Not yet recruiting
May 8, 2019
October 12, 2020
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.
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: 1. Education - Focused on antimicrobial stewardship and appropriate antimicrobial use - 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. 2. Guidelines - Aged care-specific guidelines for the assessment and antimicrobial management of urinary tract infections, respiratory tract infections and skin and soft tissue infections. - Antimicrobial management recommendations including empirical oral therapy, doses and duration of therapy. 3. Communication - Documentation for the assessment and antimicrobial management of infections. - Nurse-led engagement with residents and families. - Newsletters and online updates to highlight evidence-based prescribing practice 4. 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: - Control phase: baseline data collection. Usual care at each facility. - Transition phase: Delivery of education and integration of the intervention. No data collection. - 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.
|Experimental: Antimicrobial stewardship
Implementation of the nurse-led bundled antimicrobial stewardship intervention
Behavioral: Antimicrobial stewardship
Education, guidelines, communication tools and audit and feedback
- All residents from 12 RACFs will have de-identified data collected including
antimicrobial use, infection, hospitalisation and mortality.
- Residents or their guardians who provide informed consent to monthly biospecimen
sampling and participation in one-on-one interviews or focus groups.
- Health professionals (including aged care staff and GPs) who provide informed consent to
participate in one-on-one interviews or focus groups.
- Residents or their guardians who do not consent to biospecimen sampling and/or
participation in interviews/focus groups.
- Health professionals who do not consent to participate in interviews/focus groups.
Contact: Natali Jokanovic, BPharm, PhD +61 3 9903 0087 email@example.com
Contact: Trisha Peel, MBBS, FRACP, PhD +61 3 9076 2000 firstname.lastname@example.org
Bupa residential aged care facilities
Bupa Aged Care Australia
Principal Investigator: Anton Peleg, MBBS, PhD, FRACP, PhD Monash University
Jokanovic N, Haines T, Cheng AC, Holt KE, Hilmer SN, Jeon YH, Stewardson AJ, Stuart RL, Spelman T, Peel TN, Peleg AY; START Trial Group. Multicentre stepped-wedge cluster randomised controlled trial of an antimicrobial stewardship programme in residential aged care: protocol for the START trial. BMJ Open. 2021 Mar 2;11(3):e046142. doi: 10.1136/bmjopen-2020-046142.