Title : Antibiotic knowledge and stewardship among certified nursing assistants in Illinois post-acute and long-term care setting
Abstract:
Antibiotic use is widespread in Post Acute And Long Term Care (PALTC) settings, with a substantial proportion considered inappropriate due to nonspecific clinical presentations among older adults, contributing to antimicrobial resistance. Certified Nursing Assistants (CNAs), who provide the majority of direct resident care, are often the first to detect changes in resident condition and play a key role in infection-related communication. Despite this frontline role, limited research has examined their understanding of antibiotic use and stewardship. This study assessed antibiotic knowledge and stewardship-related attitudes among CNAs in Illinois PALTC facilities to identify knowledge gaps and inform targeted interventions. An anonymous cross-sectional survey was administered to CNAs in PALTC facilities across Illinois (n = 243). Participants were recruited through snowball sampling, direct outreach, and facility-based distribution. The survey included Likert-scale and categorical questions assessing antibiotic knowledge, sources of information, and confidence in stewardship-related communication. Data were analyzed in R using descriptive statistics, nonparametric tests, and correlation analyses. CNAs demonstrated moderate but variable antibiotic knowledge, with notable gaps in understanding appropriate antibiotic use and stewardship concepts; for example, only 22% correctly recognized that antibiotics are not indicated for viral infections such as colds or flu. Higher knowledge was associated with stronger stewardship-oriented attitudes, including greater confidence in explaining when antibiotics are not needed and increased support for stewardship education. Knowledge levels varied by source of information, with higher scores among CNAs relying on clinical professionals, and increased with years of experience. However, stewardship confidence did not differ by experience, education level, or supervisory role, suggesting that knowledge alone may be insufficient to translate into effective communication and practice.These findings highlight important gaps in antibiotic knowledge among CNAs and underscore their critical but underrecognized role in infection control and antibiotic stewardship in PALTC settings. Interventions that combine targeted education with communication training and interdisciplinary support may be necessary to strengthen CNAs’ ability to contribute to appropriate antibiotic use. Enhancing CNA engagement in stewardship efforts represents a practical and scalable strategy to improve infection management and reduce inappropriate antibiotic use in long-term care.
