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

Stepped-wedge Cluster Randomised Controlled Trial to Increase Antibiotic Appropriateness in Residential Aged Care Facilities: a Nurse-led Bundled Antimicrobial Stewardship Intervention.

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.

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.