Failure to Implement Effective Antibiotic Stewardship Program
Penalty
Summary
The facility failed to establish and implement an effective Infection Prevention and Control Program (IPCP) that included an antibiotic stewardship program, as required. Specifically, the facility did not ensure that antibiotic use protocols were followed for two residents. According to the CDC and the facility's own policy, antibiotic stewardship should include standardized practices for evaluating residents suspected of infection, optimizing diagnostic testing, and conducting antibiotic reviews or 'time-outs' after antibiotics are initiated. The facility reported using the McGeer’s Criteria for identifying infections, which requires specific clinical and laboratory findings before starting antibiotics for residents with indwelling catheters. For one resident with a history of nontraumatic intracerebral hemorrhage and an indwelling catheter, a physician ordered Bactrim DS for a possible urinary tract infection after the catheter was changed and purulent urine was observed. Although diagnostic tests were ordered, there was no evidence that an antibiotic review or time-out was completed after the antibiotic was started, as required by the facility’s policy and CDC guidelines. This omission was acknowledged by facility leadership during the survey. For another resident with atrial fibrillation and an indwelling catheter, ceftriaxone was started for a suspected urinary tract infection following episodes of hematuria. However, there was no evidence that the resident met the McGeer’s Criteria prior to starting the antibiotic, and subsequent urine culture results showed no bacterial growth. Facility staff were unable to provide documentation that the antibiotic stewardship program was followed in this case, as required by policy.