WILLMAR - Christina Jurgenson, infection preventionist at Rice Care Center and Therapy Suites, lives by the spreadsheet.

On almost a daily basis, she collects and analyzes everything infection-related, from influenza rates to antibiotic use.

And the numbers, she's proud to report, are trending in the right direction. Unnecessary antibiotic prescriptions are down 40 percent this past year. The overall infection rate, down 27 percent.

"We're doing good things," Jurgenson said. "We're doing something right."

In recognition of the advances being made, Rice Care Center recently was singled out by the Minnesota Department of Health as one of 11 skilled care facilities in the state to earn gold-level status on the department's first-ever honor roll for antibiotic stewardship in long-term care.

CentraCare Health Paynesville Koronis Manor and Granite Falls Health Care also made the honor roll.

Antibiotic stewardship, typically the province of hospitals and the doctor's office, has moved to the next frontier: the long-term care setting. Prompted by ongoing concerns about antibiotic resistance and the prevalence of antibiotic usage in nursing homes, the industry has begun pushing to curb unnecessary prescriptions of this class of drugs and do more to reduce the incidence of infections among skilled-care residents.

The impact reaches far beyond the walls of Rice Care Center, said Amanda Thorson, director of nursing.

"We are a facility but we're also a community," she said. "We're not just trying to make our facility better. We're trying to make our community better."

The prevalence of antibiotics in the nursing home setting is strikingly high. Studies estimate that in any given year, 50 to 75 percent of residents in U.S. long-term care facilities have at least one prescription for an antibiotic. More worrisome from a stewardship standpoint, up to 70 percent of these prescriptions may be inappropriate.

"That's a really large number," Jurgenson said.

Taking antibiotics when they aren't needed - for a viral infection, for example - can have consequences, especially for nursing home residents who typically are elderly, frail and often have multiple chronic health conditions.

Potential side effects of antibiotics, such as nausea, vomiting and diarrhea, can be less well-tolerated by this population, Jurgenson said. More importantly, overuse of antibiotics increases the risk of Clostridium difficile, which can be severe enough to require hospitalization. Some studies have found that up to 90 percent of C. diff cases involve antibiotic use within the preceding 90 days.

The goal isn't to get antibiotic use down to zero but to be judicious in when and how they're used, otherwise resistance will eventually render them ineffective, she said. "Antibiotics save lives, period. We need to have antibiotics but we need to use them responsibly."

The biggest change in Rice Care Center's daily practice has been to tie antibiotic use to specific clinical criteria and symptoms of active infection, Jurgenson said. "That's the big difference we are switching to."

Staff have had to work to educate residents and families, many of whom are unaccustomed to tighter standards for when antibiotics are prescribed.

"They question us. They'll say, 'At home I would just call my doctor.' Now we can really be an advocate and explain to them that taking an antibiotic they don't really need could do more harm than good," Thorson said.

Residents and families have responded well, she said. "We've not really had pushback from people once they've received the information."

Jurgenson hopes the lesson also can take hold in the wider community.

"If we educate a family member, they're going to go out and say, 'Hey, I learned about this,'" she said.

Reaching the gold level on the state Health Department's antibiotic stewardship honor roll for long-term care facilities was a three-phase process stretching over four years. Rice Care Center and Therapy Suites also has joined an initiative by the federal Agency for Healthcare Research and Quality to voluntarily track and report antibiotic use and infection rates, with a goal of measuring its performance and identifying areas for continued improvement.

With nursing homes seeing higher turnover, more short-term rehab and a more complex population, it's important to be at the forefront for the residents they serve, Thorson said. "Is being on an antibiotic continuously quality of life? Is posing a possibility of C. diff quality of life? It's all about promoting quality and reducing harm. We need to always look for the next best thing we can do."