For aged care

The rate of certain types of infection is often high in aged care facilities because residents are more likely to:

• be more frail
• have difficulties moving around
• have multiple medical problems
• have poor immune systems
• be incontinent
• have difficulty with speech
• have problems doing day-to-day activities without assistance. 

As a result, residents of aged care facilities are often prescribed antibiotics to manage infections. We need to decrease antimicrobial use in this group of people to reduce the risk of the rapid rise and spread of organisms that are resistant to many drugs. 

What you can do

1. Consider any safe alternatives to an immediate antibiotic prescription
2. Prescribe in accordance with therapeutic guidelines, and where possible use diagnostics to inform treatment decisions
3. Talk to your patients about the importance of appropriate antibiotic use and the dangers of antibiotic resistance
4. Give your patients advice on how to manage symptoms without antibiotics
5. Apply best practice infection prevention and control
6. Talk to your patients about how to prevent infections and their spread (e.g. vaccination, good hygiene and hand washing)

This is an infographic describing six important actions health professionals can take to reduce antibiotic resistance.

Key issues

• Residents of facilities with high antimicrobial use have an increased risk of antimicrobial resistant infection. This includes people who are not receiving antimicrobial therapy, because infections can be easily transmitted from one resident to another.
• Results from the 2016 Aged Care National Antimicrobial Prescribing Survey (acNAPS) highlighted the following issues:
  • prescriptions did not meet the criteria for an infection
    • 67.2% of prescriptions were for residents who did not have signs or symptoms of infection
  • antimicrobials were prescribed for longer than necessary
    • 23% of antimicrobials had been administered for longer than six months
  • documentation was incomplete
    • the antimicrobial start date was unknown for 3.2% of antimicrobials administered
    • the indication for the antimicrobial was not recorded for 22.1% of antimicrobials administered
    • the review or stop date was not recorded for 49.9% of antimicrobials administered.
• The 2016 acNAPS also identified that facilities had a high rate of use of antimicrobials for unconfirmed infections and widespread use of topical antimicrobials.
• The Antibiotic use in residential 
aged care facilities paper by Lim et al discusses the need to use antimicrobials judiciously in this high-risk population.

Areas for action

To reduce overall use and increase the proper use of antimicrobials, health professionals in aged care facilities can:

• Always use standard infection control precautions when working with residents, especially good hand hygiene. This will reduce the spread of infections between residents, health care professionals and visitors.
• Only prescribe antimicrobials in line with therapeutic guidelines and where possible use diagnostic tests to inform treatment decisions.
• Trial antimicrobial stewardship measures that can be put in place based on available resources and the  needs of the facility.
• Participate in the acNAPS to support efforts to improve antimicrobial stewardship in aged care settings.
• Nurses also play an important role in combating antimicrobial resistance. You can find more information on the Nurses and Antimicrobial Resistance fact sheet.