Appropriate Antibiotic use in Aged Care
Published: 14 July 2020
Published: 14 July 2020
Antimicrobials is the broad term used to describe all medications that treat infections caused by pathogens (viruses, bacteria, parasites and fungi). Antibiotics are the specific type of antimicrobial used to treat bacterial infections (ACSQHC 2017).
This article will focus on the use of antibiotics in aged care.
Residents in aged care are often frail, have weak immune systems and live in close proximity to others, making them more susceptible to developing infections. This, in turn, correlates to increased antibiotic use in these facilities (AMR 2017).
However, with the World Health Organization declaring antimicrobial resistance (AMR) a major health concern, the prevalence of antibiotics in aged care poses a significant threat to a vulnerable population. In order to minimise the risk of antibiotic-resistant infections emerging and spreading in these environments, it is critical to prescribe and manage antibiotics appropriately (AMR 2017; ACSQHC 2016).
Using antibiotics appropriately means:
Appropriate antibiotic prescribing and use is a component of the Aged Care Quality Standards Standard 3: Personal Care and Clinical Care.
Antimicrobial resistance describes the way in which a pathogen (in this case bacterium) may change upon exposure to an antimicrobial medication, causing it to develop a resistance to that particular medication. The medication used to treat the infection consequently becomes ineffective (WHO 2018).
These infections, sometimes known as ‘superbugs’, are notoriously difficult to treat and may result in prolonged hospital stays, disease or death. While aged care residents are particularly vulnerable, these infections can affect anybody if they spread, and they may be impossible to treat (WHO 2018; CDC 2020; AMR 2017).
There is a direct link between antimicrobial resistance and the misuse or overuse of antibiotics. Antimicrobial resistance is a naturally-occurring phenomenon, however, inappropriate antibiotic use accelerates this process (WHO 2018).
In order to reduce the risk of resistant infections emerging and spreading, we must use antibiotics only when they are most needed and practice infection-prevention practices to minimise the likelihood of contracting infections in the first place (AMR 2017).
Despite the widespread use of antibiotics in aged care, there is minimal evidence to guide antimicrobial stewardship in these facilities (AMR 2017).
It may come as no surprise, then, that there are significant issues surrounding the use of antibiotics in aged care.
The 2016 Aged Care National Antimicrobial Prescribing Survey yielded some concerning statistics:
Why is antibiotic overuse so prevalent in aged care? Some of the identified reasons include:
This reveals the key issue: there is a significant knowledge gap among both facilities and staff.
It is essential to always follow antibiotic prescribing guidelines when considering antibiotics as a treatment option.
The Therapeutic Guidelines: Antibiotic are based on the best available evidence and opinion in Australia (AMR 2017).
The Australian Medicines Handbook is another highly valuable resource for prescribing antibiotics (AMR 2017).
Remember to always follow your facility’s policies and procedures.
Antibiotic stewardship can be defined as ‘A set of commitments and activities designed to “optimise the treatment of infections while reducing the adverse events associated with antibiotic use” ’ (CDC 2015).
This is a critical skill set required by all staff involved in the prescribing and management of antibiotics.
The Antimicrobial Resistance Initiative (2017) provides the following suggestions for health professionals working in aged care:
Furthermore, the Centers for Disease Control and Prevention (2015) has developed the ‘Core Elements of Antibiotic Stewardship’ for aged care. These include:
In accordance with the Therapeutic Guidelines, antibiotics should, depending on the client’s condition and clinical response, only be used for the shortest length of time possible (TG 2019).
One of the most important components of antibiotic stewardship is practising infection control procedures and consequently minimising the transmission of infections that require antibiotic treatment in the first place (AMR 2017).
Facilities should be practising standard precautions for infection prevention and control, including:
While antibiotics are necessary for treating certain infections, Australian aged care facilities are suffering from significant training gaps that lead to antibiotic overuse, and consequently, may expose their vulnerable clients to antibiotic-resistance infections.
In order to appropriately prescribe and manage antibiotics in aged care settings, it is essential to follow the best available guidelines, as well as your facility’s policies and procedures.
Question 1 of 3
True or false? Antimicrobial resistance is a naturally-occurring phenomenon.
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