nurse-led antimicrobial stewardship intervention to increase antibiotic appropriateness in residential aged care facilities

Conditions: Antimicrobial Stewardship; Urinary Tract Infections; Respiratory Tract Infections; Skin and Soft Tissue Infections

Summary: 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.

Eligibility criteria:
inclusion criteria: residents: * all residents from 12 racfs will have de-identified data collected including antimicrobial use, infection, hospitalisation and mortality. * residents or their guardians who provide informed consent to monthly biospecimen sampling and participation in one-on-one interviews or focus groups. health professionals: - health professionals (including aged care staff and gps) who provide informed consent to participate in one-on-one interviews or focus groups. exclusion criteria: * residents or their guardians who do not consent to biospecimen sampling and/or participation in interviews/focus groups. * health professionals who do not consent to participate in interviews/focus groups.