Guidance issued on antibiotic use, fall prevention in long-term care

The Centers for Disease Control and Prevention (CDC) issued new recommendations last week on improving antibiotic prescribing in nursing homes.

The recommendations, titled “Core Elements of Antibiotic Stewardship for Nursing Homes,” expand on the CDC's 2014 recommendation that all acute care hospitals should develop and implement an antibiotic stewardship program, applying the advice to long-term care facilities. The Core Elements address leadership commitment, accountability, drug expertise, policy and practice change, tracking and reporting antibiotic use and outcomes, and education. At a minimum, nursing homes should perform the following steps, the CDC said:

1. 1. Demonstrate leadership support for antibiotic stewardship.
2. 2. Identify a lead for antibiotic stewardship activities.
3. 3. Ensure access to an individual or individuals with expertise in antibiotic stewardship.
4. 4. Take 1 or more new actions to improve antibiotic use, such as developing facility-specific algorithms for appropriate diagnostic testing for specific infections.
5. 5. Measure use and complications of antibiotics.
6. 6. Share information with clinicians and staff about how antibiotics are used in the facility.
7. 7. Provide educational resources and materials about antibiotic resistance and ways to improve antibiotic use.

The Core Elements and supporting materials, including a checklist, are available online.

Also last week, the Scientific Advisory Council of Osteoporosis Canada issued recommendations for preventing fractures in long-term care. These included the following:

• All long-term care residents should receive dietary interventions to meet the recommended dietary allowance for calcium (strong recommendation, moderate-quality evidence).
• Residents at high risk for fractures should receive daily vitamin D₃ supplements, 800 IU to 2,000 IU (strong recommendation, moderate-quality evidence). Those not at high risk may receive daily vitamin D₃ supplements, 800 IU to 2,000 IU, to meet the recommended dietary allowance, depending on resources and their and their caregivers' values and preferences (conditional recommendation, moderate-quality evidence).
• Residents at high risk for fractures should receive weekly alendronate or weekly or monthly risedronate as first-line therapy (strong recommendation, moderate-quality evidence).
• Mobile residents at high risk for fractures should receive hip protectors (strong recommendation, moderate-quality evidence). For those who are mobile but not at high risk, hip protectors are suggested based on resources and the residents' values and preferences (conditional recommendation, moderate-quality evidence).
• Balance, strength, and functional training exercises are suggested in those who are not at high risk for fractures (conditional recommendation, moderate-quality evidence). For those who are at high risk, such exercises are suggested only when part of a multifactorial intervention to prevent falls (conditional recommendation, low-quality evidence).

The complete recommendations were published Sept. 14 by CMAJ and are available free of charge online.