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 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*.