A practice guide on antimicrobial stewardship in nursing homes.

A practice guide to help nursing homes set up an antimicrobial stewardship (AMS) program was developed based on experiences gained during a project at one of the largest providers of elderly care in the South-east of the Netherlands. The guideline for the implementation of AMS in Dutch hospitals served as a starting point and were tailored to the unique characteristics of a nursing home setting. This practice guide offers recommendations and practical tools while emphasizing the importance of establishing a multidisciplinary approach to oversee AMS efforts. The recommendations and practical tools address various elements of AMS, including the basic conditions to initiate an AMS program and a comprehensive approach to embed an AMS program. This approach involves educating nurses and caregivers, informing volunteers and residents/their representatives, and the activities of an antibiotic team (A-team). The practice guide also highlights a feasible work process for the A-team. This process aims to achieve a culture of continuous learning and improvement that can enhance the overall quality of antibiotic prescribing rather than making individual adjustments to client prescriptions. Overall, this practice guide aims to help nursing homes establish an AMS program through collaborative efforts between involved physicians, pharmacists, clinical microbiologists, and infection control practitioners. The involved physician plays a crucial role in instilling a sense of urgency and developing a stepwise strategy.

Evaluation of the Abbott Panbio™ COVID-19 antigen detection rapid diagnostic test among healthcare workers in elderly care.

BACKGROUND: Coronavirus disease 2019 (COVID-19) has been especially dangerous for elderly people. To reduce the risk of transmission from healthcare workers to elderly people, it is of utmost importance to detect possible severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) positive healthcare workers as early as possible. We aimed to determine whether the Abbott Panbio™ COVID-19 antigen detection rapid diagnostic test (Ag-RDT) could be used as an alternative to reverse transcription-quantitative polymerase chain reaction (RT-qPCR). The second aim was to compare the cycle threshold (Ct) in RT-qPCR with the results of the Ag-RDT. METHODS: A prospective diagnostic evaluation of the Abbott Panbio™ COVID-19 Ag-RDT among healthcare workers across three elderly care facilities as well as home-based elderly care workers who met clinical criteria for COVID-19 during the second wave of the COVID-19 pandemic. Per healthcare worker, the first nasopharyngeal swab was obtained to perform the Ag-RDT and the second swab for RT-qPCR. A Ct-value of < 40 was interpreted as positive, ≥ 40 as negative. RESULTS: A total of 683 healthcare workers with COVID-19 symptoms were sampled for detection of SARS-CoV-2 by both Ag-RDT and RT-qPCR. Sixty-three healthcare workers (9.2%) tested positive for SARS-CoV-2 by RT-qPCR. The overall sensitivity of Ag-RDT was 81.0% sensitivity (95%CI: 69.6-88.8%) and 100% specificity (95%CI: 99.4-100%). Using a cut-off Ct-value of 32, the sensitivity increased to 92.7% (95% CI: 82.7-97.1%). Negative Ag-RDT results were moderately associated with higher Ct-values (r = 0.62) compared to positive Ag-RDT results. CONCLUSION: The Panbio™ COVID-19 Ag-RDT can be used to quickly detect positive SARS-CoV-2 healthcare workers. Negative Ag-RDT should be confirmed by RT-qPCR. In case of severe understaffing and with careful consideration, fully vaccinated healthcare workers with Ag-RDT negative results could work with a mask pending PCR results.

Preferences for healthcare worker attire among nursing home residents and residents' preferences as perceived by workers: A cross-sectional study.

