Nurse-led Antimicrobial Stewardship Intervention to Increase Antibiotic Appropriateness in Residential Aged Care Facilities
Study Details
Study Description
Brief 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.
Condition or Disease | Intervention/Treatment | Phase |
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N/A |
Detailed 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
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Focused on antimicrobial stewardship and appropriate antimicrobial use
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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
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Aged care-specific guidelines for the assessment and antimicrobial management of urinary tract infections, respiratory tract infections and skin and soft tissue infections.
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Antimicrobial management recommendations including empirical oral therapy, doses and duration of therapy.
- Communication
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Documentation for the assessment and antimicrobial management of infections.
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Nurse-led engagement with residents and families.
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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:
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Control phase: baseline data collection. Usual care at each facility.
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Transition phase: Delivery of education and integration of the intervention. No data collection.
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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 Design
Arms and Interventions
Arm | Intervention/Treatment |
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No Intervention: Control All facilities will receive usual care during the control phase of the trial. |
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Experimental: Antimicrobial stewardship Implementation of the nurse-led bundled antimicrobial stewardship intervention |
Behavioral: Antimicrobial stewardship
Education, guidelines, communication tools and audit and feedback
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Outcome Measures
Primary Outcome Measures
- Cumulative proportion of residents prescribed a systemic antimicrobial [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) [Assessed from commencement of the intervention at each facility until the conclusion of the trial at 16 months]
Secondary Outcome Measures
- Number of courses of systemic antimicrobial therapy per 1,000 OBD. [Assessed from commencement of the intervention at each facility until the conclusion of the trial at 16 months]
- Proportion of appropriate antimicrobial use. [Assessed from commencement of the intervention at each facility until the conclusion of the trial at 16 months]
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.
- Frequency of carriage of antimicrobial-resistant organisms [Assessed over a 12-month period during the trial (at least 2 months pre-intervention and 2 months post-intervention).]
Monthly biospecimen sampling will be collected from residents including nasal, faecal/rectal and wound specimens.
- Rate of Clostridium Difficile infection [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 [Assessed over a 12-month period during the trial (at least 2 months pre-intervention and 2 months post-intervention).]
Monthly biospecimen sampling will be collected from residents including nasal, faecal/rectal and wound specimens.
- Incidence of resident transfer to hospital for infectious indications [Assessed from commencement of the intervention at each facility until the conclusion of the trial at 16 months]
- All-cause mortality [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 [Assessed at the conclusion of the trial at 16 months]
Semi-structured interviews conducted one-on-one or in moderated focus groups with stakeholders including aged care staff, GPs, residents and families.
Eligibility Criteria
Criteria
Inclusion Criteria:
Residents:
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All residents from 12 RACFs will have de-identified data collected including antimicrobial use, infection, hospitalisation and mortality.
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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:
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Residents or their guardians who do not consent to biospecimen sampling and/or participation in interviews/focus groups.
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Health professionals who do not consent to participate in interviews/focus groups.
Contacts and Locations
Locations
Site | City | State | Country | Postal Code | |
---|---|---|---|---|---|
1 | Bupa residential aged care facilities | Melbourne | Victoria | Australia |
Sponsors and Collaborators
- Bayside Health
- Bupa Aged Care Australia
- Monash University
Investigators
- Principal Investigator: Anton Peleg, MBBS, PhD, FRACP, PhD, Monash University
Study Documents (Full-Text)
None provided.More Information
Publications
None provided.- 591/18