Summit on Antimicrobial Stewardship in Skilled Nursing Facilities

1. Illinois Summit on Antimicrobial stewardship 2015 Julie Sopocy, RN, BS, Director of Nursing Alden Estates of Barrington Skilled Nursing Facility

2. Our Facility • Alden Estates of Barrington is 5 star rated facility that serves a unique population of skilled nursing needs.

3. Our Population • 150 dual certified bed capacity. • Specialty • Ventilator/respiratory unit • Tracheostomy in place prior to admission to facility • Either long term care ventilator or attempting to wean • G-tube in place for enteral feeding if needed • Newly placed LVAD • Peripheral or Central lines for hydration or antibiotics. • Short term rehabilitation unit • Recent ortho surgeries • Rehab after CVA • Wound care • Post general surgical, weak due to illness • Long-term care unit • Home for 50% of residents

4. Our Clinicians • Primary Care Physicians • Primary Care Nurse Practitioners • Pulmonologists • Infectious Disease • Nephrologists • Physiatrist • Wound Care Doctors • Psychiatrists • Podiatrists • Ophthalmologists

5. Who defines Infection? • At our facility we use the McGeer’s1, 2 Infection Report Form for all suspected infections. 1Infect Control Hospital Epidemiology 2012;33:965-977 2McGeer’s Criteria were developed as a surveillance tool to identify and report evidence of infections in Long Term Care Facilities and have not been validated as a clinical tool. These criteria have become the national regulatory standard that requires potentially infectious acute clinical changes be documented and communicated to physicians in a timely manner.

6. According to McGeer’s, any symptoms used to qualify defining infection must be: • New in onset or acutely worse • Rule out other causes first • Dehydration • New medication • Infection should not be identified by a single piece of evidence • Use microbial and radiology information

7. When to Treat? • Infection report form helps define treatable infection • It is important to treat active infections, NOT asymptomatic colonizations • Use microbial studies to help determine active infection.

8. Infection report forms: • Respiratory tract • Urinary tract • Gastrointestinal tract • Skin • Eye, ear, nose, mouth

9. Barriers to Best Practice • Physicians: • use of prophylaxis treatment • maintenance use for chronic infection • treatment with broad spectrum antibiotics while a culture is pending - not having qualifying diagnosis for use of foley catheters • Staff: - improper technique (hand hygiene, use of PPE, incontinent & catheter care)

10. Overcoming Barriers • Education • To prescribers on criteria for antibiotic treatment and qualifying diagnoses for Foley Catheter use • To staff on proper hand hygiene, use of PPE with patients on precautions

11. Overcoming Barriers • Communication • With prescribers: develop relationships with practitioners, call and ask for a culture or x-ray before treatment • With staff: • clinical rounds with interdisciplinary team and frontline staff twice daily to update on change of condition • use of interact tools; stop & watch, SBAR, care pathways.

12. Overcoming Barriers • Observation • Quality Assurance rounds by a team of disciplines to assure procedures are being followed

13. References • CDC – Centers for Disease Control, www.cdc.gov • SHEA, The Society for Healthcare Epidemiology of America, www.jstor.org • NIH, National Institute of Health, www.ncbi.nlm.nih.gov • Infect Control Hospital Epidemiology 2012;33:965-977