For most facility administrators, infection control and antibiotic stewardship is a task that adds more paperwork and consumes precious time from their nurses’ lives. However, there is more to the story than paperwork and time consumption. Effective infection control and antibiotic stewardship can boost a facility’s revenues, lower operational costs, and make staff happier. While the prior statement sounds too good to be true, let’s see why it makes sense.
It’s all about patient outcomes.
It’s common knowledge that the overuse and misuse of antibiotics has side effects. About 20% of patients experience an adverse event related to antibiotics. Some of the adverse drug events associated with antibiotics are gastrointestinal, dermatologic, musculoskeletal, hematologic, renal, cardiac, among others. Particular attention is often given to the development of antibiotic resistant bacteria, or multi drug resistant organisms (MDROs) such as C.Difficile, VRE, MRSA, and others. Therefore, optimizing the use of antibiotics leads to happier and safer residents. How would a nursing home benefit from healthier patients? The optimal use of antibiotics leads to happier and safer patients.
The issue is, that currently about a quarter of nursing home residents may be colonized with an MDRO. According to our estimates, treating an MDRO costs 10x what it costs to treat a non-resistant infection and requires at least five and a half hours of nursing time per episode. Put in context, a facility with 15 infections per month, would have to deal with at least 1 to 2 MDROs in the same time period. This would mean up to ten extra hours of nursing time just to deal with the infection and up to an extra $1,000 to treat the infection. One infection can be the difference between a nurse having overtime or not.
Nurse turnover affects infection control and vice-versa
Researchers estimate an average annual turnover rate of 65 percent for CNAs and 47 percent for licensed nurses in US nursing homes. Compared to nursing homes with low CNA turnover, facilities with high turnover had significantly higher rates of pressure ulcers, pain, and urinary tract infections among residents. For licensed nurses, higher turnover was associated with twice the risk of developing pressure ulcers.
There are many risk factors affecting nurse turnover, including risk of infection. Effective infection control and antibiotic stewardship can help reduce the daily workload of nurses, therefore it helps retain nurses for longer. In a healthier facility, a nurse will spend more time taking care of the patient, thereby preventing falls, pressure ulcers, and other risks; rather than spend time on the phone with doctors and filling out paperwork related to infection.
Readmissions and infection control
Just like nursing homes, hospitals are looking to control readmissions. One solution by some hospitals is the creation of preferred SNF networks. Some of the criteria hospitals are using to select a nursing home into their preferred network are: SNF star rating, SNF cost of care, and SNF readmissions rate.
Having an effective infection control and antibiotic stewardship program helps nursing homes become more attractive to hospitals.
Not having an effective antibiotic stewardship and infection control program in place will now affect star rating related to annual health inspections. Moreover, not properly implementing infection control and antibiotic stewardship leads to an unhealthy facility which affects other areas of the annual survey as well.
Readmissions can be curtailed with antibiotic stewardship. A study published in 2018 in the US National Library of Medicine indicates that 21% of unplanned 30-day readmissions are due to infections. Optimizing antibiotic use will lead to lower hospital readmissions. First, because patients will have less drug-related adverse events. Second, because the microbiology of the facility will change and the environment itself will become less prone to MDROs. Combined with good infection control, the absolute number of nosocomial infections should go down; taking the total number of readmissions down too.
Increase revenues while improving patient outcomes
Most nursing homes do not have an effective infection control program and an antibiotic stewardship program in place yet. Often times, there is a lack of understanding that prevents the initiation of good, effective programs. How and where to start as well as a total comprehension of the benefits prevent necessary time, money, and attention being paid to having an effective infection control and antibiotic stewardship program. Programs that will lead to an improvement in patient outcomes, a decrease in resident cost of care, and a healthier facility.
Good clinical outcomes means higher revenue. How? Hospitals will want to send patients to facilities that have good star rating and low readmissions, and patients want to go to healthier facilities. Any facility that implements effective infection control and antibiotic stewardship will be primed to increase their revenue.