A recent report on the use of antimicrobials in the community published by the Australian Commission on Safety and Quality in Health Care found that, while the overall use of antimicrobials in the Australian community has reduced over time, the dispensing of antimicrobials for residents of aged care homes and people over 65 is actually trending up.
What are antimicrobials?
Antimicrobials are medicines that are used to treat, prevent, and control a broad range of infections and infectious diseases, by inhibiting or destroying the bacteria, viruses or fungi that cause the infection.
The risk with over-use of antimicrobials is that antimicrobial resistance can occur. This happens when bacteria, viruses, fungi and parasites no longer respond to the antimicrobial medicines, lessening their effectiveness at fighting infections and therefore increasing the risk of severe illness, disability and death.
Antimicrobial resistance is accelerated when antimicrobials are unnecessarily or improperly used. This can result in negative effects across the entire health system, by increasing the likelihood of resistant infections and increasing the risk of other important health procedures including organ transplantation, major surgeries, and chemotherapy.
Enhanced risk for older people in care homes
Older people residing in care homes are at advanced risk off microbial infections, due to a few factors including:
- They may have more than one medical condition affecting them (i.e. comorbidity);
- Compromised immunity; and
- The increased risk of exposure to infections due to frequent contact with staff, visitors and other residents.
Because older people are more at risk of infection, there is an enhanced risk that they may be prescribed antimicrobials inappropriately or unnecessarily.
The Report
The Commission’s report, Antimicrobial use in the Community: 2023, draws from national prescription records between 2015 and 2023. The report found that the number of antimicrobial prescriptions in the general community between 2022-2023 remained roughly steady, at about 24% of the amount in 2015. However, this general downwards trend has not been reflected among older people, particularly residents of aged care homes.
Between 2022-2023, there was an 11.1% increase in overall antimicrobial prescriptions among residents of aged care homes. Nearly three quarters of residents received at least one antimicrobial prescriptions, which is well above the average of one-third for the general community. Older people living in care homes were also much more likely to be given broad-spectrum antimicrobials, even when they were not recommended for common infections.
Antimicrobial Stewardship
The report notes the critical importance of curbing the unnecessary or inappropriate use of antimicrobials through a dual strategy — preventing infections through minimising risk of transmission, and through promoting antimicrobial stewardship (AMS).
AMS represents an ongoing effort by a provider to implement policies and processes which optimise and minimise the use of antimicrobials, to reduce the risks associated with increasing antimicrobial resistance.
AMS in the context of standards
Instituting best-practice AMS policies and procedures is a requirement of several sets of standards within the health and aged care sectors:
- Health Services:
- Aged Care:
The Aged Care Quality and Safety Commission has included antimicrobial stewardship within Standard 3(g) – (Minimisation of infection-related risks) of the Aged Care Quality Standards, and AMS also features prominently in the new Strengthened Aged Care Quality Standards under outcome 5.2 (Preventing and Controlling Infections).
SPP Resources
Self-assessment modules to track compliance
SPP provides a range of self-assessments for the standards mentioned above, to help you understand and track your compliance with their particular indicators or requirements regarding antimicrobial stewardship.
Policy templates to help implement procedures
In addition, in SPP’s Reading Room you can find our Policy: Antimicrobial Stewardship, which is a valuable introductory resource for developing effective antimicrobial stewardship procedures. Antimicrobial stewardship should be developed alongside strong medication governance procedures. Our Policy: Medication Management will assist in outlining some key considerations.
These resources are complemented by our information and policy documents regarding Clinical Governance, and our self-assessment based on the Aged Care Quality and Safety Commission’s guidance for Clinical Governance.
We are also hard at work preparing for the upcoming changes in the Strengthened Aged Care Quality Standards so we can continue to support your efforts to deliver high quality aged care.
How is your organisation supporting AMS?
Sign up to SPP and let our antimicrobial stewardship resources guide you towards compliant processes!
