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The biggest threat to LTC post-COVID-19? Antibiotic resistant infections

Date: April 18, 2021 | By: Dr. Chris Morgan, Chief Medical Officer, AMS Infection Prevention Partners

For more than a year now, clinicians in long-term care (LTC) have been on the front lines battling the COVID-19 pandemic. It’s been a difficult, consuming battle -- one that has disproportionately impacted LTC, claiming the lives of more than 130,000 residents and more than 1,600 staff members in the U.S.

At long last, we’re collectively beginning to see the light at the end of this long, dark tunnel as more and more residents and staff are vaccinated. But there are some re-infections happening across the country, so we can’t lose sight of our commitment to protect nursing facilities from COVID-19.

But as important as this fight is, there’s another one that’s perhaps as big of a threat to the LTC community - if not bigger - than COVID-19: antibiotic resistant infections. Unfortunately, we, as prescribing physicians, have been contributing to this problem for years. Even at the onset of COVID-19 - a known viral infection - many physicians were prescribing antibiotics.

Antibiotics in LTC

More than 70% of LTC residents receive one or more courses of antibiotics annually, and the Centers for Disease Control and Prevention (CDC) estimates that between 50% and 70% of these are improperly prescribed. This is leading to the increased prevalence of multi-drug resistant organisms (MDROs).

The CDC recently released its 2019 Antibiotic Resistance Threats Report that highlights the latest statistics and biggest threats.

There are more than 2.5 million MDRO infections annually, which results in the deaths of 35,000 Americans. The CDC first rang the alarm on this threat back in 2013, but it’s taken several years for many clinicians to understand and accept how big of a problem this is. And while it’s difficult to accurately capture the total economic impact of antibiotic resistance, the CDC estimates that the cost to treat infections caused by just six of the multi-drug resistant infections is more than $4.6 billion annually.

But there is some good news - infection prevention and control efforts have demonstrated success in reducing deaths related to MDROs. The report states: “Dedicated prevention and infection control efforts in the U.S. reduced deaths from antibiotic-resistant infections by 18% overall and by nearly 30% in hospitals.”

This number is still high and there’s still work to do, but there are resources to help.

IPCP efforts to combat resistance

Every medical director knows the importance of sound infection prevention and control programs (IPCP), yet for one reason or another, facilities’ commitment to these measures sometimes wane. Perhaps it’s staffing troubles - either being short-staffed or clinicians being pulled in too many directions - or perhaps we, as medical directors, are too focused elsewhere.

But this is the most important issue facing our residents and staff and we owe it to them to commit to reducing antibiotic resistant infections in our facilities.

IPCP 101 includes the following measures:

  • An infection surveillance program

  • Infection incidence reporting program

  • Infection prevention program

  • QAPI program

  • Isolation program

  • Antibiotic stewardship program

  • A designated, certified infection preventionist

  • Linen handling program

  • Immunizations

  • Annually IPCP facility assessment

  • Resident care activities program

  • Staff IPC program

We have case studies that demonstrate reducing improper antibiotic prescriptions, as well as respiratory infections at long-term facilities, is achieved through comprehensive IPCP measures. In fact, in two years, we were able to reduce not only antibiotic prescriptions but respiratory infections from more than 40 to less than five. Simply put: IPCP efforts work.

In addition to IPCP programs, there are data analytics tools and programs like “Virtual Rounding” that can help. Our Infection Preventionists have found multiple cases of improperly prescribed antibiotics just by rounding on real-time patient data virtually. We have tons of data at our disposal - all we have to do is use it.

For the latest CDC actions to combat antibiotic resistance, read about its AR Solutions Initiative. To learn how a sound IPC program can reduce antibiotic resistance in your facility, contact us today.

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