StoneThe American Health Care Association (AHCA) strongly supports antibiotic stewardship as a national priority. Since 2015’s White House Forum on Antibiotic Stewardship, the association has been partnering with the Centers for Disease Control and Prevention (CDC) to promote stewardship activities, according to Nimalie Stone, MD, medical epidemiologist for long term care in CDC’s Division of Healthcare Quality Promotion.

AHCA has been working very closely with CDC on several fronts to educate its members on antibiotic stewardship.

■ AHCA Quality Initiative. Now in its second phase, the initiative calls on AHCA members to pursue quality improvement measures to reduce unintended health care outcomes and unnecessary rehospitalizations. Those goals closely link with antibiotic stewardship efforts, says Holly Harmon, RN, MBA, LNHA, AHCA’s senior director of clinical services.

“An inappropriate use of an antibiotic, which then leads to antibiotic resistance in a resident who develops Clostridium difficile (C. difficile) infection—that would be considered an unintended health care outcome, and a key priority that needs to be identified,” she says. And the unnecessary use of an antibiotic that results in an unintended health outcome can lead to a rehospitalization.

■ Contribution to CDC Core Elements. AHCA has also been working closely with CDC to contribute to its Core Elements for antibiotic stewardship in nursing centers, which was released in 2015. “We provided member education on that, and resources to direct members looking to implement a stewardship program or how to evaluate their program,” says Harmon.

Recently, CDC awarded the Center for Long term Care Quality and Innovation, a joint partnership between AHCA and Brown University, with a contract to assess the feasibility of implementing the Core Elements within a network of nursing centers.

■ Infection preventionist training program. This will align with another forthcoming requirement that will take effect in a few years for nursing centers. Under this provision, centers must have an infection preventionist with specialized training.

To help its members prepare, AHCA has been working on developing a certificate program to provide specialized training for this role.

“One thing we really want to recognize and appreciate is when the federal agencies take a collaborative relationship approach with stakeholders, there are much better outcomes. We see that happening with CDC’s long term care division in particular,” Harmon says.

She strongly believes that efforts at the federal level and with individual providers are contributing to progress on stewardship. While some long term care centers have been slower to adopt these programs than other provider groups like hospitals, “trying to move a nation as a whole takes time. I think we need to be patient,” she says.

The Core Elements, along with its companion checklist for nursing centers on handling antibiotic use, “has made the
concept of antibiotic stewardship more concrete in terms of policies and practice changes,” Stone says. However, she believes that the forthcoming stewardship requirements issued by the Centers for Medicare & Medicaid Services “will likely be the driver of adoption of these programs” in long term care facilities.

CDC is seeking to encourage more nursing centers to report antibiotic-resistant bacteria and C. difficile infections to the National Healthcare Safety Network. This public health system could help generate estimates of the incidence of these cases in long term care settings, Stone says.