ncas-australia

Nurses: an underused, vital asset against drug-resistant infections

Sat, 03 Sep 2022 01:14:37 GMT

Nurses: an underused, vital asset against drug-resistant infections

Enrique Castro-Sánchez, Jo Bosanquet, Molly Courtenay, Rose Gallagher, Fiona Gotterson, Elizabeth Manias, Jo McEwen, Val Ness, Rita Olans, Maria Clara Padoveze, Briette du Toit & Miquel Bennasar-Veny

Read the correspondence here , in response to Murray, C. et al Global burden of bacterial antimicrobial resistance in 2019: a systematic analysis, also published in The Lancet (found here ).

Citation :

Castro-Sánchez, E., Bosanquet, J., Courtenay, M., Gallagher, R., Gotterson, F., Manias, E., ... & Bennasar-Veny, M. (2022). Nurses: an underused, vital asset against drug-resistant infections. The Lancet, 400(10354), 729. doi: https://doi.org/10.1016/S0140-6736(22)01531-8

A novel GPPAS model: Guiding the implementation of antimicrobial stewardship in primary care utilising collaboration between general practitioners and community pharmacists

Sat, 27 Aug 2022 01:15:26 GMT

A novel GPPAS model: Guiding the implementation of antimicrobial stewardship in primary care utilising collaboration between general practitioners and community pharmacists

Sajal K Saha, Karin Thursky, David C.M. Kong and Danielle Mazza

Abstract

Interprofessional collaboration between general practitioners (GPs) and community pharmacists (CPs) is central to implement antimicrobial stewardship (AMS) programmes in primary care.

This study aimed to design a GP/pharmacist antimicrobial stewardship (GPPAS) model for primary care in Australia.

An exploratory study design was followed that included seven studies conducted from 2017 to 2021 for the development of the GPPAS model. We generated secondary and primary evidence through a systematic review, a scoping review, a rapid review, nationwide surveys of Australian GPs and CPs including qualitative components, and a pilot study of a GPPAS submodel. All study evidence was synthesised, reviewed, merged, and triangulated to design the prototype GPPAS model using a Systems Engineering Initiative for Patient Safety theoretical framework. The secondary evidence provided effective GPPAS interventions, and the primary evidence identified GP/CP interprofessional issues, challenges, and future needs for implementing GPPAS interventions.

The framework of the GPPAS model informed five GPPAS implementation submodels to foster implementation of AMS education program, antimicrobial audits, diagnostic stewardship, delayed prescribing, and routine review of antimicrobial prescriptions, through improved GP–CP collaboration. The GPPAS model could be used globally as a guide for GPs and CPs to collaboratively optimise antimicrobial use in primary care. Implementation studies on the GPPAS model and submodels are required to integrate the GPPAS model into GP/pharmacist interprofessional care models in Australia for improving AMS in routine primary care.

Read the full paper here .

Citation :

Saha, S. K., Thursky, K., Kong, D., & Mazza, D. (2022). A Novel GPPAS Model: Guiding the Implementation of Antimicrobial Stewardship in Primary Care Utilising Collaboration between General Practitioners and Community Pharmacists. Antibiotics, 11(9), 1158. doi: 10.3390/antibiotics11091158

Influences on nurses’ engagement in antimicrobial stewardship behaviours: A multi-country survey using the Theoretical Domains Framework

Thu, 18 Aug 2022 01:48:10 GMT

Influences on nurses’ engagement in antimicrobial stewardship behaviours: A multi-country survey using the Theoretical Domains Framework

Angel Marie Chater, Hannah Family, Ligia Maria Abraao, Emma Burnett, Enrique Castro-Sanchez, Briëtte Du Toit, Rose Gallagher, Fiona Gotterson, Elizabeth Manias, Jo Mcewen, Rosely Moralez de Figueiredo, Martina Nathan, Val Ness, Rita Olans, Maria Clara Padoveze & Molly Courtenay

Abstract

Background

Antimicrobial resistance (AMR) is significantly affected by inappropriate antibiotic use, and is one of the greatest threats to human health. Antimicrobial stewardship (AMS) is a programme of actions promoting responsible antimicrobial use, and is essential for limiting AMR. Nurses have an important role to play in this context.

Aim

This study investigated the determinants of nurse AMS behaviours and the impact of past training.

