The study will explore the impact of a nurse-led bundled antimicrobial stewardship intervention on the appropriateness of antimicrobial use in residential aged care facilities (RACFs).~The antimicrobial stewardship intervention will include the following components:~Education~Focused on antimicrobial stewardship and appropriate antimicrobial use~Delivered face-to-face, via workbooks and fact sheets to aged care staff, general practitioners (GPs), pharmacists, and residents and families. Education will be delivered by the research coordinator.~Guidelines~Aged care-specific guidelines for the assessment and antimicrobial management of urinary tract infections, respiratory tract infections and skin and soft tissue infections.~Antimicrobial management recommendations including empirical oral therapy, doses and duration of therapy.~Communication~Documentation for the assessment and antimicrobial management of infections.~Nurse-led engagement with residents and families.~Newsletters and online updates to highlight evidence-based prescribing practice~Audit and feedback - Surveillance and feedback to prescribers on antimicrobial use and facility-level antimicrobial susceptibility data.~The intervention bundle will first be implemented and tested for feasibility and acceptability over a 3-month period in two RACFs in Victoria, Australia. This tailored intervention will then be assessed in a stepped-wedge cluster randomised controlled trial across 12 RACFs over an 16-month period.~A cluster of two facilities will each transition through three phases over the 16 month trial:~Control phase: baseline data collection. Usual care at each facility.~Transition phase: Delivery of education and integration of the intervention. No data collection.~Intervention phase: implementation of the intervention and outcome data collection. Ongoing education to new and existing staff will be provided as required.~Following the 16-month trial, the refined intervention bundle will be implemented nationally across a network of RACFs.
The study will explore the impact of a nurse-led bundled antimicrobial stewardship intervention on the appropriateness of antimicrobial use in residential aged care facilities. The intervention will be assessed in a stepped-wedge cluster randomised controlled trial across 14 residential aged care facilities over an 18-month period.