Illinois Summit on Antimicrobial stewardship 2015

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