Date of Conferral

8-12-2026

Date of Award

August 2026

Degree

Doctor of Nursing Practice (DNP)

School

Nursing

Advisor

Margaret Harvey

Abstract

Antimicrobial overuse in long-term care facilities (LTCFs) contributes to antimicrobial resistance, avoidable healthcare costs, and adverse drug events, particularly when antibiotics are prescribed for asymptomatic bacteriuria rather than symptomatic urinary tract infections (UTIs). Evidence-based clinical practice guidelines, including the McGeer Criteria, provide standardized approaches for differentiating true UTIs from asymptomatic bacteriuria and supporting appropriate antimicrobial prescribing. The purpose of this evidence-based practice project was to evaluate the development and implementation of a clinical practice guideline incorporating the McGeer Criteria into an antibiotic stewardship program in an LTCF. The practice-focused question examined what evidence supports strategies for reducing unnecessary antimicrobial use among LTCF residents with suspected asymptomatic UTIs through appropriate utilization of the McGeer Criteria. Evidence from the literature demonstrated that antibiotics are frequently overprescribed in LTC settings and that standardized, evidence-based criteria can improve clinical decision-making and reduce inappropriate antimicrobial use. The clinical practice guideline was developed using current evidence and evaluated by an interprofessional panel using the Appraisal of Guidelines for Research and Evaluation II (AGREE II) instrument. The guideline demonstrated high scores across all AGREE II domains, supporting its quality, applicability, and suitability for implementation. Incorporating the McGeer Criteria into routine infection assessment can strengthen antimicrobial stewardship by promoting consistent, evidence-based prescribing practices, reducing unnecessary antibiotic exposure, and improving patient safety and quality of care in LTCFs.

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