Infection Control & Hospital Epidemiology (2019), 40, 221–223 doi:10.1017/ice.2018.309
Concise Communication
One-day point prevalence as a method for estimating antibiotic use in nursing homes
Grant R. Barney BS1, Christina B. Felsen MPH2 and Ghinwa K. Dumyati MD2,3 1University at Albany, School of Public Health, Albany, New York, 2Center for Community Health and Prevention, University of Rochester Medical Center, Rochester, New York and 3Infectious Diseases Division, University of Rochester Medical Center, Rochester, New York
Abstract
Antibiotic use tracking in nursing homes is necessary for stewardship and regulatory requirements but may be burdensome. We used pharmacy data to evaluate whether once-weekly sampling of antibiotic use can estimate total use; we found no significant differences in estimated and measured antibiotic use.
(Received 17 August 2018; accepted 27 October 2018; electronically published 5 December 2018)
More than half of nursing home residents receive at least 1 course of antibiotics each year, many are unnecessary or inappropriate.1 Improving antibiotic use in nursing homes is a national priority and a Centers for Medicare and Medicaid Services condition of participation.2 The Centers for Disease Control and Prevention Core Elements of Antibiotic Stewardship for Nursing Homes provide a framework for implementing antibiotic stewardship programs (ASPs).3 A key component of an ASP is measuring antibiotic use to identify and track quality improvement targets.3–5 Multiple antibiotic tracking methods exist; antibiotic days of therapy (DOT) is a reliable method of measuring the antibiotic use burden and the effect of antibiotic stewardship interventions.4,5 Tracking antibiotic DOT in nursing homes is challenging because of lack of readily available data fromelectronic medication administration records and limited expertise in gen- erating antibiotic data summaries.We evaluated whether a regular weekly point-prevalence survey of antibiotic use can accurately estimate DOT and identify targets for improving antibiotic use.
Methods
This analysis includes 4 nursing homes in Monroe County, New York, participating in a 5-year quality-improvement project to implement antibiotic stewardship practices. The median nursing home size was 134 beds. Two of these nursing homes have dedicated ventilator units (8% and 14% of beds), and 3 have a post-acute care unit (range, 15%–21% of beds). Also, 2 of these nursing homes have an in-house dispensing pharmacy. We obtained 6 months of antibiotic dispensing data (October 1, 2016, through March 31, 2017) from nursing home pharmacies
Author for correspondence: Ghinwa Dumyati, Center for Community Health, 46
Prince Street, Rochester, NY 14607. E-mail:
Ghinwa_dumyati@urmc.rochester.edu PREVIOUS PRESENTATION: The findings of this short communication were pre- sented at the SHEA Spring 2019 conference on April 19, 2019, in Boston, Massachusetts. Cite this article: Barney GR, et al. (2019). One-day point prevalence as a method for
estimating antibiotic use in nursing homes. Infection Control & Hospital Epidemiology 2019, 40, 221–223. doi: 10.1017/ice.2018.309
© 2018 by The Society for Healthcare Epidemiology of America. All rights reserved.
because medication administration records data were not avail- able. Data included a resident identifier, antibiotic name, and directions for use (ie, indication, dose and duration). We assumed that dispensed antibiotics were taken as prescribed. Using the start date and treatment duration, we identified all antibiotics dispensed for a specific date and day of the week. We chose Wednesday to conduct a 1-day point-prevalence survey of anti- biotic use because there is little variation in daily antibiotic use within a single week and nursing home medical staffing is gen- erally more consistent during the week. Also, other point- prevalence estimates have used midweek sampling.6
Statistical analysis
The point-prevalence antibiotic use data for each Wednesday in a month were summed then divided by the average daily census for the number of Wednesdays in the month to generate an estimate of the monthly antibiotic DOT per 1,000 resident days. Denominator data were obtained from publically available nur- sing home occupancy data. The overall estimated DOT rate was compared to the measured DOT rate for each month. The DOT rate by drug class and for 3 common indications in nursing homes (urinary tract infections [UTIs], skin and soft-tissue infections [SSTI], and pneumonia)7 were also compared. The distribution of the DOT for antibiotics used to treat the 3 most common indications were also evaluated. The Wilcoxon rank- sum test was used to compare the distribution of monthly mea- sured and estimated DOT rates. A P value <0.05 was considered statistically significant, and all tests were 2-sided. Calculation for estimated monthly DOT per 1,000 resident
days for each nursing home: PWednesday Point PrevalenceAU
ðAverage Daily Census Number of Wednesdays in MonthÞ 1; 000 Results
In the 4 nursing homes, the median 1-day prevalence for antibiotic use was 6.7% (25%–75% interquartile range [IQR], 5.0%–8.6%).
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