Summary
Background
The World Health Organisation has identified antimicrobial resistance as one of the greatest threats to human health, with overuse and misuse of antimicrobials driving this process. In residential aged care facilities (RACFs), antimicrobials are often prescribed inappropriately. Although antimicrobial stewardship programs are well established in the hospital setting, few programs exist in RACFs and their impact on antimicrobial use and resistance has not been well-explored.
Aims
The START project will implement and evaluate the impact of a nurse-led bundled antimicrobial stewardship program on the appropriateness of antimicrobial use in RACFs.
The project will also explore the impact of resident movement on the spread of antimicrobial resistance and model the transmission of antimicrobial resistance.
Study design
The nurse-led antimicrobial stewardship intervention will be implemented in a stepped-wedge randomised controlled trial. The trial will be conducted in collaboration with Bupa Aged Care Australia and include 12 RACFs over 16 months.
Methods
The antimicrobial stewardship intervention will comprise a nurse-led care and education bundle to support appropriate antimicrobial use.
The intervention will first be pilot tested across 2 RACFs and revised prior to implementation across 12 RACFs in a randomised controlled trial. Following the trial, the intervention will be rolled out nationally across Bupa RACFs.
Outcome measures
Primary outcomes include the proportion of residents prescribed an antimicrobial and the total number of days of antimicrobial therapy.
Secondary outcomes include the number of courses of antimicrobials prescribed, the incidence of carriage of drug-resistant bacteria and other health-care associated infections, change in antimicrobial susceptibility profiles, incidence of resident transfer to hospital, and all-cause mortality.
