1. ANTIMICROBIAL STEWARDSHIP HERITAGE ENTERPRISES, INC. MARCH 5, 2015

2. HERITAGE ENTERPRISES SHARING A HERITAGE OF CARE SINCE 1963  Heritage Enterprises is a Long Term Care Company that:  Owns, operates and manages facilities throughout Illinois and with a new property in Indiana  Provides care to more than 4700 seniors  Is proud to have more than 4200 professional and technical employees  Owns 26 Skilled Long Term Care Facilities with more than 2700 beds  Owns several Assisted & Supportive Living Facilities  Manages several Skilled, Assisted, Supportive and Shelter Care Facilities. Tracking and trending data in this presentation is for Heritage owned skilled facilities only!

3. REVIEWED COMPANY PRACTICE RELATED TO INFECTION CONTROL

4. REVELATIONS:  “Infections” were at times being reported to physicians without a comprehensive clinical assessment  Antibiotics were periodically being ordered without a positive culture  Logs were sometimes incomplete  Inconsistent surveillance documentation was noted Antimicrobial stewardship was necessary!

5. CHANGES MADE  Developed a user friendly Infection Control Manual based on guidance in Medicare and Medicaid Requirements for Long Term Care Facilities - F441 (Federal Guidelines for Infection Control).  Adopted Revised McGeer Criteria 1,2 to determine true infection status of residents  Educated staff on detecting and reporting ‘early’ changes in residents (e.g. changes in color of urine)  Began tracking and trending all infections, focusing on UTIs  Hydration stations were set up and made available for all residents 1 Infect Control Hosp Epidemiol. 2012;33:965-977 2 McGeer’s Criteria were developed as a surveillance tool to identify and report evidence of infections in Long Term Care Facilities and have not been validated as a clinical tool. McGeer’s Criteria have become the national regulatory standard that requires potentially infectious acute clinical changes be documented and communicated to physicians in a timely manner.

6. URINARY TRACT INFECTIONS BEGAN TO SLOWLY DECREASE

7. 2014 URINARY TRACT INFECTIONS IN HERITAGE OWNED SKILLED FACILITIES

8. WE ARE MOVING IN THE RIGHT DIRECTION!

9. LESSONS LEARNED  Every person with increased confusion does NOT have a UTI  Cultures MUST be reviewed  Reporting a change in condition does not always require an order

10. STUMBLING BLOCKS TO SUCCESS  Lack of proactivity in observation and assessment of resident for early detection of symptoms  Infection Preventionists are struggling. Even though every facility has an Infection Preventionist, most of them have numerous other job duties. Some of them are also the Director of Nursing.  Families, Nurses and even Physicians need more education Getting and keeping the elderly hydrated can be a task.

11. TEAMWORK IS REQUIRED WE NEED EACH OTHER WE ARE CONTINUING TO EVALUATE OUR PROCESSES AND MAKING CHANGES AS WE LOOK FOR BETTER WAYS TO IMPROVE OUR OUTCOMES