The study will explore the impact of a nurse-led bundled antimicrobial stewardship intervention on the appropriateness of antimicrobial use in residential aged care facilities. The intervention will be assessed in a stepped-wedge cluster randomised controlled trial across 14 residential aged care facilities over an 18-month period.
The study will explore the impact of a nurse-led bundled antimicrobial stewardship intervention on the appropriateness of antimicrobial use in residential aged care facilities (RACFs). The antimicrobial stewardship intervention will include the following components: 1. Education * Focused on antimicrobial stewardship and appropriate antimicrobial use * Delivered face-to-face, via workbooks and fact sheets to aged care staff, general practitioners (GPs), pharmacists, and residents and families. Education will be delivered by the research coordinator. 2. Guidelines * Aged care-specific guidelines for the assessment and antimicrobial management of urinary tract infections, respiratory tract infections and skin and soft tissue infections. * Antimicrobial management recommendations including empirical oral therapy, doses and duration of therapy. 3. Communication * Documentation for the assessment and antimicrobial management of infections. * Nurse-led engagement with residents and families. * Newsletters and online updates to highlight evidence-based prescribing practice 4. Audit and feedback - Surveillance and feedback to prescribers on antimicrobial use and facility-level antimicrobial susceptibility data. The intervention bundle will first be implemented and tested for feasibility and acceptability over a 3-month period in two RACFs in Victoria, Australia. This tailored intervention will then be assessed in a stepped-wedge cluster randomised controlled trial across 12 RACFs over an 16-month period. A cluster of two facilities will each transition through three phases over the 16 month trial: * Control phase: baseline data collection. Usual care at each facility. * Transition phase: Delivery of education and integration of the intervention. No data collection. * Intervention phase: implementation of the intervention and outcome data collection. Ongoing education to new and existing staff will be provided as required. Following the 16-month trial, the refined intervention bundle will be implemented nationally across a network of RACFs.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Education, guidelines, communication tools and audit and feedback
Bupa residential aged care facilities
Melbourne, Victoria, Australia
RECRUITINGCumulative proportion of residents prescribed a systemic antimicrobial
Time frame: Assessed from commencement of the intervention at each facility until the conclusion of the trial at 16 months
Rate of total days of systemic antimicrobial therapy per 1,000 occupied bed days (OBD)
Time frame: Assessed from commencement of the intervention at each facility until the conclusion of the trial at 16 months
Number of courses of systemic antimicrobial therapy per 1,000 OBD.
Time frame: Assessed from commencement of the intervention at each facility until the conclusion of the trial at 16 months
Proportion of appropriate antimicrobial use.
Antimicrobials will be considered to be appropriate if minimum criteria for their initiation are met according to guidelines by the Society of Healthcare Epidemiology of America.
Time frame: Assessed from commencement of the intervention at each facility until the conclusion of the trial at 16 months
Frequency of carriage of antimicrobial-resistant organisms
Monthly biospecimen sampling will be collected from residents including nasal, faecal/rectal and wound specimens.
Time frame: Assessed over a 12-month period during the trial (at least 2 months pre-intervention and 2 months post-intervention).
Rate of Clostridium Difficile infection
Time frame: Assessed from commencement of the intervention at each facility until the conclusion of the trial at 16 months
Change in facility-level antimicrobial susceptibility profile
Monthly biospecimen sampling will be collected from residents including nasal, faecal/rectal and wound specimens.
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Purpose
TREATMENT
Masking
NONE
Enrollment
700
Time frame: Assessed over a 12-month period during the trial (at least 2 months pre-intervention and 2 months post-intervention).
Incidence of resident transfer to hospital for infectious indications
Time frame: Assessed from commencement of the intervention at each facility until the conclusion of the trial at 16 months
All-cause mortality
Time frame: Assessed from commencement of the intervention at each facility until the conclusion of the trial at 16 months
Perceptions from stakeholders on quality and uptake of the intervention
Semi-structured interviews conducted one-on-one or in moderated focus groups with stakeholders including aged care staff, GPs, residents and families.
Time frame: Assessed at the conclusion of the trial at 16 months