Background: In Dutch nursing homes, healthcare workers' attire has been the subject of debate for years. White uniforms and professional white jackets are increasingly being replaced by casual personal attire. Many nursing homes have made this choice because they want to create a homey atmosphere. However, with regard to infection control, casual personal attire is far from ideal. It is unknown what attire is preferred by residents. Objective: To determine both residents' preferences regarding nurses' attire and nurses' perceptions of these preferences. Design: Cross-sectional. Setting: Nursing homes, the Netherlands. Participants: Residents and nurses. Methods: Between February and October 2019, a convenience sample of 94 participants were surveyed across 10 Dutch nursing homes among residents with physical impairments and nurses caring for them. A standardized data collection tool included color photographs of a female nurse dressed in: 1) casual attire; 2) professional polo shirt with blue jeans; 3) professional white jacket with blue jeans; and 4) completely white uniform. Six randomly composed photosets of two different types of attire were shown to each participant.. Participants had to select one out of two displayed photographs (forced choice method) guided by two propositions regarding 'comfort preference' and 'care preference'. The propositions for residents were: 1) I feel most comfortable with this nurse, and 2) I would prefer to be cared for by this nurse. The propositions for nurses were:) I think residents feel most comfortable with this nurse, and 2) I think the residents would prefer to be cared for by this nurse. Some demographic data and personal characteristics of the participants were collected. (Perceived) preferences for nurses' attire were calculated in estimated marginal means (preference per type of attire compared to the other three types of attire) with 95% confidence intervals. Differences were tested with the Chi-squared test. Results: In total, 92 participants were included in the analysis. Overall, the strongest (perceived) preference was for a professional white jacket with blue jeans, compared to the three alternative types of nurses' attire for both propositions in both groups. Casual attire was the least preferred. Residents of 85 years or older and nurses who had been working for two years or fewer were more likely to choose more formal attire. Conclusion: Residents preferred more professional attire, which conforms to infection control requirements. Tweetable abstract: involve nursing home residents in determining nurses' attire; a professional white jacket should be one of the options @AEICP.

Dutch guideline for preventing nosocomial transmission of highly-resistant micro-organisms (HRMO) in long-term care facilities (LTCFs).

In 2012, the Dutch Working Party for Infection Control (WIP) issued the first Guideline for prevention of transmission of highly-resistant micro-organisms (HRMO) in Hospitals. The next step was to focus on long-term care facilities (LTCFs) both for nursing homes as for small-scale living facilities with nursing home care. These facilities providing care for residents with functional disabilities, chronical illnesses and cognitive disorders, such as dementia. The objective was to adapt the Guideline for prevention of transmission of HRMO in hospitals to LTCFs with a strong accent on living conditions and social interactions. Residents of LTCFs may be carriers of HRMO over a long period of time and most of the residents of the LTCF stay for extended periods of time. To respect individual living circumstances and to prevent unnecessary limitations in the social life of the residents due to the use of isolation measures, the WIP has chosen to describe infection control precautions per individual micro-organism instead of a 'one size fits all' method. The term "isolation" was therefore replaced by the term "additional" precautions. This guideline describes the screening policies for residents in LTCFs, definition and detection of HRMO carriage, standard and additional infection control precautions for HRMO positive residents, documentation and communication of HRMO carriage and discontinuation of additional infection control precautions. It also describes contact tracing of HRMO, environmental control/investigation, surveillance of HRMO and what is important when there is an outbreak.

Methicillin-resistant Staphylococcus aureus in veterinary doctors and students, the Netherlands.

The prevalence of methicillin-resistant Staphylococcus aureus (MRSA) in the Netherlands, at 1.0%, is among the lowest in Europe. In 2004, a relationship between pig farming and a high risk for MRSA carriage was found. To investigate if those in professional contact with livestock are at higher risk for MRSA carriage, we screened 80 veterinary students and 99 veterinarians and questioned them about animal contacts and known MRSA risk factors. Of these, 27 students who did not have livestock contact were excluded from further analysis. We found 7 carriers of MRSA, a prevalence of 4.6%, which is similar to that found in patients who had previously been treated at foreign hospitals. A correlation of MRSA carriage with a specific animal group could not be established. To preserve the low prevalence of MRSA in the Netherlands, persons involved in the care of livestock should be isolated and screened on admission to the hospital.