Nursing Homes aka Antibiotic Saunas

One of the aspects of antibiotic resistance that will prove difficult to solve, even with a presidential national action plan, is the issue of nursing homes and long term acute care hospitals (LTACs) These facilities are populated by many chronically ill individuals, some of who are chronically critically ill and continually on ventilators and hemodialysis. Many have long term intravenous lines and urinary catheters in place. In these settings infection control is sparse or non-existent and these individuals contract infection after infection as the residents of such facilities rotate in and out of hospitals continuously. 

Antibiotic stewardship, rapidly becoming the lynchpin in the defense against resistance, is a joke at many nursing homes. I have heard first hand anecdotes of ordinary nurses starting antibiotics without consultation for cloudy urine, for example. In essence, such settings literally marinate bacteria in antibiotics spawning super bugs.

The danger is magnified when these patients are transferred to hospitals--often to ICUs--where the superbug they harbor finds new frontiers to conquer. Also, people visit nursing home and LTAC patients and they themselves can contract infections from this visit (this may be behind some of the community-onset C.diff cases). 

When solutions to the antibiotic resistance plague are proposed they will only gain traction to the extent that they address all settings, particularly ones in which microorganisms literally bathe in inappropriately prescribed antibiotics. To that end, I believe that hospitals should find a mechanism for their infectious disease physicians to have some oversight and consultative roles at the nursing homes and LTACs that frequently utilize their hospital for acute hospitalizations--such as has been piloted by the VA