Nursing Home Training Sessions Introduction

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We hope that you find these training tools and resources helpful in your work to implement antibiotic stewardship and prevent C. difficile infections in your residents. All are welcome to explore this site and use the information as applicable to you and your organization. Thank you for your dedication to preventing infections in residents (and staff, too) and promoting appropriate antibiotic use.

C. difficile harms residents!

  • C. difficile caused almost half a million infections among patients in the US in 2011. More than 80% of the deaths associated with C. difficile occurred among Americans aged 65 or older (CDC 2015).
  • 1 out of 3 C. difficile infections occurs in patients 65 years or older (CDC 2015).
  • 1 out of 9 patients aged 65 or older with a healthcare-associated C. difficile infection died within 30 days following their diagnosis (CDC 2015).
  • 70% of C. difficile infection-related harm was preventable (OIG 2014 report on adverse events in SNFs).

Training sessions and resources for nursing homes to support:

  • Implementation of principles and practices of antibiotic stewardship
  • Prevention and management of Clostridium difficile infections
  • TeamSTEPPS® communication strategies and tools to promote quality and safety


Nursing Homes and Quality Innovation Networks-Quality Improvement Organizations (QIN-QIOs) across the country are working together in the CMS National Nursing Home Quality Care Collaborative from 2016-2019, in part to implement antibiotic stewardship and prevent and manage C. difficile infections. This initiative will support nursing home submission of data into the CDC’s National Healthcare Safety Network (NHSN) that will create a new national baseline for C. difficile infections.

Tracking C. difficile infections, implementing antibiotic stewardship, and effectively preventing and managing C. difficile infections will improve quality of care and outcomes for nursing home residents.

Topics covered in the training sessions:

Six sessions are provided on the following topics. Click on the title to see expanded descriptions of each session.

1. TeamSTEPPS® in LTC: Communication Strategies to Promote Quality and Safety

2. Exploring Antibiotics and their Role in Fighting Bacterial Infections

3. Antibiotic Resistance: How it Happens and Strategies to Decrease the Spread of Resistance

4. Antibiotic Stewardship

5. Clostridium Difficile Part One: Clinical Overview

6. Clostridium Difficile Part Two: Strategies to Prevent, Track, and Monitor C. Difficile

Purpose of the training sessions:

  • To provide nursing home leaders with a set of training materials that they can use to enhance understanding of important concepts and practices that promote stewardship and C. difficile prevention, and to provide information, tools, and resources to take action to improve practices
  • To develop and disseminate materials that can be accessed and used by long-term care partners and stakeholders interested in these topics

Use of the training sessions:

Nursing home leaders can review the content in each session and decide which components would be helpful for themselves and which to include in educating other staff. The components can be shared and discussed during staff education in-services or discussion sessions, or they can be accessed by staff online at any time. Leaders can decide which components to include and the appropriate staff to include for the different components. Some materials are appropriate for all staff, while other information may be better for clinicians or other leaders.

Leaders can use materials during education sessions by pulling up the website and by projecting information on a screen, or by printing each session or selecting certain components to review with staff as determined appropriate. Leaders can customize the content to work for their audience – all content is optional and may be adapted to meet the needs and priorities of each organization/​learner.

The intent is not to review this content all at once. Leaders can decide how to best provide this training over time.

Each session includes the following components:

  • Welcome and overview
  • Objectives
  • How you can use this session
  • Orientation (list of sections and content)
  • Topic information presented via text/​narrative, video, PowerPoint presentations with notes, or links to website pages 
  • Interactive activities and scenarios, including discussion questions
  • Informational handouts
  • Take home messages
  • Evaluation
  • Links to additional optional resources

Time to allow for each session:

Sessions are designed to take 30-90 minutes per session, depending on the number of components reviewed and the time spent on discussions and activities.

Again, trainers can decide how to best provide the training. For example, they can review a whole session at one time or break it into smaller pieces over time.

Recommended order for the sessions:

We suggest that you consider reviewing the sessions in the order they are listed above in order to build sequential knowledge and skills that support stewardship and C. difficile prevention and management. However, nursing homes may choose the order and review content components that will help support their organization’s priorities and needs with regards to these topics.

Session development:

The Quality Innovation Network National Coordinating Center (QIN NCC), under contract with the Centers for Medicare & Medicaid Services (CMS), developed these sessions with support from the Centers for Disease Control and Prevention (CDC). At the request of nursing home and QIN-QIO leaders, the content for each session was developed as a set of bite-sized” sections, rather than as a more traditional 60-minute didactic webinar, for example. Session developers also responded to requests to keep the information as concise and brief as possible.

The QIN NCC would like to thank Nimalie Stone, MD; Angela Anttila, PhD; and others at the CDC for providing content and content review for the sessions; they were very generous with their time and provided recommendations to support meaningful and useful training and resources for nursing home leaders. The QIN NCC is also grateful to other speakers featured in the webinars for their generous time, support, and passion for these topics in long term care, including Robin Jump, MD and Elizabeth Dodds Ashley, PharmD, MHS. The QIN NCC also acknowledges and thanks Agency for Healthcare Research and Quality (AHRQ) leaders for providing TeamSTEPPS® resources and for content review and suggestions.

The sessions were piloted in October 2016 by QIN-QIO and nursing home staff in three states, and their suggestions for improvement were incorporated into the final sessions. The sessions were unveiled at the 2016 CMS Quality Conference where additional suggestions for improvement were provided by QIN-QIOs.

Technical assistance:

You will need to be connected to the internet in order to access these sessions. To minimize compatibility issues, we recommend using Firefox, Google Chrome, or Safari.

To change the font size, use these buttons in the top right corner of the page.

To print these sessions or download them as PDFs, use these buttons at the top of each session underneath the header images.

To watch some of the videos in these sessions, you will need to download Adobe Flash Player and Windows Media Player. Some videos are links to YouTube, which may be blocked by your employer. Please test all videos in the sessions prior to your trainings to ensure you can access them. If you are experiencing difficulties accessing the videos, please contact your IT department.

Feedback and suggestions for improvement of the training materials:

We welcome your feedback on ways to improve the sessions and training resources.

Please email feedback or suggestions for improvement to QINNCC@​area-​d.​hcqis.​org.

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