TIP OF THE WEEK
12 Steps to Prevent Antimicrobial Resistance in Long-Term Care
Over the last few decades, antimicrobial resistance has become an increasingly urgent issue in long-term care facilities. The figure below shows the prevalence of antibiotic-resistant infections among U.S. nursing home residents.
The Centers for Disease Control and Prevention (CDC) has initiated an antimicrobial resistance campaign to increase awareness of the problem and to prevent it, focusing on 12 steps that fall within four major areas.
This 12-step CDC fact sheet is reprinted below. It is also available on the Internet at http://www.cdc.gov/drugresistance/healthcare/ltc/12steps_ltc.htm.
PREVENT INFECTION
Step 1. Vaccinate
- Give influenza and pneumococcal vaccinations to residents
- Promote vaccination among all staff
Step 2. Prevent conditions that lead to infection
- Prevent aspiration
- Prevent pressure ulcers
- Maintain hydration
Step 3. Get the unnecessary devices out
- Insert catheters and devices only when essential and minimize duration of exposure
- Use proper insertion and catheter-care protocols
- Reassess catheters regularly
- Remove catheters and other devices when no longer essential
DIAGNOSE AND TREAT INFECTION EFFECTIVELY
Step 4. Use established criteria for diagnosis of infection
- Target empiric therapy to likely pathogens
- Target definitive therapy to known pathogens
- Obtain appropriate cultures and interpret results with care
- Consider C. difficile in patients with diarrhea and antibiotic exposure
Step 5. Use local resources
- Consult infectious disease experts for complicated infections and potential outbreaks
- Know your local and/or regional data
- Get previous microbiology data for transfer residents
USE ANTIMICROBIALS WISELY
Step 6. Know when to say “no”
- Minimize use of broad-spectrum antibiotics
- Avoid chronic or long-term antimicrobial prophylaxis
- Develop a system to monitor antibiotic use and provide feedback to appropriate personnel
Step 7. Treat infection, not colonization or contamination
- Perform proper antisepsis with culture collection
- Re-evaluate the need for continued therapy after 48-72 hours
- Do not treat asymptomatic bacteriuria
Step 8. Stop antimicrobial treatment
- When cultures are negative and infection is unlikely
- When infection has resolved
PREVENT TRANSMISSION
Step 9. Isolate the pathogen
- Use Standard Precautions
- Contain infectious body fluids (use approved Droplet and Contact isolation precautions)
Step 10. Break the chain of contagion
- Follow CDC recommendations for work restrictions and stay home when sick
- Cover your mouth when you cough or sneeze
- Educate staff, residents, and families
- Promote wellness in staff and residents
Step 11. Perform hand hygiene
- Use alcohol-based handrubs or wash your hands
- Encourage staff and visitors [to do the same]
Step 12. Identify residents with multi-drug resistant organisms (MDROs)
- Identify both new admissions and existing residents with MDROs
- Follow standard recommendations for MDRO case management
For more information about antimicrobial resistance, go to http://www.cdc.gov/drugresistance/index.htm
RESOURCE SPOTLIGHT
FACT SHEET: 12 STEPS TO PREVENT ANTIMICROBIAL RESISTANCE AMONG LONG-TERM CARE RESIDENTS
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