RESULTS: The gap survey was disseminated in December 2016 and results will be summarized in January 2017. The first webinar is planned for late January 2017, and subsequently will occur monthly. We will track the number of participants on webinars and number of electronic visits to the EQuIP for LTC website, as well as results of an annual survey of facility stewardship and IP resources. SNFs formally enrolled in EQuIP for LTC will be encouraged to track available data such as antibiotic use, Clostridium difficile infections, and antibiotics ordered without indication.
CONCLUSIONS: New CMS requirements for LTC facilities to establish an ASP may present challenges. EQuIP for LTC will provide education, support and resources to staff in SNFs to successfully meet the new regulatory requirements and improve care for residents.