Preventing infection-related hospitalisations from residential aged care
A study by Monash University’s Centre for Medicine Use and Safety (CMUS) has identified strategies to limit infections in residential aged care services (RACS) and avoid unnecessary hospitalisations.
- Study identifies strategies to limit infections in residential aged care services (RACS) and avoid unnecessary hospitalisations.
- Infections are leading causes of hospitalisations from RACS, where residents often live in close proximity, have comorbid conditions and unavoidable contact with health care workers.
- These conditions are conducive to rapid infection transmission and increase the risk of morbidity and mortality from infectious diseases.
Implementing strategies to prevent infections within RACS is a key requirement outlined within Australia’s new Aged Care Quality Standards, with the need for vigilant infection management strategies becoming increasingly prevalent.
Researchers from CMUS - leading experts in medicine safety within aged care settings – worked alongside not-for-profit aged care provider Resthaven Incorporated to assess the root causes of infections in RACS and develop strategies to minimise the risk of infection and hospitalisations.
The study, published in the International Journal of Environmental Research and Public Health, involved a comprehensive review of 49 consecutive infection-related hospitalisations from six RACS, with more than half (59.2 per cent) of hospitalisations attributed to respiratory infections, 28.9 per cent for urinary infections and 10.2 per cent for skin infections.
The review, led by a team of clinical specialists, enabled researchers to assess the root causes of infection and develop key prevention strategies across five main domains including resident assessment, staff training, equipment and environment, policies and procedures, and communication and coordination.
Potential root causes of infections included use of medications that may increase infection risk, selection of empirical antimicrobial therapy, limitations within RACS to establish on-site intravenous access for antimicrobial administration and the need for rapid access medical services external to the RACS (e.g. radiology and pathology).
Lead researcher and director of CMUS, Professor Simon Bell, said: “Transmission of infection within RACS can be difficult to control - our research identifies strategies to mitigate against the risk of infection-related hospitalisations, providing a roadmap to prevent infection and limit unnecessary hospital transfers.”
Specific medications that may increase the risk of infection were also identified as a factor leading to hospitalisation. Professor Bell said: "While it's not always possible to avoid these medications, new strategies to prevent and monitor for infection in residents taking these medications may be particularly important.”
Other strategies to prevent infection-related hospitalisations included early detection of infection, employing pharmacists as member of aged care teams to help ensure appropriate antimicrobial use, clinical pathways for staff to respond to specific infections, and telehealth services to review and inform the decision to initiate hospital transfers.
Resthaven’s Executive Manager for Residential Services, Tina Cooper, said: “Involvement in this study has provided opportunities for Resthaven to review clinical practice and provide ongoing education to staff including additional learning and guidance resources to improve practice. Resthaven has launched on its internal intranet access for clinicians to e-therapeutic guidelines to support best practice prescribing and best use of antimicrobial therapy.”
“Additionally, Resthaven was pleased to have the opportunity to participate in the Pharmacist in Aged Care Program at one of our regional locations, whereby a pharmacist provides onsite support to staff, residents, families and GPs. We look forward to seeing the benefits of this program, which also supports the Residential Medication Management Review Program undertaken across all Resthaven homes by our contracted clinical pharmacist.”
Professor Bell says future studies could explore factors associated with successful implementation and associated outcomes for residents and other stakeholders.
11 June 2020.