# Improving Antimicrobial Stewardship in Veterans Affairs (VA) Community Living Centers

> **NIH VA I01** · PROVIDENCE VA  MEDICAL CENTER · 2020 · —

## Abstract

Antimicrobial resistance is one of the greatest public health threats worldwide. The development and
proliferation of multidrug-resistant pathogens is largely driven by inappropriate antimicrobial use.
Current reports state that over 50% of antimicrobial use in hospitals and up to 70% in long-term care
facilities is potentially inappropriate. Recognizing the urgency of this national crisis, President Obama
issued an executive order in September 2014, mandating the implementation of antimicrobial
stewardship programs (AMS) nationally, and specifically noting that “all VA healthcare settings,
including long-term care facilities” will be involved. Unfortunately, this process of developing
AMS in VA Community Living Centers has lagged behind those in acute-care facilities and little is
known about the degree of antibiotic resistance and the types of stewardship interventions that might
work in these facilities.
Antimicrobial stewardship promotes the appropriate use of antimicrobials in order to improve patient
safety and to decrease adverse events related to inappropriate antimicrobial use. Improving
antimicrobial use in acute-care facilities is a critical focus of The Veterans Health Administration
(VHA), as evidenced by the recent VHA Directive 1031. This policy charges every Veterans Affairs
(VA) acute care facility to develop and implement an antimicrobial stewardship program led by
champion physicians and pharmacists. This VHA Directive does not currently require the
implentation of antimicrobial stewardship activities within nursing homes. In 2013, the VHA
provided care to over 100,000 veterans in nursing homes.
This proposal brings together a cadre of VA experts in the fields of long term care quality
improvement, infectious diseases, geriatrics, and antibiotic stewardship (MDs, PharmDs, PhD) to
directly address this timely area of study. In direct response to an HSRD priority area for research
involving long term care, the overall goals of this 4 year mixed methods merit proposal are to
determine the scope of antimicrobial resistance among VA CLCs, to compare that information with
antimicrobial utilization patterns in CLCs and proximal VAMCs, and to develop effective antimicrobial
stewardship strategies tailored for the long term care environment. We hypothesize that resistance
patterns and antibiotic use for CLCs will vary significantly and will be different from those observed in
proximal acute care facilities. Furthermore, we hypothesize that comprehensive interdisciplinary
antimicrobial stewardship programs will have the capacity to reduce selection for drug-resistant
pathogens for the CLC, minimize transmission of antimicrobial-resistant pathogens among patients,
and ultimately improve clinical outcomes provided that they are tailored to the unique barriers that
long term care entails. The specific aims of this study are:
1) Measure antimicrobial use and resistance in VA-CLCs nationally through the development of a
longitudinal database ...

## Key facts

- **NIH application ID:** 9873902
- **Project number:** 5I01HX001894-04
- **Recipient organization:** PROVIDENCE VA  MEDICAL CENTER
- **Principal Investigator:** David M., MD, MPH Dosa
- **Activity code:** I01 (R01, R21, SBIR, etc.)
- **Funding institute:** VA
- **Fiscal year:** 2020
- **Award amount:** —
- **Award type:** 5
- **Project period:** 2016-12-01 → 2021-11-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/9873902

## Citation

> US National Institutes of Health, RePORTER application 9873902, Improving Antimicrobial Stewardship in Veterans Affairs (VA) Community Living Centers (5I01HX001894-04). Retrieved via AI Analytics 2026-05-22 from https://api.ai-analytics.org/grant/nih/9873902. Licensed CC0.

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