The Systemic Over-Use of Antibiotics in Nursing Homes

The Systemic Over-Use of Antibiotics in Nursing Homes The antibiotic is considered one of the greatest achievements in the history of mankind.  However, scientist have been studying antibiotic resistance since the 1940’s.  In 1947, penicillin became ineffective against its first bacterium.  Unfortunately, only as recent as 2017 have nursing homes been forced to develop, implement, and maintain an antibiotic stewardship program. An Overview of the Problem In any long-term care facility, the spread of bacteria and viruses is all but inevitable.  Mitigation techniques such as hand washing, frequent bathing, linen changes, and contact precautions do help, but at some point, this is not enough.  Increasingly, nursing home residents are being prescribed antibiotics even when their indications do not meet the criteria.  You may be surprised to know that, according to the CDC, 50%-70% of nursing home residents are prescribed antibiotics in any rolling 12-month period.  Additionally,

• 38% of nursing home residents are prescribed antibiotics while lacking the required documentation to meet the prescribing criteria;
• 40%-75% of antibiotics are prescribed incorrectly; and
• Over 50% of antibiotic courses last longer than a week regardless of the patient’s illness or progress.

When Antibiotics Are Appropriate It should go without saying that antibiotic prescription and administration is not always inappropriate.  Nursing homes can be a bit of a “petri dish” when it comes to the collection of germs and bacteria.  This can be attributed to several factors:

• Reduced personal hygiene. Nursing home staff are responsible for making sure the cleanliness of your loved ones is adequately managed.
• Proximity to others. Many times, nursing home residents are formed in groups for social activities.  They may even just reside in a small facility.  Either way, the passing of bacteria or other germs is extremely hard to eliminate in close quarters.
• Transmission by staff. Regardless of the amount of handwashing, contact precaution, and other mitigation techniques, bacteria are carried from room to room by nursing home staff.
• Increased frequency of infection occurrences. Elderly people have weaker immune systems in general and this leads to more frequent colonization of bacteria.  Things like urinary tract infections and pneumonia are common in nursing homes and easily transmittable among residents.

To manage these illnesses, antibiotics are essential (assuming bacteria are responsible).  Withholding antibiotics from elderly people with infections could prove fatal.  Unfortunately, administering antibiotics too often comes with its own litany of adverse outcomes. The Negative Side-Effects of Antibiotic Over-Use: The Resident Negative outcomes as they pertain to the over-administration of antibiotics are twofold; the effect on the patient and on the community as a whole.  Long-term antibiotic consumption can lead to:

• Clostridium difficile. Also known as C. diff, this bacterium naturally colonizes in the intestines.  Unfortunately, when antibiotics kill bad bacteria, they also destroy the good ones.  This causes an imbalance of the gut microbiome and allows C. diff to thrive.  This imbalance leads to colitis, nausea, diarrhea, and vomiting.  It is also extremely contagious.
• Bloating and indigestion;
• Abdominal pain;
• Rash; and/or
• Fungal infections.

Perhaps the worst side-effect of long-term antibiotic exposure is death. Over-Exposure of Antibiotics in Nursing Homes: The Community As bacteria face push back from antibiotics, they mutate to become resistant.  By over-prescribing antibiotics, physicians are speeding up this evolution process.  Not only is this an expensive problem, it is dangerous for the residents.  In some cases, bacteria can colonize in or on a resident and be immune to all prescribed treatments.  By the time the physician prescribes the right antibiotic, it can be too late. What Is Being Done to Protect Nursing Home Residents from the Over-Exposure of Antibiotics? The CDC developed core elements of antibiotic stewardship specifically for nursing homes.  In 2017, California passed Senate Bill 361 becoming the first state to pass a bill that made it mandatory for all skilled nursing facilities to develop and implement a stewardship program that reflected these core elements:

• Leadership commitment;
• Accountability;
• Drug expertise;
• Action;
• Tracking;
• Reporting; and

Since the CDC developed the core elements, facilities throughout the country are reporting substantial decreases in instances of C. diff, antibiotic use, and unnecessary urine cultures. A Few Ways You and Your Family Can Support Antibiotic Stewardship To help mitigate the over-use of antibiotics in nursing homes, you and your family can:

• Ask the physician about antibiotic resistance when the medication is prescribed. Make sure the antibiotic is the right one.  Do not be afraid to ask questions.
• Be sure to ask which antibiotic is intended to treat which infection. Ask how long the course should continue and what the potential side-effects are.
• Talk to the nursing home staff about what processes are in place to protect you and your loved ones from the spread of bacteria such as C. diff.
• Enforce hand washing and sanitization before allowing anyone to touch you or your loved one.
• Insist that people do not visit when they are sick.
• Insist on vaccinations.

If you believe your loved one was adversely affected by the inappropriate use of medications, you need help.  Christopher C. Walton, is an experienced and award-winning elder abuse attorney in San Diego. Walton Law, APC focuses its practice on nursing home abuse & neglect. If you believe you or somebody you know has been subjected to abuse or neglect while residing in a Southern California nursing home, contact Chris at (866) 338-7079 for a free and confidential consultation.