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CDC

Antibiotic Stewardship

Long-term Care Antibiotic Stewardship

Long-term Care Facilities Reporting Implementation of the Core Elements

4,933

Facilities reporting implementation in 2024

Long-term Care Implementation of All 7 Core Elements of Antibiotic Stewardship

82%

National implementation in 2024

Implementation Change from Previous Survey Year

No change

The percent of long-term care facilities reporting implementation of all 7 Core Elements did not change from 2023 to 2024.

Long-Term Care Antibiotic Stewardship

Antibiotic stewardship is critical to improving the treatment of infections, protecting long-term care residents from unintended consequences of antibiotic use, and helping combat antimicrobial resistance. The data presented on this page reflect the implementation of the Core Elements of Antibiotic Stewardship for Nursing Homes.

The implementation of antibiotic stewardship in long-term care facilities is assessed through the National Healthcare Safety Network's (NHSN) Long-term Care Facility Component Annual Facility Survey. Annual surveys are completed by staff in the long-term care facilities, including certified skilled nursing facilities/nursing homes. Survey questions relating to antibiotic stewardship gauge a facility's uptake of CDC's Core Elements of antibiotic stewardship. Facility responses are mapped to the seven Core Elements of antibiotic stewardship: leadership commitment, accountability, drug expertise, action, tracking, reporting, and education.

Years Included
2016 - 2024

Core Element Implementation in 2024

Leadership Commitment: 99%

Demonstrating support and commitment to safe and appropriate antibiotic use.

Accountability: 97%

Identifying physician, nursing and pharmacy leads responsible for promoting and overseeing antibiotic stewardship activities.

Drug Expertise: 96%

Establishing access to consultant pharmacists or other individuals with experience or training in antibiotic stewardship.

Action: 99%

Implementing at least one policy or practice to improve antibiotic use.

Tracking: 100%

Monitoring antibiotic prescribing and resistance patterns.

Reporting: 91%

Provide regular feedback on antibiotic use and resistance to prescribing clinicians and nursing staff.

Education: 94%

Providing resources to clinicians, nursing staff, residents and families about antibiotic resistance and opportunities for improving antibiotic use.

Geographic Location

Implementation of antibiotic stewardship varies by state, and can be affected by state, local, and territorial health department programs as well as facility infrastructure and resources.

Long-Term Care Antibiotic Stewardship By State

This map shows the yearly variation in the percentage of long-term care facilities reporting CDC's Core Elements of Antibiotic Stewardship implementation from 2016 to 2024. Click on a state to see more information on that state's uptake of the Core Elements of Antibiotic Stewardship.

Long-Term Care Facilities Implementing All 7 Core Elements in 2024

Changes Over Time

Implementation of antibiotic stewardship varies over time, and can be affected by state, local, and territorial health department programs, facility infrastructure and resources, regional collaborations, and accreditation and regulatory requirements.

Long-Term Care Antibiotic Stewardship Changes Over Time

This graphic shows the change over time in long-term care implementation of antibiotic stewardship by state and Core Element from the available years. Hover over the bar in the graphic to see the number of facilities reporting the implementation of the Core Elements by year.

Long-Term Care Facilities Implementing All 7 Core Elements in All States Over Time

Core Element Reporting

Responses to antibiotic stewardship questions in the NHSN LTCF Annual Survey are mapped to the seven Core Elements: leadership commitment, accountability, drug expertise, action, tracking, reporting, and education.

Long-Term Care Antibiotic Stewardship Implementation By Core Element

This graphic shows the percent of long-term care facilities that report the implementation of each Core Element of Antibiotic Stewardship in 2024. Click on the bar in the graphic to see the number of facilities reporting the implementation of each Core Element.

Visit the National and State data reports to view aggregated data on Healthcare Associated Infections, Antimicrobial Resistance, and Antibiotic Use & Stewardship by state.

Long-term Care Core Element Reporting in All States in 2024

Footnotes

  • Participation in NHSN LTCF Component varies by state and year. Data summarized in this Portal may not be representative of all long-term care facilities in the United States. Caution should be used when making direct comparisons of uptake of Core Elements between states and across years.
  • Map legends are classified using the Jenks Natural Breaks method.
  • Luciano A, Kabbani S, Neuhauser MM, et al. Implementation of core elements of antibiotic stewardship in long-term care facilities-National Healthcare Safety Network, 2019-2022. Antimicrob Steward Healthc Epidemiol. 2025;5(1):e86. https://pubmed.ncbi.nlm.nih.gov/40160222/
  • Gouin KA, Kabbani S, Anttila A, et al. Implementation of Core Elements of antibiotic stewardship in nursing homes-National Healthcare Safety Network, 2016-2018. Infect Control Hosp Epidemiol. 2022;43(6):752-756. https://pubmed.ncbi.nlm.nih.gov/34036926/
  • Palms DL, Kabbani S, Bell JM, Anttila A, Hicks LA, Stone ND. Implementation of the Core Elements of Antibiotic Stewardship in Nursing Homes Enrolled in the National Healthcare Safety Network. Clin Infect Dis. 2019;69(7):1235-1238. https://pubmed.ncbi.nlm.nih.gov/30945729/