Changes in US Nursing Home Infection Prevention and Control Programs From 2014 to 2018

J Am Med Dir Assoc. 2020 Jan;21(1):97-103. doi: 10.1016/j.jamda.2019.10.020.


Objective: Burgeoning rates of antibiotic resistance have resulted in a shift in national focus to improve infection prevention and control programs in US nursing homes (NHs). We sought to evaluate the changes in nursing home infection prevention and control programs over time.

Design: Retrospective comparative analysis of national nursing home survey data from 2014 and 2018.

Setting and participants: We used survey data from 2 nationally representative samples of US nursing homes (945 NHs in 2014 and 888 in 2018).

Methods: Three indices measuring antibiotic stewardship, outbreak control, and urinary tract infection prevention (ranging from 0 to 100) were developed to measure the change in infection prevention and control programs. Multivariable linear regression models were used to identify facility and infection preventionist characteristics associated with each index. Decomposition models were used to identify contributions of factors on the differences in each index over time.

Results: From 2014 to 2018, we saw strengthening of antibiotic stewardship practices by 33 percentage points, outbreak control practices by 13 percentage points, and urinary tract infection prevention practices by 6 percentage points. Although we found several predictors of these improvements, much of the improvement was due to the difference in time.

Conclusions and implications: Policy mandates and greater national attention are likely important factors in improving nursing home infection prevention and control practices. Further work is needed to evaluate the effect of these programs on resident outcomes.

Keywords: Infection control; antibiotic stewardship; nursing homes; policy change.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Antimicrobial Stewardship
  • Cross Infection / prevention & control*
  • Health Care Surveys
  • Humans
  • Infection Control / organization & administration*
  • Nursing Homes*
  • Retrospective Studies
  • Urinary Tract Infections / drug therapy
  • Urinary Tract Infections / prevention & control