For aged care

The rate of certain types of infection is often high in aged care facilities because residents often:

• are more frail
• have difficulties moving around
• have multiple medical problems
• have poor immune systems
• are incontinent
• have difficulty with speech
• need assistance with day-to-day activities. 

As a result,  health professionals prescribe antimicrobials to manage infections. We need to decrease antimicrobial use in this group to reduce the risk of rapid rise and spread of organisms resistant to many drugs.

What you can do

Health professionals

1. Consider any safe alternatives to an antimicrobial prescription
2. Prescribe according to the therapeutic guidelines  
3. Where possible, use diagnostics to inform treatment decisions
4. Talk to your patients about the importance of appropriate antibiotic use and the dangers of antimicrobial resistance
5. Give your patients advice on how to manage symptoms without antimicrobials
6. Apply best practice infection prevention and control
7. Talk to your patients about how to prevent infections and their spread (e.g. vaccination, good hygiene and handwashing) 

Aged care staff, residents and their families

1. Prevent infections by washing your hands often and keeping up to date with vaccinations
2. Prevent food-borne infections by washing fruits and vegetables and cooking food properly
3. Understand that antibiotics only work against bacteria. They do not work for colds and flus caused by a virus
4. Don’t pressure health professionals for antimicrobials if they say you don’t need them. Ask about other ways to relieve symptoms
5. Only take antimicrobials prescribed for you. Don’t use or share leftover antimicrobials
6. Follow health professionals’ instructions for prescribed antimicrobials

This is an infographic describing six important actions health professionals can take to reduce antibiotic resistance.

Key issues

• Residents of facilities with high antimicrobial use have an increased risk of antimicrobial resistant infection. This includes people who are not receiving antimicrobial therapy, because infections can pass to other people.
• The Antimicrobial use in the community: 2023 report shows fewer antimicrobials used in the general community in 2023 compared to 2015. However, health professionals’ prescribing of antimicrobials remains high in aged care homes. This increased by over 11% from 2022 to 2023. It is an area of concern.
• In response to the COVID-19 pandemic, the Australian Government set new requirements for aged care homes. This is to strengthen infection prevention and control (IPC) capability and expertise across the sector. The strengthened Aged Care Quality Standards will include new IPC and antimicrobial stewardship (AMS) requirements. They take effect from 1 July 2025.
• The Aged Care Infection Prevention and Control Guide (August 2024):
  o    supports aged care organisations meet the IPC-related actions in the strengthened Aged Care Quality Standards
  o    minimises the risk of infection for older people and the workforce. 
• The 2022 Aged Care National Antimicrobial Prescribing Survey (acNAPS) highlights the following:
  o    3% of residents had signs or symptoms of at least one suspected infection
  o    12.5% of residents had a current prescription for antimicrobials
  o    37.6% of antimicrobials were administered for longer than six months
  o    78.4% of antimicrobials administered had the indication recorded
  o    55.4% of antimicrobials administered had the review or stop date recorded.
• The Australian Government Department of Health and Aged Care funded a pilot surveillance project on antimicrobial use in aged care facilities. The National Antimicrobial Utilisation Surveillance Program (NAUSP) delivered the project. As part of this project, Maher et al, published a paper in 2024 that maps antimicrobial use in these facilities. 

Areas for action

To improve the use of antimicrobials, health professionals in aged care facilities, aged care providers and aged care staff can:

• Always use standard infection control precautions when working with residents, e.g. good hand hygiene. This will reduce the spread of infections between residents, health care professionals and visitors.
• Prescribe antimicrobials in line with therapeutic guidelines.
• Where possible, use diagnostic tests to inform treatment decisions.
• Adopt antimicrobial stewardship (AMS) measures based on available resources and the facility needs.
  • See Aged Care Quality and Safety Commission’s AMS resources for providers and clinicians
  • Watch a webinar on the new Aged Care Infection Prevention and Control Guide.
  • Read the Aged Care Infection Prevention and Control Guide.
• Ensure residents are up to date with recommended vaccinations.
• Participate in the Aged Care National Antimicrobial Prescribing Survey (acNAPS) to improve antimicrobial stewardship in aged care facilities.
• Nurses also play an important role in combating antimicrobial resistance. You can find more information on the Nurses and Antimicrobial Resistance fact sheet.