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Long Term Care

Antibiotic Stewardship in Nursing Home (AHRQ)


The Conditions of Participation (CoP) for Center for Medicare and Medicaid Services (CMS) was revised in October 2016 for long-term care facilities (LTCF).  The current regulations require LTCF to develop an Infection Prevention and Control Program (IPCP) that includes an Antimicrobial Stewardship Program (ASP).  The ASP must, at a minimum, includes antibiotic use protocols and a system to monitor antibiotic use.  To view the full updated CoP, visit

The interpretive guidance for the new CMS CoP was published on June 30th, 2017.  To view the full document, visit  The following are excerpts from the 696-page document relevant to ASP in LTCF.

42 CFR 483.80(a)(3)–pertaining to antibiotic stewardship program

Intent of the regulation is to ensure facility

  • optimizes treatment of infection through use of protocols
  • reduces risk of adverse events from antibiotic use
  • monitors facility-wide antibiotic use

ASP should include leadership support and accountability via the participation of

  • the medical director
  • consulting pharmacist
  • nursing
  • administrative leadership, and
  • individual with designated responsibility for the infection control program if different.

ASP protocols must

  • be incorporated in the infection prevention and control program
  • be reviewed on an annual basis
  • contain a system of reports to monitor antibiotic usage and resistance data
  • incorporate monitoring of antibiotic use
  • assess residents for suspected infection using standardized tools and criteria
  • include mode and frequency of prescribers and nursing education on ASP

Review by surveyor will determine if facility’s ASP includes

  • antibiotic use protocol(s) to address antibiotic prescribing practices such as
    • documentation of indication, dose, duration of antibiotic
    • review of laboratory reports to determine if antibiotic is indicated or needs adjustment
    • use of an infection assessment tool or management algorithm
  • system to monitor antibiotic use such as
    • antibiotic use reports
    • antibiotic resistance reports
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