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Asymptomatic Bacteriuria (ASB) Antibiotic Stewardship Pilot Project
According the Centers for
Disease Control, each year 50-70% of nursing home residents receive a course of
antibiotics, which costs between $38 - $137 million dollars. Overuse of
antibiotics leads to the development of antibiotic resistant infections, many of
which result in significant morbidity and mortality. Ensuring that staff
follows guidelines on the indications for treatment of ASB presents a great
opportunity to reduce unnecessary antibiotic use in nursing homes. Additionally,
reducing antibiotic use for suspected urinary tract infections may also lead to
a decrease in C. difficile infections. A study conducted on residence in
the US Department of Veterans Affairs long-term care facilities found that
residents with ASB who were treated with antibiotics are 8.5 times more likely
to develop a C. difficile infection within the three months following the
course of antibiotics (Phillips, C. BMC Geriatrics, 2012, 12:73).
The Florida Department of
Health Healthcare-associated infection prevention program has initiated a pilot
project with a goal to reduce inappropriate use of antibiotics for the treatment
of asymptomatic bacteriuria in nursing home residents. The specific objectives
for nursing homes participating in the pilot are to:
(1) develop a policy/protocol
for test ordering practices/protocol for ASB;
(2) educate staff on proper procedures for sterile specimen collection;
(3) educate appropriate staff on the indications for treatment of ASB;
(4) implement one process change to support ASB antibiotic stewardship (I.e.
specimen collection process change, test ordering practices, etc.);
(5) evaluate process changes; and
(6) identify next steps to reduce inappropriate antibiotic use for the treatment
of ASB.
These objectives are to be completed
by November 30, 2013.
The Florida Department of Health
will provide webinars, education and training, on-site consultation, and tools
to assist nursing homes with implementing process changes. In addition, nursing
homes will have the opportunity to collaborate with other participants on best
practices and lessons learned.
Upon completion of the pilot
project, the Florida Department of Health is planning to implement this project
statewide.
Supporting Tools
ASB Pilot Project Overview
ASB Pilot Project Timeline
Checklist for Sterile Urine Specimen Collection
Catheter Sterile Urine Specimen Collection Checklist
Specimen Storage Reminder
Assessment tool for Sterile Urine Collection Process
Algorithm for Assessing Residents Without A Catheter for UTI
Algorithm for Assessing Residents With A Catheter for UTI
Urine Specimen Collection Policy
Resources
IDSA Guidelines for the Diagnosis and Treatment of Asymptomatic Bacteriuria in
Adults
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