Appendices
26
Appendix E: Applying the CDC's Core Elements for Antibiotic
Stewardship in Nursing Homes to Support the
Diagnosis, Treatment and Prevention of Suspected UTIs
Core Element Description Examples
1. Leadership
Commitment
Demonstrate
support and
commitment
to safe and
appropriate
antibiotic use in
your facility.
• Establish that the appropriate diagnosis and
treatment of UTIs is a priority.
• Communicate that priority to nursing staff,
prescribing clinicians and to residents and
families with consistent messaging and
education.
2. Accountability Identify individuals
accountable
for antibiotic
stewardship
activities who have
the support of
facility leadership.
• Empower the medical director to establish
policies and procedures for the diagnosis of
UTIs based on specific signs and symptoms,
and for treatment with recommended
antibiotics and length of therapy.
• Empower the director of nursing to establish
standards for evaluating the necessity of
urinary catheters, catheter care, collecting
high-quality urine specimens and for
communication with providers.
3. Drug
Expertise
Establish access to
individuals with
antibiotic expertise.
• Engage the consultant pharmacist to help
improve the selection of antibiotics used
to treat a suspected UTI, including the
dose and duration, with consideration of
potential drug-drug interactions.
• Ask for assistance from the consultant
pharmacists, the microbiolog y laboratory or
experts from hospitals within your referral
network to help develop an antibiogram
specific to urinary pathogens for your
population.
4. Action Implement at
least one policy or
practice to improve
antibiotic use.
• Implement a Situation, Background,
Assessment and Recommendations (SBAR)
tool for data to gather prior to contacting a
medical provider about a suspected UTI.
• Establish standing orders for active
monitoring (e.g., hydration, mobilization,
medical/nursing evaluation, regular vital
signs and ongoing monitoring ) for residents
with a non-specific change in condition in
whom a UTI is suspected but not clinically
obvious.
