New survey shows link between comprehensive antibiotic stewardship programs and infection preventionist certification

Arlington, Va., October 24, 2019

Nearly half of all nursing homes do not have adequately trained infection prevention staff and their efforts to combat the over prescription of antibiotics are suffering as a result, according to a new study in the American Journal of Infection Control (AJIC), the journal of the Association for Professionals in Infection Control and Epidemiology, published by Elsevier.

Elderly nursing home residents are more vulnerable to contracting infections and experiencing complications. To combat this greater risk of infection, antibiotics are routinely inappropriately prescribed, and in response, the Centers for Medicare & Medicaid Services (CMS) issued new requirements in 2014 that mandated nursing homes have antibiotic stewardship programs (ASPs) in place to track antibiotic use.

Researchers at Columbia University School of Nursing conducted a nationally representative survey of nursing homes in 2018 to determine the efficacy of ASPs following the 2014 regulations. The survey gauged the effectiveness of the ASPs by analyzing nursing homes’ rates of infection preventionist (IP) training and certification, participation in Quality Innovation Network-Quality Improvement Organization (QIN-QIO) activities, and facility and staff characteristics. Of the more than 800 nursing homes analyzed, only 33.2 percent had comprehensive ASPs. The nursing homes surveyed with certified IPs were nearly five times more likely to have comprehensive ASPs compared to those with no specific training.

“Inappropriate use and overuse of antibiotics puts nursing home residents at an increased risk of developing infections from multidrug-resistant organisms,” said study author, Mansi Agarwal, PhD, MPH, Columbia University School of Nursing, New York, NY, USA. “This survey shows the importance of certified IPs in ensuring antibiotic stewardship programs are operating that reduce the risk for patients and increase their safety.”

A growing body of evidence demonstrates that IPs who are certified in infection prevention and control achieve better outcomes for their patients. IPs are experts in identifying sources of infections and limiting their transmission in healthcare facilities.

Despite the positive link between infection prevention certification and ASP comprehensiveness, the research found that 46 percent of all nursing homes surveyed reported that their infection preventionists did not have specific infection control training. Only 7.6 percent of nursing homes surveyed had an IP certified in infection control and 35.8 percent reported that their IP had state or professional organization training. Nursing homes without comprehensive antibiotic stewardship plans also had a much higher IP turnover rate when compared to nursing homes with moderately comprehensive or comprehensive plans.

“With the third and final implementation phase of the CMS rule approaching, it’s important that nursing homes ensure adequate training for IPs,” said 2019 APIC President Karen Hoffmann, RN, MS, CIC, FSHEA, FAPIC. “Facility-wide infection prevention programs that include antibiotic stewardship are critical and require well-trained IPs, especially in light of recent widely publicized outbreaks of Candida auris.”

Comprehensive ASPs were defined as performing six of the following seven actions: (1) collecting data on antibiotic use; (2) using antibiotic prescribing guidelines or therapeutic formularies; (3) restricting use of antibiotics; (4) communicating antibiotic usage information when residents are transferred; (5) reviewing cases to assess appropriateness of antibiotic administration; (6) providing feedback to clinicians on antibiotic use and prescribing; and (7) providing educational resources for improving antibiotic use.


Notes for editors
The article is “Characteristics of nursing homes with comprehensive antibiotic stewardship programs: Results of a national survey,” by Caroline J. Fu, Elise Mantell, Patricia W. Stone, and Mansi Agarwal ( It appears in the American Journal of Infection Control published by Elsevier.

It is openly available at

About AJIC: American Journal of Infection Control
AJIC: American Journal of Infection Control covers key topics and issues in infection control and epidemiology. Infection preventionists, including physicians, nurses, and epidemiologists, rely on AJIC for peer-reviewed articles covering clinical topics as well as original research. As the official publication of APIC, AJIC is the foremost resource on infection control, epidemiology, infectious diseases, quality management, occupational health, and disease prevention. AJIC also publishes infection control guidelines from APIC and the CDC. Published by Elsevier, AJIC is included in MEDLINE and CINAHL.

About APIC
The Association for Professionals in Infection Control and Epidemiology (APIC) is creating a safer world through the prevention of infection. APIC’s nearly 16,000 members develop and direct infection prevention and control programs that save lives and improve the bottom line for healthcare facilities. APIC advances its mission through patient safety, education, implementation science, competencies and certification, advocacy, and data standardization. Visit us at

About Elsevier
Elsevier is a global information analytics business that helps scientists and clinicians to find new answers, reshape human knowledge, and tackle the most urgent human crises. For 140 years, we have partnered with the research world to curate and verify scientific knowledge. Today, we’re committed to bringing that rigor to a new generation of platforms. Elsevier provides digital solutions and tools in the areas of strategic research management, R&D performance, clinical decision support, and professional education; including ScienceDirect, Scopus, SciVal, ClinicalKey and Sherpath. Elsevier publishes over 2,500 digitized journals, including The Lancet and Cell, 39,000 e-book titles and many iconic reference works, including Gray's Anatomy. Elsevier is part of RELX, a global provider of information-based analytics and decision tools for professional and business customers.

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