Infection prevention and control involves numerous interconnected elements, all of which must work together to keep residents, staff, and others safe and ensure regulatory compliance. One element closely connected to EBP use in nursing homes is antibiotic stewardship and efforts to prevent and manage multidrug-resistant organism (MDRO) transmission.
MDROs are bacteria or fungi that are resistant to some antimicrobial agents, primarily due to the overuse of antibiotics. Because they are resistant to antibiotics, MDROs can be difficult to treat. They also can be spread via direct contact with an infected individual’s bodily fluids and contaminated surfaces. MDROs include methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant enterococci (VRE), and some gram-negative bacilli. These can cause illnesses such as urinary tract infections, pneumonia, or blood or wound infections.
Clinical team leaders, including the consultant pharmacist, can help make sure staff understand the impact of MDROs and why preventing transmission is essential. Debbie Milito, PharmD, director of consultant and clinical services and chief antimicrobial stewardship officer at Diamond Pharmacy Services and American Society of Consultant Pharmacists board chair, said, “When I conduct education, I use the CDC core elements for an effective antibiotic stewardship program.” These elements are leadership commitment, accountability, drug expertise, action, and tracking.
“When you are educating everyone from the administrator to the CNA [certified nurse assistant], residents, and family members, you are more likely to get everyone on board and have successful outcomes,” Milito said. She stressed the importance of educating residents and their families, as they often don’t realize the limitations and risks of antibiotics.
For example, family members may expect antibiotics to treat a urinary tract infection when adequate fluid intake and other nonpharmacological interventions are safer and more appropriate. “When staff and families understand and support appropriate and responsible antibiotic prescribing and use, we can decrease antibiotic resistance,” she said.
Protecting against MDRO transmission is especially crucial in frail older adults. If facilities don’t practice consistent infection control and prevention practices, infections can spread rapidly. Milito suggested, “We need to consistently go back to the basics, including effective handwashing. This information is worth repeating.”
Monitoring data to track antibiotic prescribing is key, and the pharmacist is perfectly positioned to do this as part of monthly or targeted reviews. “I'm listening very intently to the infection preventionist report and hearing how many multidrug-resistant organisms there are and where they are in the building,” Milito shared. “This can help identify how and by whom the MDROs are being transmitted.”
Even when the numbers are good and there haven’t been any recent outbreaks, Milito stressed, “we can’t let our guard down.”