New Resource from the CDC – Core Elements of Antibiotic Stewardship for Nursing Homes

September 22, 2015
The Core Elements of Antibiotic Stewardship for Nursing Homes
The Core Elements of Antibiotic Stewardship for Nursing Homes
adapts the CDC Core Elements of Hospital Antibiotic Stewardship into practical ways to initiate or expand antibiotic stewardship activities in nursing homes. Nursing homes are encouraged to work in a step-wise fashion, implementing one or two activities to start and gradually adding new strategies from each element over time. Any action taken to improve antibiotic use is expected to reduce adverse events, prevent emergence of resistance, and lead to better outcomes for residents in this setting.

Approximately 4.1 million Americans are admitted to or reside in nursing homes each year.(1) Antibiotics are the most frequently prescribed medications in nursing homes. Up to 70 percent of residents receive one or more courses of antibiotics during a year.(2-3) Up to 75 percent of antibiotics prescribed in nursing homes are given incorrectly, meaning either the drug is unnecessary or the prescription is for the wrong drug, dose, or duration.(2-3)

"Superbugs that are hard to treat pose a health risk to all Americans, particularly the elderly whose bodies don’t fight infection as well,” said CDC Director Tom Frieden, MD, MPH. “One way to keep older Americans safe from these superbugs is to make sure antibiotics are used appropriately all the time and everywhere, particularly in nursing homes.”

The Core Elements provide practical ways for nursing homes to initiate or expand antibiotic stewardship activities. The guide provides examples of how antibiotic use can be monitored and improved by nursing home leadership and staff. The companion checklist can be used to assess policies and practices already in place and to review progress in expanding stewardship activities on a regular basis. However, depending on resources, some facilities may need more time to implement all these important protections. Ultimately, nursing home antibiotic stewardship activities should, at a minimum, include the following:

1. Leadership commitment: Demonstrate support and commitment to safe and appropriate antibiotic use.
2. Accountability: Identify leaders who are responsible for promoting and overseeing antibiotic stewardship activities at the nursing home.
3. Drug expertise: Establish access to experts with experience or training in improving antibiotic use.
4. Action: Take at least one new action to improve the way antibiotics are used in the facility.
5. Tracking: Measure how antibiotics are used and the complications (e.g., C. difficile infections) from antibiotics in the facility.
6. Reporting: Share information with healthcare providers and staff about how antibiotics are used in the facility.
7. Education: Provide resources to healthcare providers, nursing staff, residents and families to learn about antibiotic resistance and opportunities for improving antibiotic use.

“We encourage nursing homes to work in a step-wise manner implementing one or two activities at first, then gradually adding new strategies from each core element over time,” says Nimalie Stone, MD, CDC medical epidemiologist for long-term care. “Taking any of these actions to improve antibiotic use in a nursing home will help protect against antibiotic-resistant infections and more effectively treat infections. This could lead to better recoveries from infections and ultimately improve health outcomes for all residents.”

The release of CDC’s Core Elements for Nursing Homes is one step in achieving the objectives set out in the National Action Plan for Combating Antibiotic-resistant Bacteria. Investments to improve antibiotic stewardship across all settings are part of CDC’s Antibiotic Resistance Solutions Initiative for fiscal year 2016.

As part of the plan, within three years CDC will provide technical assistance to federal facilities (e.g., those operated by the Department of Defense, the Department of Veterans Affairs, and the Indian Health Service) and other large health systems to scale up implementation and assess interventions to improve outpatient antibiotic prescribing, extend effective interventions to long-term care settings, and ensure long-term sustainability of antibiotic stewardship efforts.

To learn more about the Core Elements of Antibiotic Stewardship for Nursing Homes, visit:


1 AHCA Quality Report 2013. 

2 Lim CJ, Kong DCM, Stuart RL. Reducing inappropriate antibiotic prescribing in the residential care setting: current perspectives. Clin Interven Aging. 2014; 9: 165-177.

3 Nicolle LE, Bentley D, Garibaldi R, et al. Antimicrobial use in long-term care facilities. Infect Control Hosp Epidemiol 2000; 21:537–45

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