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Antimicrobial prescribing in Australian residential aged care

Aged care homes are important settings to better understand both antimicrobial resistance and antimicrobial use. Reports to date indicate that high levels of inappropriate antimicrobial prescribing and use occur in these settings, providing opportunities for improved antimicrobial prescribing.

Aged care homes are recognised nationally and internationally as an important community setting for monitoring antimicrobial resistance and antimicrobial use because of the prevalence of infections and colonisation caused by antimicrobial-resistant organisms in residents. High levels of inappropriate antimicrobial prescribing and use in aged care homes are also well documented. Actions to improve the appropriateness of prescribing are key to improving care for residents.

Aged care home residents are susceptible to infections for a variety of reasons, including advanced age, multiple co-morbidities, poor functional status, compromised immune status, and the use of invasive devices such as urinary tract catheters. In addition, there is a close living environment for residents, and they may have frequent contact with potentially colonised or infected staff or other residents. Some aged care home residents may also have multiple and/or prolonged hospitalisations for the same reasons they are susceptible to infections. Ensuring appropriate care for the older members of our community is a priority.

The Aged Care National Antimicrobial Prescribing Survey (AC NAPS) is a standardised surveillance tool that can be used to monitor the prevalence of infections and antimicrobial use in aged care homes and multi-purpose services. The Commission provides funding for AC NAPS for the inclusion of data into the AURA Surveillance System. AC NAPS is a collaborative project between the National Centre for Antimicrobial Stewardship (NCAS), the Guidance Group and Victorian Healthcare Associated Infection Surveillance System (VICNISS) Co-ordinating Centre.

All Australian aged care homes and multi-purpose services are able to participate in AC NAPS, and participation is mostly voluntary. Since 2017, Victorian State Government operated aged care homes have been required to participate in AC NAPS as part of the VICNISS Infection Control Indicator Program.

Participation in AC NAPS supports these facilities to identify areas for improvement in antimicrobial use, preventing infections and helping reduce antimicrobial resistance. Participation also helps improve care for residents and assists the demonstration of compliance with the Australian Aged Care Quality Standards.

The Commission is working with the Aged Care Quality and Safety Commission to promote implementation of antimicrobial stewardship programs in aged care homes.