When a MRSA outbreak affecting at least 22 patients and employees at the Park Manor Nursing Home was confirmed in the summer of 2006, facility medical director Dr. Joe Boero didn't know where to begin.
The infection control team at the Park Falls, Wis., facility suspected the high rate of drug-resistant bacteria in the facility was linked to physicians prescribing antibiotics “to anything that moved,” Boero recalled. Nursing director Paula Koch had just returned from a conference on antibiotic overuse and drug-resistant bacteria. But the team had no proof this was linked to Park Manor's methicillin-resistant Staphylococcus aureus outbreak. “You have to get me some data,” Boero told the team.
So they developed a spreadsheet on antibiotic use. “Anything they could think of, they started counting,” Boero said. The spreadsheet listed the type of antibiotic given to each patient for specific symptoms and length of use. Each physician, antibiotic and type of bacteria was given a color for easy tracking.
“They essentially made an invisible problem more visible,” said Dr. Chris Crnich, an associate professor in the infectious diseases division at the University of Wisconsin, who advised and evaluated the program. Collaboration, charting and leadership support were critical to the project's success, he added.
The team found that staff at the 108-bed facility had prescribed a total of 503 antibiotics in 2006, which averaged 11.7 prescriptions per 1,000 patient days. That led the nursing home to launch an antibiotic resistance-reduction program.
All physicians were educated about antibiotic overuse through a letter campaign at the end of 2006. In 2009, Boero began contacting doctors who showed up as outliers. He faced some pushback.
In September, the Centers for Disease Control and Prevention issued recommendations to fight superbugs in nursing homes. It said that up to 75% of antibiotics prescribed in long-term-care facilities are given unnecessarily. In recent years, public health leaders have urged use of antibiotic stewardship programs to combat overuse in healthcare settings.