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Why is there so much focus recently on infection control and antibiotic use in nursing centers?

Dr. Andy Kramer
Provider Magazine – December 2015

Infections are the single greatest cause of preventable readmissions among frail nursing care center residents. The Centers for Medicare & Medicaid Services (CMS) estimates that infections in these residents result in 150,000 to 200,000 hospital admissions a year, with mortality rates as high as 40 percent of those hospitalized. Urinary tract infections (UTIs), respiratory infections, and sepsis are the primary reasons for about one-third of all readmissions to hospitals for skilled nursing residents.

Infection Control is now the most frequently cited F-tag (F441), with 38 percent of nursing centers cited by surveyors across the nation in their most recent survey. The current regulations, last revised in 2009, address the full range of infection control practices, including reducing transmission of infectious diseases that are airborne and those transmitted by contact. The regs highlight surveillance, monitoring, reporting, education, and antibiotic review.

Standard required precautions include, but are not limited to, hand hygiene; safe injection practices; the proper use of gloves, gowns, and masks; resident placement; and care of the environment, textiles, and laundry.

Recently, the Centers for Disease Control and Prevention (CDC) reported that 40 to 75 percent of antibiotics in nursing centers are prescribed incorrectly. For example, asymptomatic bacteriuria without signs or symptoms of UTI occurs in about 100 percent of catheterized residents and 25 to 50 percent of noncatheterized residents. Treating asymptomatic bacteriuria does not prevent symptomatic UTI nor reduce mortality, but can result in antibiotic -resistant bacteria. Thus, treatment is not only inappropri –
ate, but can be harmful.

Preventing UTI begins with removing indwelling catheters whenever possible.

With the growing number of antibiotic-resistant outbreaks, CDC has now turned its attention to nursing centers. The new proposed rule for participation from CMS echoes the CDC infection control and antibiotic stewardship recommendations.

While there has been considerable challenge to the proposed rule related to infection control and antibiotic stewardships as too much too fast, it is time nursing centers take the initiative in the challenge to reduce infection and antibiotic resistance.

First and foremost is prevention. Preventing UTI begins with removing indwelling catheters whenever possible. Efforts to prevent respiratory infection also should be made, starting with vaccination of residents for influenza and pneumonia. In addition, all staff should receive the influenza vaccine, and contact with residents should be avoided when a staff member is infectious.

Other infection control practices such as hand washing, isolation of infected residents, and use of other known precautions in care delivery are critical.

By taking the initiative, providers can balance the need for infection control and treatment with the need to preserve quality of life for frail elders. CMS acknowledges that “because of the potential negative impact that a resident may experience as a result of implementation of special precautions, the facility is challenged to promote individual residents’ rights and well-being while trying to prevent and control the spread of infections.”

Still, providers cannot ignore the devastating consequences of infection in nursing centers.

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