702. Frequently Identified Gaps in Antimicrobial Stewardship Programs in Long-Term Care Facilities
Session: Poster Abstract Session: Stewardship: Data and Program Planning
Thursday, October 5, 2017
Room: Poster Hall CD
  • Chung IDWeek ASP LTCF, 092017, final.pdf (688.9 kB)
  • Background: Nebraska (NE) Infection Control Assessment and Promotion Program (ICAP) is a CDC funded project. ICAP team works in collaboration with NE Department of Health and Human Services (NEDHHS) to assess and improve infection prevention and control programs (IPCP) in acute care, outpatient and long-term care facilities (LTCF). New Centers for Medicare and Medicaid Services (CMS) regulation requires LTCF to develop antimicrobial stewardship programs (ASP) by November 2017. Hence, we decided to study the current level of ASP activities and associated factors in LTCF.

    Methods: NE ICAP conducted on-site surveys in 30 LTCF from 11/2015 to 3/2017. ASP activities related to 7 CDC recommended core elements (CE) including leadership support (LS), accountability, drug expertise, action, tracking, reporting, and education were assessed using the CDC Infection Control Assessment Tool for LTCF. Gap frequencies were calculated for CE. Fisher’s exact, Mann-Whitney and Kruskal-Wallis tests were used for statistical analyses examining the associations of LS, accountability, bed size (BS), hospital affiliation (HA), presence of trained infection preventionist (IP), and IP weekly hours (WH)/100-bed for IPCP with level of ASP activites.

    Results: Of the 30 LTCF surveyed, 23% had HA and 60% had trained IP. Median BS, IP WH/100-bed for IPCP, and number of CE implemented were 60.5, 6.5, and 3, respectively. Only 1 (3%) LTCF had all 7 CE in place. LTCF with LS had a higher median number of the 6 remaining CE implemented compared to LTCF without LS (3 vs. 2; p=0.03). Similarly, LTCF with accountability for ASP had a median of 3 remaining CE in place as opposed to 2 in LTCF without accountability (p<0.05). LTCF with LS, accountability, and ≥20 IP WH/100-bed for IPCP were more likely to implement ≥2 of the last 4 CE, i.e., action, tracking, reporting and education (100% vs. 30%, p<0.05). LTCF with ≥20 IP WH/100-bed dedicated towards IPCP were more likely to have ≥5 CE in place than the LTCF with lower dedicated IP time (60% vs. 8%, p<0.05).

    Conclusion: Implementation of all 7 ASP CE in LTCF is uncommon. Presence of LS, accountability for ASP, and ≥20 IP WH/100-bed for IPCP are significant factors driving implementation of more ASP CE. Further guidance is needed for LTCF to assist them in dedicating appropriate IP time towards IPCP for promoting ASP as IP time varies greatly among LTCF.

    Philip Chung, PharmD, MS, BCPS1, Regina Nailon, PhD, RN2, Kate Tyner, RN, BSN, CIC2, Sue Beach, BA2, Scott Bergman, PharmD, FIDSA, FCCP, BCPS3, Margaret Drake, MT, ASCP, CIC2,4, Teresa Fitzgerald, RN, BSN, CIC2, Elizabeth Lyden, MS5, Mark E. Rupp, MD6, Michelle Schwedhelm, MSN, RN2, Maureen Tierney, MD, MSc7, Trevor Van Schooneveld, MD6 and Muhammad Salman Ashraf, MBBS6, (1)Nebraska Antimicrobial Stewardship Assessment and Promotion Program, Nebraska Medicine, Omaha, NE, (2)Nebraska Infection Control Assessment and Promotion Program, Nebraska Medicine, Omaha, NE, (3)Department of Pharmaceutical Care, Nebraska Medicine, Omaha, NE, (4)Division of Epidemiology, Nebraska Department of Public Health, Lincoln, NE, (5)College of Public Health, University of Nebraska Medical Center, Omaha, NE, (6)Division of Infectious Diseases, University of Nebraska Medical Center, Omaha, NE, (7)Public Health, Nebraska Department of Health and Human Services, Lincoln, NE


    P. Chung, None

    R. Nailon, None

    K. Tyner, None

    S. Beach, None

    S. Bergman, None

    M. Drake, None

    T. Fitzgerald, None

    E. Lyden, None

    M. E. Rupp, None

    M. Schwedhelm, None

    M. Tierney, None

    T. Van Schooneveld, None

    M. S. Ashraf, None

    Findings in the abstracts are embargoed until 12:01 a.m. PDT, Wednesday Oct. 4th with the exception of research findings presented at the IDWeek press conferences.