Rohit M Jangi MD Medical Director Bethany Health Care Center RJANGIPCHIPARTNERSORG 130 Beds Average patient age 89 Average l ife expectancy 90 years Medical Staff 1 physician always accessible by phone ID: 1046089
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1. Antibiotic stewardship in long term care: making it work at Bethany Health Care CenterRohit M. Jangi, MDMedical Director, Bethany Health Care CenterRJANGI@PCHI.PARTNERS.ORG
2. 130 BedsAverage patient age: 89Average life expectancy: 90 yearsMedical Staff: 1 physician (always accessible by phone) Evercare nurse practitioners.Bethany Health Care Center
3. Comprehensive approachto tackle the common and complex problem facing long term care of the elderly.Critical thinking By staff at all levelsPrevention first, then treatmentCore principles
4. PreventionOral hygiene Aspiration precautionsAvoid feeding tubesAvoid psychotropic drugs TreatmentWe do not routinely treat aspiration episodes with antibiotics Aspiration pneumonia
5. PreventionSkilled staffHigh CNA retention rate Residents rarely develop decubitiiSedative use is minimizedWound cultures are avoided TreatmentUse narrow spectrum drugs Don’t use cephalosporins. Skin Infection
6. Prevention Hydration hygiene, Only send urine cultures when specific signs and symptoms of UTI are present.Minimize use of indwelling Foley catheter; most catheters are discontinued on admission Avoid drugs that promote urinary retention Urinary tract infection
7. PreventionAll staff is educated in proper clinical assessment, which includes taking history, clinical examination, taking vital signs , and reporting to physician/NPs.We always do urinalysis along with culture so that no UTI is treated in absence of significant pyuria. We treat all residence with home made yogurt after course of antibiotic.Urinary tract infection
8. TreatmentOften patients come in with diagnosis of UTI without evidence. We take them off if no cause.If resident shows evidence of gram negative sepsis, parenteral broad spectrum antibiotic is chosen only on day by day basis, and switched to narrowest spectrum antibiotic as soon as culture report is available. Generally we wait to treat for culture is patient is clinically stable, monitoring closely. Trimethoprim / Sulfa or Nitrofurantoin are drugs of choice as these drugs do not cause C. Difficile .We treat all residence with home made yogurt after course of antibiotic.Urinary tract infection
9. 10 UTIs treated in 2013Of these only 1 failed meet protocol criteriaLast UTI at Bethany Health Care: August 20130 cases ofC. difficile infection in 5 years0 cases of other MDROs in 5 yearsRESULTS