What is the outcome that needs to be achieved?
Older people, workers* and others are encouraged and supported to use antimicrobials* appropriately to reduce risks of increasing resistance.
Infection* risks are minimised and, if they occur, are managed effectively.
Actions
The provider implements an antimicrobial stewardship* system* that complies with contemporary, evidence based practice* and is relevant to the service context.
The provider implements processes* to minimise and manage infection* when providing clinical care* that include but are not limited to:
- performing clean procedures* and aseptic techniques*
- using, managing and reviewing invasive devices* including urinary catheters*
- minimising the transmission of infections* and complications from infections*.
Why is this outcome important?
Infection prevention and control* (IPC) is an important part of providing safe aged care. Everyone has a role and a responsibility to prevent and control infection* in aged care, including:
- people providing and managing care in any aged care setting
- everyone going into a residential aged care home.
This includes aged care workers*, health professionals*, families, visitors, contractors and carers.
Older people are more vulnerable to infectious diseases. This is because of factors like:
- age-related physiological changes
- lower immunity
- co-morbidities. This means a person has more than one health issue at the same time. For example, someone might have arthritis, diabetes and depression.
- living with a group of other people in an aged care home
- invasive devices* used in their care.
These factors can also mean infections* can be harder to treat in older people. They might need more complex treatment or hospitalisation.
Outcome 5.2 is closely related to Outcome 4.2, in which general infection prevention and control* (IPC) processes* are required for all aged care service environments*. Outcome 5.2 specifically includes IPC in relation to clinical care* and includes the requirement for antimicrobial stewardship* (AMS) processes. The actions in Outcome 5.2 support providers to use systems* and processes*:
- to prevent people getting infections* from clinical care* procedures* and invasive devices*
- to reduce exposure to and minimise the spread of infections*
- to reduce resistance to antimicrobial* medicines such as antibiotics.
Providers can reduce the risk of infection* by following evidence-based* IPC strategies and national and local IPC guidelines. Clinically trained and qualified workers* and health professionals* should use aseptic technique* during relevant procedures. This can prevent people getting infections* from clinical procedures* such as inserting, maintaining and removing invasive medical devices*.
AMS programs:
- promote appropriate use of antimicrobials*
- improve care outcomes*
- reduce negative effects of using antimicrobials* (including antimicrobial resistance*, toxicity and unnecessary costs).
Service context considerations
Providers of both residential and home services are expected to have systems* and processes* for IPC and AMS. The provider’s IPC focus may be different depending on the type of clinical services they offer and where they deliver these services.
Clinical procedures* in any service should only be done by qualified and trained workers* or health professionals* and within their scope of practice*.
Key tasks
Providers
Providers
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 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* and 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 residential services, 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 service context
Residential service providers
Put in place an effective system* and processes* for AMS. All key tasks for Action 5.2.1 can support residential service providers to do this.
Home service providers
Home service providers offering clinical care* including prescribing, supplying or administering antimicrobial medicines*
Put in place an effective system* and processes* for AMS. All key tasks for Action 5.2.1 can support home service providers to do this.
Home service providers that don’t prescribe, supply or administer antimicrobial medicines*
Put in place an effective system* and processes* for AMS. As there is less involvement with antimicrobials* in these services, the focus of AMS systems* and processes* may be on activities that support:
- preventing infections* through basic IPC practices such as hand hygiene
- educating home service workers* and health professionals* about using antimicrobials* appropriately and raising concerns about inappropriate use
- providing information to the older person receiving care about antimicrobial risks and benefits to support them make informed decisions.
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 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* and 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*.
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’* and health professionals’* scope of practice*.
Make sure you support workers* and 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 exposure and transmission of infection* during clinical care*.
Outcome service context
Residential and home service providers
Clinical processes* and procedures* should only be done by appropriately qualified and trained workers* or health professionals*, within their scope of practice*.
Residential service providers
Put in place an effective system* and processes* for IPC. All key tasks for Action 5.2.2 can support providers to do this.
Home service providers
Put in place an effective system* and processes* for IPC. In the home service context, IPC is complicated by a reduced ability to control the environment where clinical procedures* are carried out. This may affect how you provide clinical care* and surveillance activities. Home service providers should design an IPC system* and processes* that use a risk-based approach. This makes sure they consider factors based on the type and context of their service.