1. Illinois Summit on Antimicrobial stewardship 2015
Julie Sopocy, RN, BS,
Director of Nursing
Alden Estates of Barrington
Skilled Nursing Facility

2. Our Facility
Alden Estates of Barrington is 5 star rated facility that serves a unique population of skilled nursing needs.

3. Our Population 150 dual certified bed capacity. Specialty
Ventilator/respiratory unit
Tracheostomy in place prior to admission to facility
Either long term care ventilator or attempting to wean
G-tube in place for enteral feeding if needed
Newly placed LVAD
Peripheral or Central lines for hydration or antibiotics.
Short term rehabilitation unit
Recent ortho surgeries
Rehab after CVA
Wound care
Post general surgical, weak due to illness
Long-term care unit
Home for 50% of residents

4. Our Clinicians Primary Care Physicians
Primary Care Nurse Practitioners
Pulmonologists
Infectious Disease
Nephrologists
Physiatrist
Wound Care Doctors
Psychiatrists
Podiatrists
Ophthalmologists

5. Who defines Infection?
At our facility we use the McGeer’s1, 2 Infection Report Form for all suspected infections.
1Infect Control Hospital Epidemiology 2012;33:
2McGeer’s Criteria were developed as a surveillance tool to identify and report evidence of infections in Long Term Care Facilities and have not been validated as a clinical tool. These criteria have become the national regulatory standard that requires potentially infectious acute clinical changes be documented and communicated to physicians in a timely manner.

6. New in onset or acutely worse Rule out other causes first
According to McGeer’s, any symptoms used to qualify defining infection must be:
New in onset or acutely worse
Rule out other causes first
Dehydration
New medication
Infection should not be identified by a single piece of evidence
Use microbial and radiology information

7. When to Treat? Infection report form helps define treatable infection
It is important to treat active infections, NOT asymptomatic colonizations
Use microbial studies to help determine active infection.

8. Infection report forms:
Respiratory tract
Urinary tract
Gastrointestinal tract
Skin
Eye, ear, nose, mouth

9. Barriers to Best Practice
Physicians:
use of prophylaxis treatment
maintenance use for chronic infection
treatment with broad spectrum antibiotics while a culture is pending
- not having qualifying diagnosis for use of foley catheters
Staff:
- improper technique (hand hygiene, use of PPE, incontinent & catheter care)

10. Overcoming Barriers Education
To prescribers on criteria for antibiotic treatment and qualifying diagnoses for Foley Catheter use
To staff on proper hand hygiene, use of PPE with patients on precautions

11. Overcoming Barriers Communication
With prescribers: develop relationships with practitioners, call and ask for a culture or x-ray before treatment
With staff:
clinical rounds with interdisciplinary team and frontline staff twice daily to update on change of condition
use of interact tools; stop & watch, SBAR, care pathways.

12. Overcoming Barriers Observation
Quality Assurance rounds by a team of disciplines to assure procedures are being followed

13. References CDC – Centers for Disease Control, www.cdc.gov
SHEA, The Society for Healthcare Epidemiology of America,
NIH, National Institute of Health,
Infect Control Hospital Epidemiology 2012;33: