The incidence of infection in ltc residents is 22

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The incidence of infection in LTC residents is 22 percent and can result in significant morbidity and mortality (Health and Human Services, 2014). The most common infections that develop and being treated with antibiotics in LTCFs are diagnoses such as urinary tract infections (32%–66%), trailing by respiratory tract infections (15%–36%) and skin and soft tissue infections (13%–18%) (High et al., 2009; Van Buul et al., 2012). Antimicrobial agents account for approximately 40 percent of all systemic medications prescribed in LTCFs (Nicolle et al., 2000). Van Buul and colleagues (2012) have examined the percentage of inappropriate use of antibiotics in LTCFs, and estimates the appropriateness of the prescribed antibiotics range from 49% to 62 % . Unfortunately, 40 % -75% of these antimicrobial
AN EDUCATIONAL PROGRAM FOR NURSES 7 agents prescribed in LTC residents are either clinically inappropriate or unnecessary (Peron, Hirsch, Jury, Jump, & Donskey, 2013) and nearly 33 percent of suspected UTIs in LTC residents actually do not support a clinical diagnosis of symptomatic infection (High et al., 2009). Yet, antibiotics remain one of the most commonly prescribed medications in LTCFs. Antibiotic Resistance in Long Term Care Facility It is well understood that residents in LTCFs have become a reservoir for antimicrobial resistance infections. Antibiotic resistance develops when bacteria adapt and grow in the presence of antibiotics. The development of resistance is linked to how often antibiotics are used. Because many antibiotics belong to the same class of medicines, resistance to one specific antibiotic agent can lead to resistance to a whole related class (WHO, 2015). Antimicrobial resistance is spreading and there are few prospects for the development of new classes of antibiotics in the short term (Lessa, Mu, Bamberg, Beldavs, Dumyati, Dunn, & Farley, 2015; WHO, 2015). Multidrug resistance organisms’ prevalence in LTCFs is an increasingly serious threat to global public health due to secondary effects including uncontrolled infections, increased risk of cross contamination, increased length of illness, re-hospitalizations, increased length of hospitalization, increased economic and social costs, as well as a greater risk of death (Nicolle et al., 2005; WHO, 2015). The adverse consequences of antibiotics overuse in LTCFs, lead to adverse drug reactions or interactions, the development of Clostridium difficile infections, the emergence of colonization of MDROs such as methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant enterococci (VRE), the newer multidrug- resistant gram-negative bacilli (R-GNB), antibiotic failure, increased mortality, and greatly increased costs (Lessa et al., 2015). The World Economic Forum has identified antibiotic resistance as a global risk beyond the capacity of any organization or nation to manage or
AN EDUCATIONAL PROGRAM FOR NURSES 8 mitigate alone (Howell, 2013), but in general there is little awareness of the potential social, economic and financial impacts of drug resistance.

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