Nurse-led Antimicrobial Stewardship Intervention to Increase Antibiotic Appropriateness in Residential Aged Care Facilities

Bayside Health

Status

Unknown

Conditions

Urinary Tract Infections

Skin and Soft Tissue Infections

Respiratory Tract Infections

Antimicrobial Stewardship

Treatments

Behavioral: Antimicrobial stewardship

Study type

Interventional

Funder types

Other

Identifiers

NCT03941509

591/18

Details and patient eligibility

About

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.

Full description

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:

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.
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.
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
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.

Enrollment

700 estimated patients

Sex

All

Volunteers

No Healthy Volunteers

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.