Nursing Home Infection Control Program Characteristics, CMS Citations, and Implementation of Antibiotic Stewardship Policies: A National Study
Nursing Home Infection Control Program Characteristics, CMS Citations, and Implementation of Antibiotic Stewardship Policies: A National Study
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DOI：
10.1177/0046958018778636
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发表时间：
2018-05-28
影响因子：
1.7
通讯作者：
Dick, Andrew W.
中科院分区：
文献类型：
--
作者：
Stone, Patricia W.;Herzig, Carolyn T. A.;Dick, Andrew W.
最近，医疗保险和医疗补助服务中心（CMS）的最终规则要求养老院（NH）制定一项感染控制计划，其中包括抗生素管理组成部分，并雇用训练有素的感染预防师（IP）。本研究的目的是提供以下方面的基线评估：（1）与感染控制缺陷引文相关的NH设施和感染控制项目特征;（2）IP培训与抗生素管理政策之间的相关性，控制NH特征。对2514名随机抽样的美国NH进行了一项横断面调查，以评估IP培训、员工流动率和感染控制项目特征（即感染控制委员会会议频率和7种抗生素管理政策的存在）。响应链接到并发的认证和调查提供商增强报告数据，其中包含有关NH设施的特点和引用的信息。进行描述性统计和多变量回归分析来解释NH特征。从990个国家卫生机构收到了调查; 922个国家卫生机构有完整的数据。在这个样本中，三分之一的NH收到了感染控制缺陷的引用。收到缺陷引文的国家卫生机构更有可能有每周/每月一次的委员会，而不是每季度一次（P <0.01）。39%的设施的执行伙伴接受了专门培训。不到3%的受过培训的执行伙伴获得感染控制认证。经过培训的IP的NH更有可能拥有抗生素管理的7个组成部分中的5个（所有P <0.05）。IP培训虽然不频繁，但与抗生素管理政策的存在相关。收到感染控制引用与更频繁的感染控制委员会会议有关。需要培训和支持IP，以确保NHS的感染控制和抗生素管理。随着CMS规则的实施，有必要进行更多的研究。美国国家卫生机构需要增加受过培训的执行伙伴。这些数据可用于评估CMS最终规则对美国NHS感染管理流程的有效性。
Recently, the Centers for Medicare & Medicaid Services (CMS) final rule required that nursing homes (NHs) develop an infection control program that includes an antibiotic stewardship component and employs a trained infection preventionist (IP). The objectives of this study were to provide a baseline assessment of (1) NH facility and infection control program characteristics associated with having an infection control deficiency citation and (2) associations between IP training and the presence of antibiotic stewardship policies, controlling for NH characteristics. A cross-sectional survey of 2514 randomly sampled US NHs was conducted to assess IP training, staff turnover, and infection control program characteristics (ie, frequency of infection control committee meetings and the presence of 7 antibiotic stewardship policies). Responses were linked to concurrent Certification and Survey Provider Enhanced Reporting data, which contain information about NH facility characteristics and citations. Descriptive statistics and multivariable regression analyses were conducted to account for NH characteristics. Surveys were received from 990 NHs; 922 had complete data. One-third of NHs in this sample received an infection control deficiency citation. The NHs that received deficiency citations were more likely to have committees that met weekly/monthly versus quarterly (P < .01). The IPs in 39% of facilities had received specialized training. Less than 3% of trained IPs were certified in infection control. The NHs with trained IPs were more likely to have 5 of the 7 components of antibiotic stewardship in place (all P < .05). The IP training, although infrequent, was associated with the presence of antibiotic stewardship policies. Receiving an infection control citation was associated with more frequent infection control committee meetings. Training and support of IPs is needed to ensure infection control and antibiotic stewardship in NHs. As the CMS rule becomes implemented, more research is warranted. There is a need for increase in trained IPs in US NHs. These data can be used to evaluate the effectiveness of the CMS final rule on infection management processes in US NHs.