1827. Clinical Staff Retention and Leadership Stability and Antibiotic Utilization in Nursing Homes

BACKGROUND: Antibiotic utilization in skilled nursing facilities (SNFs) varies widely and the factors responsible for this variation remain poorly understood. Staff retention and leadership stability in SNFs has been associated with a number of important resident and facility outcomes but the relationship to antibiotic utilization has not been examined previously. Data collected as part of an ongoing study of an antibiotic stewardship intervention in SNFs in two states provided an opportunity to explore the relationship between these facility characteristics on baseline antibiotic utilization in SNFs participating in this study. METHODS: Twelve months of pre-intervention data on antibiotic use were abstracted from pharmacy records in nine SNFs in Wisconsin and Pennsylvania. Baseline SNF characteristics were collected. The analysis focused on four clinical nursing variables: (1) director of nursing stability (1 = tenure? 5 years); (2) RN and LPN retention (1 = retention ≥ median of 79.5); (3) CNA retention (1 = retention ≥ median of 77.3); and full-time infection control practitioner (1 = works 50% of time or more). Measures of overall antibiotic utilization, including antibiotic starts (AS) and days of therapy (ADT) per 1,000 resident days, were calculated for each SNF over a 12-month baseline period. A GLM repeated-measures analysis explored the differences for the dichotomous variables where 1 is a Yes response. RESULTS: GLM analysis results shown in the table below indicate that SNFs with a full time ICP had significantly fewer ADT and fewer AS with higher RN/LPN retention. Antibiotic Starts (AS) Antibiotic Days of Therapy (ADT) DON Leadership Stability (µ = 0.74, P = 0.37) (µ = 3.85, P = 0.66) RN/LPN retention (µ = −1.53, P = 0.04) (µ = −13.62, P = 0.11) CNA retention (µ = −0.55, P = 0.53) (µ = −11.44, P = 0.20) Full time ICP (µ = −1.44, P = 0.051) (µ = −15.75, P = 0.04). CONCLUSION: Our study shows that RN/LPN staff retention and having a fulltime ICP are associated with lower rates of antibiotic use in SNFs. Future studies should examine how these attributes exert influence on provider antibiotic decision-making. Nevertheless, our results suggest that ongoing efforts to improve staff retention, if successful, will positively impact the quality of antibiotic prescribing in SNFs. DISCLOSURES: All authors: No reported disclosures.