MDRO’s in Long-term Care


n 2004, the Centers for Disease Control (CDC) developed a 12 steps campaign to prevent antimicrobial resistance in long-term care.  Step # 4 states “Broad Spectrum Antibiotics must be targeted to known pathogens.” Broad Spectrum Antibiotics are frequently ordered in long-term care. The physician is usually not on the premises when they receive a call that a patient has a complaint of burning when they urinate, they seem more confused than usual, or any number of vague complaints. The physician may not even know the patient; they may be on call for another physician. Are these symptoms, as reported, relative to a true change in condition?

Is the physician getting an accurate picture of what is going on with the patient? When the physician does not have a clear picture of what might be going on, the Broad Spectrum Antibiotic is a tempting choice to make; It may be prophylactic but it treats multiple organisms and buys time until labs are ordered, drawn and resulted. But, misuse of Broad Spectrum Antibiotics has also caused the resistance that is now actually limiting a physician’s choice for treatment.

Communication from nursing staff to physician could be one of the most important steps toward preventing the misuse of antibiotics. Treatment of suspected infections must be supported by accurately reporting pertinent data gathered by nurses experienced in using established surveillance tools. Nurses need encouragement and education to develop familiarity with established criteria and strong nursing observation skills. Without a professional nursing assessment the physician may be left in the dark with little else to do but to choose the Broad Spectrum Antibiotic; conversely, a concise nursing assessment could prevent an order for a treatment that may not be in the best interest of the patient.  

“Observation tells how the patient is; reflection tells what is to be done; training tells how it is to be done.Training and experience are, of course, necessary to teach us too; how to observe, what to observe; how to think, what to think.” (Nightingale, 1882)

Reference picture: CDC Phil (March 23, 2012)