Antimicrobial stewardship for aged residential care
The below article was contributed by Ruth Barrett – RN, BSc, MAdvPrac (Hons); Independent Infection Prevention & Control Advisor
What is your New Year resolution for 2017 in the world of infection prevention and control (IPC)? If you haven’t thought of it I would suggest looking at antimicrobial stewardship in your facility.
I was fortunate to attend a recent international IPC conference in Melbourne (ACIPC Conference 2016) and was pleased that aged residential care was a popular theme for both oral presentations and posters. One of the topical subjects was feedback from the first survey of antimicrobial use in residential care facilities in Australia. The results of this research are freely available and make interesting reading. A good deal of the findings could equally apply to ARC in New Zealand.
Antimicrobial resistance and antimicrobial stewardship are two topics that go hand in hand.
As rates of antibiotic resistant bacteria continue to rise in New Zealand, then the responsibility for and management of the use of antibiotics becomes more important. Aged residential care (ARC) facilities are an important reservoir for MDRO transmission within the community. In the ARC setting, there are frequent transfers between the acute hospital setting and back to the rest home. This along with an over-use of antibiotics in the community can lead to a higher prevalence of multi-drug resistant organisms (MDRO) in ARC.
Even if a resident does not usually receive antibiotics, the resident is still at risk of picking up an MDRO if a lot of antibiotics are used. Managers, nurses and carers who work in a residential care facility all have apart to play in reducing the amount of antibiotics used and minimising the increase and spread of MDRO.
Some of the ways you can do this include-
- Ensuring hand hygiene compliance is high for all staff and providing hand sanitiser close at hand for carers.
- Using other specific contact precautions to control the spread of MDRO in your facility according to local policy.
- Not using topical antimicrobial creams unless prescribed e.g. don’t routinely use Mupiricin (Bactroban) on wounds.
- Only sending wound swabs, urines etc if there are obvious signs and symptoms of infection.
- Recognising influenza or other respiratory outbreaks earlier to avoid secondary chest infections in the elderly, which would require antibiotics. Remember that in the winter season, many respiratory infections are caused by viruses and do not need antibiotic treatment.
- Ensuring the residents finish their course of antibiotics.
- Monitoring infections using a surveillance programme.
- Monitoring the incidence of MDRO in the facility.
- Accessing specialist IPC advice if infection or MDRO rates are of a concern.
So why don’t you make antimicorbial stwardship your IPC focus for 2017?
Ruth Barratt RN, BSc, MAdvPrac (Hons)
Independent Infection Prevention & Control Advisor
 Antibiotic use in residential aged care facilities, Australian Family Physician, Volume 44, No.4, April 2015
 Antimicrobial Stewardship in Residential Aged Care Facilities. Result of survey.