Nurse-led Antimicrobial Stewardship Intervention to Increase Antibiotic Appropriateness in Residential Aged Care Facilities

NCT ID: NCT03941509

Last Updated: 2022-01-13

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

UNKNOWN

Clinical Phase

NA

Total Enrollment

700 participants

Study Classification

INTERVENTIONAL

Study Start Date

2021-01-01

Study Completion Date

2022-06-30

Brief Summary

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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.

Detailed Description

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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:

1. 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.
2. 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.
3. 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
4. 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.

Conditions

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Antimicrobial Stewardship Urinary Tract Infections Respiratory Tract Infections Skin and Soft Tissue Infections

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

CROSSOVER

Stepped-wedge design will see a staggered roll out of the intervention over 16 months. Each cluster of two facilities will commence in the control phase (2 months) and transition to the intervention phase until all facilities receive the intervention. A transition phase of 2 months between the control and intervention phase will occur to allow for education and integration of the intervention.
Primary Study Purpose

TREATMENT

Blinding Strategy

NONE

Study Groups

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Control

All facilities will receive usual care during the control phase of the trial.

Group Type NO_INTERVENTION

No interventions assigned to this group

Antimicrobial stewardship

Implementation of the nurse-led bundled antimicrobial stewardship intervention

Group Type EXPERIMENTAL

Antimicrobial stewardship

Intervention Type BEHAVIORAL

Education, guidelines, communication tools and audit and feedback

Interventions

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Antimicrobial stewardship

Education, guidelines, communication tools and audit and feedback

Intervention Type BEHAVIORAL

Eligibility Criteria

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Inclusion Criteria

Residents:

* All residents from 12 RACFs will have de-identified data collected including antimicrobial use, infection, hospitalisation and mortality.
* Residents or their guardians who provide informed consent to monthly biospecimen sampling and participation in one-on-one interviews or focus groups.

Health professionals:

\- Health professionals (including aged care staff and GPs) who provide informed consent to participate in one-on-one interviews or focus groups.

Exclusion Criteria

* Residents or their guardians who do not consent to biospecimen sampling and/or participation in interviews/focus groups.
* Health professionals who do not consent to participate in interviews/focus groups.
Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Bupa Aged Care Australia

UNKNOWN

Sponsor Role collaborator

Monash University

OTHER

Sponsor Role collaborator

Bayside Health

OTHER_GOV

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Anton Peleg, MBBS, PhD, FRACP, PhD

Role: PRINCIPAL_INVESTIGATOR

Monash University

Locations

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Bupa residential aged care facilities

Melbourne, Victoria, Australia

Site Status RECRUITING

Countries

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Australia

Central Contacts

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Natali Jokanovic, BPharm, PhD

Role: CONTACT

+61 3 9903 0087

Trisha Peel, MBBS, FRACP, PhD

Role: CONTACT

+61 3 9076 2000

References

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Jokanovic N, Haines T, Cheng AC, Holt KE, Hilmer SN, Jeon YH, Stewardson AJ, Stuart RL, Spelman T, Peel TN, Peleg AY; START Trial Group. Multicentre stepped-wedge cluster randomised controlled trial of an antimicrobial stewardship programme in residential aged care: protocol for the START trial. BMJ Open. 2021 Mar 2;11(3):e046142. doi: 10.1136/bmjopen-2020-046142.

Reference Type DERIVED
PMID: 33653766 (View on PubMed)

Other Identifiers

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591/18

Identifier Type: -

Identifier Source: org_study_id

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