Clinical Question
Between 1995 and 2003, scientists discovered several antimicrobials used to save lives and prevent the spread of infections (Doron & Davidson., 2011). The availability of a variety of antimicrobials came with overuse of the same, with a resulting antimicrobial resistance. The increasing number of microbes that do not respond to microbial paints a grim future for healthcare across the world. The Center for Disease Control reports that about 60%of Staphylococcus aureus are resistant to methicillin (Doron & Davidson., 2011). There is a worrying trend of increasing resistance against gram-negative bacteria, with patients dying of diseases that fail to respond to medication. It is even more worrisome that from 1998, there are minimal antibiotics that have been approved for use in treating infections. The increasing resistance has caused an increase in the use of broad-spectrum antibiotics, which sets the stage for worsening antimicrobial resistance. The growing resistance to antimicrobial resistance necessitated the need for antimicrobial stewardship, which is the use of the right medication at the proper dosage and duration.
The goals of antimicrobial stewardship aim at reducing the resistance of antimicrobials. One of its goals is to ensure that health workers administer the right medication in the correct dosage and duration (Dyar et al., 2017). Another goal is to reduce the misuse of antimicrobials while the final goal is to ensure minimal development of antimicrobial resistance. To achieve these goals, it is essential to set up stewardship programs in all levels of healthcare and even in the community (Doron & Davidson., 2011). Every healthcare facility ought to come up with a team of competent individuals and resources to work towards the goals of antimicrobial stewardship. Most programs on antimicrobial stewardship focus on hospitals with minimal or no programs in many long-term care facilities (Dyar et al., 2017). This is despite evidence indicating that there is a high level of antimicrobial misuse in these facilities, necessitating the development of stewardship programs. This finding led us to developing the PICOT question: “Do nursing homes have a dire need for antimicrobial stewardship programs to reduce antimicrobial misuse? Our paper aims to demonstrate that nursing homes need antimicrobial stewardship programs similar to those in hospitals to reduce the incidence of antimicrobial resistance.
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Levels of Evidence
My PICOT question is a prevention question since it discusses the need for a preventive measure to be set up in a facility. The study aims to assess the need to set up antimicrobial stewardship programs, which will aid in reducing antimicrobial resistance. We searched for studies that demonstrated the need for stewardship programs in nursing homes to ensure prudent antimicrobial usage. We hoped that some of the studies we would find would provide the benefits and harms of putting in place stewardship programs. Our searches will most likely yield meta-analysis or systematic review studies. We hoped to find articles that have undertaken reviews of several studies that seek to address the need for stewardship programs within nursing homes. The most appropriate education would be one that analyzes nursing home use of antibiotics and suggests the need for antimicrobial stewardship programs. It would also be essential to compare nursing home set-ups with hospital set-ups with regards to antibiotic usage.
Search Strategy
Our search strategy began with deciding the search terms to use in this search. We aimed for words that would provide a narrowed scope of articles to select from. Our words included: - antimicrobial stewardship, nursing homes, and antimicrobial resistance. We went further and combined the words 'antimicrobial stewardship' with the words 'nursing homes.' Combining these words in our search yielded a rich pool of results that we needed. We used these words in searching sites that provided credible and peer-reviewed information. Some of the sites we used were PubMed and Google Scholar. These two sites produced results that could answer our PICOT question. However, we added a 5-year limit to our search to provide results whose publication dates were within the last five years as this was a requirement for the articles. To access the credibility of our articles, we examined the authors to find out their qualifications. Credible authors authored most articles, but our search yielded two credible articles that met out timeline limit and addressed out PICOT question.
One of the articles we found suitable is “Antimicrobial Stewardship in Long-Term Care Facilities: A Call to Action." The report acknowledges the lack of antimicrobial stewardship programs despite the evident need. It examines the barriers that have led to this lack and some of the interventions that have been put in place to encourage good antimicrobial use in nursing homes. This paper is appropriate in answering the PICOT question since it discusses the need for antimicrobial stewardship programs. It examines the worsening use of antimicrobials and the impact it has on residents and their families (Morrill et al., 2016). The article later describes some of the strategies that have been put in place, and the positive results witnessed after the interventions.
The second article selected to answer the PICOT question is “Optimizing Antibiotic Stewardship in Nursing Homes: A Narrative Review and Recommendations for Improvement." The article also acknowledges the rising incidences of antimicrobial resistance and the need for antimicrobial stewardship programs in healthcare facilities. It also appreciates the efforts put in place to set up such programs in hospitals and the need for the same in nursing homes (Crnich et al., 2015). The article summarizes research findings on the state of these programs in nursing homes. If further examines existing interventions and the impact they have had on antimicrobial use. The article eventually prescribes ways of implementing antimicrobial stewardship to reduce antimicrobial resistance. These two articles sufficiently answered our PICOT question and were thus selected from the search.
Conclusion
Conclusively, antibiotic resistance can be overcome through stewardship whereby people are sensitized about the proper use of antibiotics because it is lack of proper knowledge on the proper use of antibiotics that has contributed to antibiotic resistance. As this research has shown, nursing homes form a prime target for the antibiotic stewardship programs because as it were, this is one of the institutions where antibiotics are inappropriately prescribed.
References
Beaulac, K., Corcione, S., Epstein, L., Davidson, L. E., & Doron, S. (2016). Antimicrobial stewardship in a long-term acute care hospital using offsite electronic medical record audit. infection control & hospital epidemiology , 37 (4), 433-439.
Crnich, C. J., Jump, R., Trautner, B., Sloane, P. D., & Mody, L. (2015). Optimizing Antibiotic Stewardship in Nursing Homes: A Narrative Review and Recommendations for Improvement. Drugs & aging , 32 (9), 699–716. https://doi.org/10.1007/s40266-015-0292-7
Doron, Shira, and Lisa E. Davidson. "Antimicrobial Stewardship". Mayo Clinic Proceedings , vol 86, no. 11, 2011, pp. 1113-1123. Elsevier BV , doi:10.4065/mcp.2011.0358.
Dyar, O. J., Huttner, B., Schouten, J., & Pulcini, C. (2017). What is antimicrobial stewardship?. Clinical Microbiology and Infection , 23 (11), 793-798.
Morrill, H. J., Caffrey, A. R., Jump, R. L., Dosa, D., & LaPlante, K. L. (2016). Antimicrobial Stewardship in Long-Term Care Facilities: A Call to Action. Journal of the American Medical Directors Association , 17 (2), 183.e1–183.16. https://doi.org/10.1016/j.jamda.2015.11.013
