Nursing Homes Receive New Rules on Antibiotic Stewardship

With the use of antibiotics remaining high and steady in American hospitals and healthcare facilities, new rules on infection prevention and antibiotic use are set to bring changes to thousands of nursing homes nationwide.

The Centers for Medicare and Medicaid Services (CMS) administers the Medicare and Medicaid programs through the United States Department of Health and Human Services. CMS recently released new rules set to bring improvements in care, safety, and consumer protections for residents of long-term care facilities. The guidelines require that all nursing homes in the network put into place officers to oversee infection prevention and control. They also call for all nursing homes participating in Medicare and Medicaid programs to implement antibiotic stewardship programs that include protocols for judicious antibiotic and a monitoring system to track use. In their press release, CMS officials emphasize that the rules signal major changes that will impact 15,000 facilities around the country, which currently house nearly 1.5 million residents. These rules are part of the agency’s ongoing effort to offer higher quality care to patients and make needed changes to the health system.

While antibiotic-resistant bacteria can affect anyone— causing approximately 2 million infections and 23,000 deaths in the US each year— people who are at higher risk include those receiving chemotherapy, recent surgery patients, and adults ages 65 and older who take antibiotics and receive medical care. This places residents of nursing home facilities with older populations often under medical treatment, squarely in danger of acquiring potentially deadly superbug infections. According to the Centers for Disease Control and Prevention, nearly half a million people in the United States suffered from Clostridium difficile infections in 2015, and more than 100,000 of those infected were living in nursing homes. At least 80% of people who die with these infections are 65 years of age or older. One in nine patients with a healthcare-associated case of C. difficile die within 30 days.

“Antibiotic resistance has become a national concern and the inappropriate use of antibiotics contributes to this problem,” CMS officials told Contagion in an interview. “There are between 1.6 and 3.8 million healthcare-associated infections in nursing homes every year. Annually, these infections result in an estimated 150,000 hospitalizations, 388,000 deaths, and between $673 million to $2 billion dollars in additional healthcare costs. Individuals receiving care in a nursing home may have increased susceptibility to infections as a result of malnutrition, dehydration, comorbidities, or functional impairments, such as urinary and fecal incontinence, or medications that diminish immunity, or immobility. In addition, residents may have a higher risk of exposure to infectious agents in the facility due to socialization among residents, staff, and visitors.”

With antibiotic use remaining high in many hospitals and healthcare facilities, health experts have placed a new emphasis on reducing the unnecessary and inappropriate prescribing of antibiotics as a key part of the strategy in the battle against superbugs. A CDC report notes that 40% to 75% of the antibiotics prescribed in nursing homes are unnecessary and the agency has helped develop a set of Core Elements of Antibiotic Stewardship for Nursing Homes. This set of pledges and actions is designed to optimize the treatment of infections while reducing adverse events associated with antibiotic use, to reduce the threat of antibiotic resistance. It’s a strategy that includes leadership commitment, accountability, drug expertise, action, tracking, reporting, and education.

While CMS officials note that they’ve taken into account the framework for nursing home antibiotic stewardship as created by the CDC, following these guidelines is not a requirement in their new rules. “We believe that facilities need the flexibility to determine the standard they will follow,” say CMS officials. “However, we agreed that the CDC guidelines were an excellent source for guidelines.”