Outcome 5.2.1

While medical practitioners are responsible for prescribing antimicrobials (such as antibiotics), there are many other antimicrobial stewardship (AMS) strategies that aged care providers need to put into practice. The AMS Self-Assessment Tool and User Guide supports providers to monitor and understand their progress towards creating a comprehensive AMS program. Chapter 16 of the Antimicrobial Stewardship Book – Antimicrobial stewardship in community and residential aged care and the Antimicrobial Stewardship Clinical Care Standard have recommendations of contemporary, evidence-based practice.

Put in place a system for AMS.

Document the parts of your AMS system, including:

• policies and procedures to promote using antimicrobials appropriately
• roles and responsibilities for AMS in your organisation, including leadership responsibilities
• processes for regular clinical reviews of the appropriate duration of antimicrobials use, as well as specialist referrals, including microbiological testing where needed
• processes outlining how the service accesses AMS expertise, if needed. For example, through a referral or by asking for advice from a suitably qualified registered health practitioner or allied health professional, such as a pharmacist credentialed to conduct medication reviews. For example, a clear process for collection and arranging laboratory testing of a wound swab.
• AMS education and training for workers, registered health practitioners and allied health professionals you employ or contract, suitable to their role
• Processes for monitoring and reporting the effectiveness of the AMS system
• quality improvement processes for antimicrobial issues.

Put in place processes for effective AMS.

Make sure workers and health professionals:

• understand what they need to do to promote using antimicrobials appropriately and reducing antimicrobial resistance. This includes their role in preventing infection through:
  • hydration and diet
  • maintaining skin integrity
  • following appropriate hygiene and IPC practices such as hand hygiene.
• have the training and qualifications they need to perform their role
• understand how to monitor older people who have been prescribed antimicrobials for effectiveness, side effects and adverse events
• understand how to recognise and escalate if they find antimicrobials are being used inappropriately, including following appropriate processes for raising concerns with prescribers
• have access to relevant clinical guidelines, such as Therapeutic Guidelines: Antibiotics, the Australian Medicines Handbook and other locally endorsed guidelines.

AMS activities can also include giving the older person information and an opportunity to discuss the risks and benefits of antimicrobials. This can help them make informed decisions with their prescriber.

Monitor, review and improve AMS processes.

In proportion to the service’s level of involvement in supplying, administering and monitoring antimicrobials, consider how to:

• monitor the frequency, duration and the clinical reasons for using antimicrobials for the older people using the service
• analyse trends for using antimicrobials. This may include working with local pharmacies to gather data.
• regularly monitor infections and the use of antimicrobials. For aged care services delivered in a residential care home, this may include taking part in the Aged Care National Antimicrobial Prescribing Survey (AC-NAPS).
• analyse the data you collect through this monitoring and report it to relevant stakeholders. This includes your governing body, prescribers and to older people receiving care and their families. This can help you improve the effectiveness of your AMS systems and processes

Some of the key tasks in Action 5.3.6 on monitoring and evaluating medication management systems can also be helpful when monitoring antimicrobial use and trends in adverse medicine related events and side effects.

Outcome 5.2.2

Put in place an IPC system.

Document the parts of your IPC system, including:

• policies and procedures that guide:
  • IPC practices relevant to the clinical care services you provide
  • identifying people with suspected or confirmed infections and notifying and escalating to local public health units and health and medical practitioners if relevant in a timely way.
• roles and responsibilities for IPC, including senior leadership responsibilities and who holds the IPC Lead role (where relevant)
• clinical procedures that need aseptic technique and protocols for using aseptic technique and clean procedures
• invasive devices and protocols for their insertion, monitoring, maintenance and removal
• training systems to support workers, registered health practitioners and allied health professionals to meet their IPC responsibilities, including education for care workers to reduce the risk of contracting or spreading infection.

Make sure the IPC system is in line with:

• endorsed national and state or territory guidelines, legislation and regulations
• contemporary, evidence-based practice in line with the Aged Care Infection Prevention and Control (IPC) Guide, a resource of the Australian Guidelines for the Prevention and Control of Infection in Healthcare.

Put in place IPC processes for clinical care services.

Make sure processes support a risk-based approach to IPC for the service context. The processes should consider:

• the risk of infection in the environment that you deliver care
• types of services offered
• workers’, registered health practitioners and allied health professionals’ scope of practice.

Make sure you support workers, registered health practitioners and allied health professionals to meet their IPC roles and responsibilities, including:

• easy access to your IPC policies, procedures and protocols
• adequate training and time for workers responsible for IPC, such as the IPC Lead, to carry out their IPC activities
• adequate training and education for those who perform aseptic procedures and manage invasive medical devices
• appropriate equipment to perform aseptic procedures and safely manage invasive medical devices
• making sure that workers can recognise the signs and symptoms of infection
• a system to recognise and respond to older people with signs of infection and escalate concerns. This may include escalation process, and workers roles in responding to infection.
• processes to prevent, identify and manage urinary tract infections.

Monitor, review and improve IPC processes and outcomes.

As relevant to the service’s context and level of involvement in clinical procedures and using invasive devices, consider how to:

• monitor compliance with processes and protocols for aseptic technique and managing invasive devices, such as urinary catheters
• assess and monitor risks of infection and how effective your strategies to mitigate risk are
• use the data you collect from monitoring to identify opportunities where you can reduce the exposure and transmission of infections during clinical care services.