Health

Antimicrobials in aged care

Recent works by Australian Commission on Healthcare Safety and Quality — As part of Antimicrobial Use and Resistance (AURA) Monitoring System in Australia Studies on Antimicrobial Resistance (AMR) and Antimicrobial Prescribing in Australian Residential Elderly Housing with Care — A strong reminder that actions to improve antimicrobial use are essential to resident safety.

Strategies to improve antibiotic prescribing and reduce the risk of inappropriate antibiotic use in older patients are key to combating antibiotic resistance. These strategies include reducing the number of prescriptions for prevention in Elderly Housing with Care (this is rarely recommended). Continuously improve the documentation of antimicrobial formulations. Consider better use of preventative measures such as non-pharmacological management of some clinical indications such as cystitis, skin and wound infections.

As part of the AURA surveillance system, the committee recently 2019 Aged Care National Antioxidant Prescribing Survey (AC NAPS) ReportIn combination with National Antibacterial Stewardship Center.. The 2019 AC NAPS Report provides information on infections and antimicrobial use of 32,347 elderly care residents from 568 Australian residential elderly care services.

The 2019 AC NAPS data show the level of continued and concern about inappropriate antibiotic use in Australian residential geriatric care services, impacting resident safety. Inappropriate use of this antimicrobial agent, coupled with the prevalence of antimicrobial resistance in the community, creates the potential for increased antimicrobial resistance in this vulnerable population.

Multidrug-resistant strains such as the following strains, as shown in AURA 2019, a biennial report on antimicrobial use and resistance in Australia: E. coli And methicillin resistance Staphylococcus aureus It is already widespread in elderly care facilities.

Elderly people are regularly hospitalized, have a close living environment, are immunocompromised, and often use invasive devices, which can lead to infections, so the use of antibiotics in elderly care services is This is an important area for service improvement. Also, the likelihood of taking multiple medications increases the burden of adding antibiotics to these patients. Antibiotics are not without safety risks and side effects such as renal dysfunction. Clostridium difficile It can be more important in the elderly population.

The AURA monitoring system also includes: Australian Passive AMR Surveillance (APAS) provides data showing that Elderly Housing with Care is experiencing a high rate of multidrug-resistant infections, including: E. coli.. The Geriatric Care Quality and Safety Commission’s Geriatric Care Quality Standards also specifically mention the promotion of proper antimicrobial prescribing.

The Australian Commission on Healthcare Safety and Quality is currently Elderly Care Quality and Safety Committee, Multipurpose services, elderly care providers, and general practitioners working in elderly care facilities promote antimicrobial prescription improvement programs based on ACNAPS findings.

Continuous monitoring of infectious diseases and antimicrobial use remains important in communicating the strategy of home elderly care providers to improve care. Strategies for improving resident safety include:

  • We will work with medical and nursing staff, including antimicrobial prophylaxis prescriptions, to regularly review usage patterns and comply with Australian treatment guidelines for recommended duration and selection of antibiotics.
  • Share analysis of AC NAPS data with administrators, governance groups, and clinicians such as general practitioners, pharmacists, and nurses to develop targeted improvement strategies.
  • Review how the results of AC NAPS data are communicated to clinicians, governance and leadership groups, residents and their families.
  • Use a medication chart that matches the Commission’s National Home Medication Chart to improve the documentation.
  • Implement policies that require default fixed-length treatment courses and mandatory review dates, especially for “if needed” prescribing.
  • If necessary, we provide outside expert support for elderly care staff regarding the use of antibiotics and the diagnosis, prevention and management of infectious diseases.
  • Use of resources to support the implementation of policies and procedures that are consistent with Australian guidelines for the prevention and control of infections in healthcare.
  • Raise awareness and skill levels by introducing infection prevention and control, and antimicrobial management education for nurses, prescribers, and resident families.
  • Educate non-nursing staff who provide care to residents about infection prevention and control, and the importance of basic personal and hygienic care.

Key findings from the AC NAPS 2019 report

  • About 20% of prescriptions were for prevention. This is a concern as antibiotics are rarely recommended for prevention.
  • Almost one-third (30.4%) of all prescriptions are topical antibiotics, which also account for more than 90% of prn (if needed) prescriptions, most commonly clotrimazole (74.1%). I did. Prn use of clotrimazole can lead to inadequate duration of treatment and unnecessary use of antifungal agents, either locally or systemically, which can contribute to the development of resistance. There is sex.
  • Almost one-sixth (15.0%) of antibiotics were prescribed for prn administration, which could reduce clinical reviews of antibiotic selection and treatment duration decisions at the onset of infection and extend treatment duration. ..
  • Improved antimicrobial review or discontinuation date documentation (64.7%) compared to 2018 (58.9%).
  • The most common clinical indication for antibiotic use was cystitis. Other — skin, soft tissue or mucous membranes; pneumonia; ringworm; and non-surgical wound infections. Many of these conditions can be prevented by managing hydration and providing proper basic hygiene. Non-pharmacological management is also an important consideration for these conditions.
  • Cephalexin, topical clotrimazole, amoxicillin-clavulanic acid, trimethoprim, and doxycycline were the most commonly used antibacterial agents. Drugs with a narrower spectrum than cephalexin or amoxicillin-clavulanic acid are recommended for many infections because they are less likely to promote antibiotic resistance.

Topical antifungal use and unnecessary treatment of asymptomatic bacteriuria are two permanent problems identified by ACNAPS, and resources have been developed to support the response to these problems. I did.

Access current resources to support antimicrobial management in the elderly care environment at: https://www.safetyandquality.gov.au/antioxidant-stewardship-aged-care..

Kristin Xenos is a Senior Project Officer of the Antimicrobial Stewardship (AMS) of the AURA team of the Australian Healthcare Safety and Quality Commission. Kristin is a Fellow of the Australian Hospital Pharmacist Association (SHPA), a member of the SHPA Infectious Diseases Leadership Committee, and an Advancing Practice Pharmacist (Stage III).She is a co-host of Purple pen podcast (All podcasts about clinical pharmacies).

Professor John Turnidge AO is a Senior Medical Advisor to the AURA Monitoring Program of the Australian Healthcare Safety and Quality Commission and has been the clinical leader in the establishment and operation of the AURA monitoring system since 2014. Professor Turnidge is a science secretary. An affiliated professor of the European Commission on Antimicrobial Sensitivity Testing, an honor, and a clinical professor of the University of Adelaide School of Health Sciences (Pathology and Pediatrics).

Image Credit: © stock.adobe.com / au / MonkeyBusiness

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