Antimicrobial stewardship (AMS) in residential aged-care facilities
Older people, especially those living in residential aged-care facilities, have increased susceptibility to infection due to physiological changes that occur with aging. There are high rates of antimicrobial use in residential aged-care facilities. The rate of antimicrobial resistance is higher in residential aged-care facilities than in hospitals Australian Commission on Safety and Quality in Health Care (ACSQHC), 2021. Patients in residential aged-care facilities often move in and out of hospital, which increases the risk of infection. Antimicrobial use in residential aged-care facilities is often inappropriate; this is likely due to the difficulty in diagnosing infection in older adults, especially those with comorbiditiesAustralian Commission on Safety and Quality in Health Care (ACSQHC), 2018. A significant number of patients in residential aged-care facilities are prescribed antimicrobials for prolonged durations; these include prescriptions for prophylactic therapy despite there being limited supporting dataAustralian Commission on Safety and Quality in Health Care (ACSQHC), 2023.
The Aged Care Quality and Safety Commission require residential aged-care providers to:
- assess the risk of infections
- implement strategies to prevent, detect and control the spread of infections
- minimise the development and spread of resistant organismsAged Care Quality and Safety Commission, 2018.
|
Strategy |
Actions to be considered |
|
Provide access to and use evidence-based infection assessment tools and guidelines |
Participation in online learning modules on antimicrobial stewardship (AMS) Participation in audit and feedback activities for prescribing of antimicrobials (eg Aged Care National Antimicrobial Prescribing Survey) Communication within the treating team about AMS priorities, results of evaluation and use of guidelines Promotion of safe and effective use of antimicrobials that are evidence based Staff education about antimicrobial resistance and AMS Prescribe according to Therapeutic Guidelines: Antibiotic |
|
Review antimicrobial prescribing |
Use shared decision making with patients for antimicrobial decisions (if appropriate) Provide information for residents and their families (see Antimicrobial stewardship (AMS) resources for patients) Discuss vaccination to minimise need for antibiotics Consider the indication for ‘when required’ antimicrobials Review appropriateness of antimicrobial use for prophylaxis Consider whether broad-spectrum antimicrobials or parental antimicrobials are indicated in end-stage illness Unless there is confirmed bacterial infection, refrain from prescribing antimicrobials for upper respiratory tract infections (eg chronic obstructive pulmonary disease [COPD], bronchiectasis, acute bronchitis) Refrain from prescribing antimicrobials for asymptomatic bacteriuria Review the antimicrobial prescribed after 2 to 3 days of treatment to follow up clinical response, adverse effects and microbiology results. Change to directed rather than empirical prescribing |
|
Improve documentation |
Specify the start date of antimicrobial therapy on the prescription Specify the duration of antimicrobial therapy on the prescription Document the indication of antimicrobial therapy on the prescription |
|
Use microbiological testing or diagnostic tests |
Use targeted treatment for organisms from chronic wounds only if clinically infected Consider the appropriateness of antimicrobial use based on clinical appearance (eg skin rash or irritation incorrectly identified as infection). See Assessing patients with an ulcer or wound Understand the difference between urinalysis and urine culture. Urinalysis or collection of urine cultures should not occur from asymptomatic patients Refrain from prescribing antimicrobials without microbiological investigation Education regarding obtaining an appropriate sample (particularly in patients who are incontinent, uncooperative, or have a urinary catheter) |
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Implement infection prevention and control practices |
Reduce the risk of patients acquiring a preventable infection Support appropriate management of infections Effective infection prevention strategies include wound management, optimal oral health and good toileting practices |
Useful resources for antimicrobial stewardship in aged care include:
- Aged Care Quality and Safety Commission:
- Australian Commission on Safety and Quality in Health Care (ACSQHC):
- National Centre for Antimicrobial Stewardship (NCAS) Community Information Sheets.