Infection Prevention and Antimicrobial Stewardship in aged care – Australian perspective

Dr Noleen Bennett

VICNISS Co-ordinating Centre/ National Centre for Antimicrobial Stewardship, Peter Doherty Institute for Infection and Immunity 792 Elizabeth St, VIC 3000 Noleen.Bennett@mh.org.au

 

The emergence of potentially untreatable multi-drug resistant organisms (MDROs) represents a serious threat in Australia. There has been little screening for carbapenemase-producing Enterobacteriaceae in our aged care homes (ACHs), however residents are considered high-risk because of their age, medical conditions and frequent episodes of acute health service care.

To ensure all Australian ACHs are committed to preventing the establishment and transmission of MDROs, the draft Australian Aged Care Quality Standards document that implementation of standard and transmission based precautions to prevent and control infection and for the first time antimicrobial stewardship (AMS) is required. There are national guidelines for the prevention and control of infection in ACHs. There are not however equivalent AMS guidelines.

In 2016, 251 ACHs voluntarily participated in the annual Aged Care National Antimicrobial Prescribing Survey. The aim of this infection prevention and AMS strategy is to monitor the prevalence of infections and identify inappropriate antimicrobial use. The survey identified some ‘key areas for improvement’ including:

  • Incomplete documentation of key prescribing elements (eg: dose, indication and duration)
  • The prescription of antimicrobials for unconfirmed infections
  • Prolonged duration of antimicrobial prescriptions
  • Widespread use of topical antimicrobials

The VICNISS Coordinating Centre together with the National Centre for Antimicrobial Stewardship have developed an action plan to assist participating ACHs address these key areas for improvement. The plan focuses on the provision of education and includes links to relevant guidelines and information sheets and Infectious Diseases Physicians, Pharmacists, Microbiologists and Infection Control Practitioners being available to provide expert advice as required.