Antimicrobial resistance in aged-care facilities requires a novel approach

The volume of antimicrobials used in aged-care facilities is startling and needs to be addressed. The call for research grants in this space provides hope for the future.

We are ageing.

More and more of us are planning for, and accessing, care in residential aged-care facilities (RACFs). In Australia, the number of people aged 80 and over — the group most likely to require RACFs — is expected to double from 3% of the population in 1998 to 6% in 2031.^1,2

Recent research^3,4,5 sheds light on the extraordinary and startling use of antimicrobials in RACF settings and the complex factors contributing to this, for which there are few original, ready solutions. AURA 20166 and AURA 20177, the first and second reports on antimicrobial use in human health respectively, document the extent of the AMR problem Australia faces and the significant challenges we all face. The extent of these issues was brought into sharp focus⁸ in the 2015 Aged Care National Antimicrobial Prescribing Survey (acNAPS), which called for improvements in three main areas:

1. Better documentation of antimicrobial use; 36% of prescriptions did not have an indication recorded as to why they were being used and 65.0% of prescriptions did not have a review or stop date.
2. Less use of antimicrobials for unspecified infections; 17.5% of antimicrobials were being used for unspecified skin infections.
3. The need to review and reduce prolonged prescription duration; 31.4% of prescriptions were prescribed six months or longer, and only 51% had an indication documented, and only 2% had a review or stop date recorded.

Delivery care in RACFs is complex due to:

• the presenting conditions and infections being chronic;
• delayed diagnosis and poorer clinical outcomes³;
• the lack of or limited access to diagnostics;
• client placement in shared accommodation, close living proximity and frequent transfer in and out of acute care settings.^3,4,5

These data paint a bleak picture, demonstrating how complex and challenging it is to achieve quality use of antimicrobials in RACF settings.

Responding to the challenges of AMR and antimicrobial use in RACFs requires novel and original solutions. This need is highlighted by the lack of RACF-specific AMR surveillance and AMS programs to address the high levels of inappropriate antimicrobial use.

News of the Australian Government’s recent commitment to address these challenges through the Medical Research Future Fund Antimicrobial Resistance Targeted Call for Research Grants is very encouraging.

These grants focus squarely on the development of novel and innovative approaches to containing and preventing of AMR in residential and aged-care facilities to the tune of $5.9 million.² They seek to stimulate research on novel and innovative methodologies, such as genomics, to determine antimicrobial resistance profiles and transmission within and to/from RACFs. The ultimate goal is to promote and develop optimal and appropriate antimicrobial use in RACFs.

We, and our colleagues within the Australasia College for Infection Prevention and Control, welcome this new commitment of the Australian Government. We look forward to future opportunities for targeted research that focuses specifically on other non-antimicrobial solutions, specifically infection prevention and control practices, education and surveillance of infection in RACFs more generally. These are inseparable from the challenges of, and solutions to, antimicrobial use and AMR.

References

1. Australian Bureau of Statistics. (2006). Available at: http://www.abs.gov.au/AUSSTATS/abs@.nsf/2f762f95845417aeca25706c00834efa/63378CA41AC510AECA 2570EC00114198 . (Accessed: 06/09/2017)

2. National Health and Medical Research Council. (2017). Medical Research Future Fund – Antimicrobial Resistance Targeted Call for Research Grants. Canberra: Department of Health, Australia Government.

3. Lim CJ, Stuart RL & Kong DCM. (2015). Antibiotic use in residential aged care facilities. Australian Family Physician, 44(4):192-196

4. Lim, C.J., Kwong, M.W.-L., Stuart, R.L., Buising, K.L., Friedman, N.D., Bennett, N.J., Cheng, A.C., Peleg, A.Y., Marshall, C. and Kong, D.C.M. (2014) Antibiotic prescribing practice in residential aged care facilities — health care providers’ perspectives. The Medical Journal of Australia, 201(10), p. 574. doi: 10.5694/mja13.00102

5. Stuart, R. L., Orr, E., Kotsanas, D., & Gillespie, E. E. (2015). A nurse-led antimicrobial stewardship intervention in two residential aged care facilities. Healthcare infection, 20(1), 4-6

6. Australian Commission on Safety and Quality in Health Care (ACSQHC). (2016). AURA 2016: First Australian report on antimicrobial use and resistance in human health. Sydney: ACSQHC, 2016.

7. Australian Commission on Safety and Quality in Health Care (ACSQHC). (2017). AURA 2016: Second Australian report on antimicrobial use and resistance in human health. Sydney: ACSQHC, 2017.

8. National Centre for Antimicrobial Stewardship and Australian Commission on Safety and Quality in Health Care. Antimicrobial prescribing and infections in Australian residential aged care facilities: Results of the 2015 Aged Care National Antimicrobial Prescribing Survey pilot. Sydney: ACSQHC, 2016.

*Prof Ramon Z Shaban, RN PhD CICP-E, is Clinical Chair of Infection Prevention and Control, Department of Infection Control, Gold Coast Hospital and Health Service and Menzies Health Institute Queensland, School of Nursing and Midwifery, Griffith University. He also holds the position of President, Australasian College for Infection Prevention and Control.

Prof Brett Mitchell, RN PhD CICP-E, is Professor of Nursing, Discipline of Nursing, Faculty of Arts, Nursing and Theology, Avondale College of Higher Education and Editor in Chief, Australasian College for Infection Prevention and Control.

Dr Philip L Russo, RN PhD CICP-E, is Research Fellow, School of Nursing and Midwifery, Faculty of Health, Centre for Quality and Patient Safety Research - Alfred Health Partnership, Deakin University and Board Director, Australasian College for Infection Prevention and Control.

Dr Deborough Macbeth, RN PhD CICP-E, is Assistant Director of Nursing - Infection Control, Department of Infection Control, Gold Coast Hospital and Health Service, and Board Director, Australasian College for Infection Prevention and Control.

Image credit: ©stock.adobe.com/au/bernanamoglu