Antimicrobial Stewardship and Analyzing How We Talk About LTC

The development of antimicrobial resistance remains one of the major global public health threats today. Antimicrobial stewardship programs (ASPs) are important to help curb this problem because they foster appropriate antimicrobial use. Patients in long-term care (LTC) facilities, due to their advanced age and preexisting comorbid conditions, are at an increased risk of infection and complications secondary to an infection. The stigma often associated with LTC facilities can also be a barrier to quality care and successful programs. The articles in this issue of Annals of Long-Term Care: Clinical Care and Aging provide implementation strategies related to ASPs, tips on preventing and managing infectious outbreaks, and a discussion of how LTC staff terminology during daily care can influence the quality or perceived quality of care delivered.

To combat bacterial resistance, the Centers for Disease Control and Prevention recommends initiatives such as developing geographically-focused or facility-specific antibiograms, staff education, implementation of antimicrobial therapy algorithms for common infections, and automatic stop-order policies. Potential challenges to the development and implementation of ASPs in LTC facilities include inadequate resources, opposition from providers, and lack of administrative support. Jonathan C Cho, PharmD, MBA, BCPS, and colleagues conducted a review of successful antimicrobial stewardship practices in LTC and present their findings and suggestions for providers.

Several studies have shown that living in an LTC facility is an independent risk factor for Clostridium difficile (C diff) infection (CDI). The spore-forming bacteria C diff can cause symptoms ranging from diarrhea to life-threatening inflammation of the colon. Milta Little, DO, CMD, provides an overview of CDI in older adults and in LTC particularly, covering background, prevention, and treatment. An accompanying quick-reference Tip Sheet is included at the end of the article. 

The care for residents of LTC facilities is often delivered in a stressful environment by staff with various educational backgrounds and experience levels who often work with confused residents and concerned family members. The perception about how services are provided in the LTC setting can negatively influence resident and family assessment of care quality, even in settings where the actual skills of the care provider are high. At times, particularly under large resident care assignments, staff may respond to residents or family members in ways that may cause them to infer that there are problems among individual staff or in the facility in general. Ilene Warner-Maron, PhD, RN-BC, CWCN, CALA, NHA, FCPP, discusses common phrases and assumptions present in LTC facilities that may potentially negatively influence how care is communicated and delivered