Method

A cross-sectional multi-country survey design with mixed methods was employed. Participants were 262 nurses (223 female; mean age = 44.45; SD = 10.77 years) from ten nationalities, with individual survey links sent via professional networks in 5 countries, alongside Twitter. Nine AMS behaviours and 14 behavioural determinants were quantitatively assessed using the Theoretical Domains Framework (TDF), and mapped to the COM-B (Capability, Opportunity, Motivation – Behaviour) model. Analysis identified differences between nurses with and without AMS training. The influence of COVID-19 on AMS behaviour was qualitatively investigated using free text data.

Findings

Nurses performed all nine AMS behaviours, which were significantly higher (t(238) = -4.14, p < .001), by those who had training (M = 53.15; SD = 7.40) compared to those who had not (M = 48.30; SD = 10.75). Those with AMS training scored significantly higher in all of the TDF domains. The TDF was able to explain 27% of the variance in behaviour, with ‘Skills’ and ‘Behavioural Regulation’ (e.g. ability to self-monitor and plan), shown to be the most predictive of AMS actions. Both of these domains are situated in the Capability construct of COM-B, which can be enhanced with the intervention strategies of education and training. An increase in AMS behaviours was reported since COVID-19, regardless of previous training. Six core themes were linked to AMS: 1) Infection prevention and control, 2) Antimicrobials and antimicrobial resistance, 3) The diagnosis of infection and the use of antibiotics, 4) Antimicrobial prescribing practice, 5) Person-centred care, and 6) Interprofessional collaborative practice.

Conclusion

This research, has identified the significant benefit of nurse training on AMS behaviour, and its determinants. Those who had training, scored higher in all TDF determinants of behaviour, compared to those who had had no training, resulting in higher Capability, Opportunity and Motivation to perform AMS behaviours. AMS education and training should be offered to nurses to enhance these factors. Future research should consider the optimal level of training to optimise AMS behaviour, with a focus on developing skills and behavioural regulation.

Read the full paper here .

Citation :

Chater, A. M., Family, H., Abraao, L. M., Burnett, E., Castro-Sanchez, E., Du Toit, B., Gallagher, R., Gotterson, F. ... & Courtenay, M. (2022). Influences on nurses’ engagement in antimicrobial stewardship behaviours: A multi-country survey using the Theoretical Domains Framework. Journal of Hospital Infection. 2022 July. doi: https://doi.org/10.1016/j.jhin.2022.07.010

Prophylactic antimicrobial prescribing in Australian residential aged-care facilities: Improvement is required.

Wed, 17 Aug 2022 03:30:29 GMT

Prophylactic antimicrobial prescribing in Australian residential aged-care facilities: Improvement is required

Noleen Bennett , Michael J Malloy , Rodney James , Xin Fang , Karin Thursky & Leon J Wort h

Abstract

Background and objective: Inappropriate antimicrobial use can lead to adverse consequences, including antimicrobial resistance. The objective of our study was to describe patterns of prophylactic antimicrobial prescribing in Australian residential aged-care facilities and thereby provide insight into antimicrobial stewardship strategies that might be required.

Methods: Annual point prevalence data submitted by participating residential aged-care facilities as part of the Aged Care National Antimicrobial Prescribing Survey between 2016 and 2020 were extracted. All antimicrobials except anti-virals were counted; methenamine hippurate was classified as an antibacterial agent.

Results: The overall prevalence of residents prescribed one or more prophylactic antimicrobial on the survey day was 3.7% (n = 4643, 95% confidence interval 3.6-3.8). Of all prescribed antimicrobials (n = 15,831), 27.1% (n = 4871) were for prophylactic use. Of these prophylactic antimicrobials, 87.8% were anti-bacterials and 11.4% antifungals; most frequently, cefalexin (28.7%), methenamine hippurate (20.1%) and clotrimazole (8.8%). When compared with prescribing of all antimicrobial agents, prophylactic antimicrobials were less commonly prescribed for pro re nata administration (7.0% vs 20.3%) and more commonly prescribed greater than 6 months (52.9% vs 34.1%). The indication and review or stop date was less frequently documented (67.5% vs 73.8% and 20.9% vs 40.7%, respectively). The most common body system for which a prophylactic antimicrobial was prescribed was the urinary tract (54.3%). Of all urinary tract indications (n = 2575), about two thirds (n = 1681, 65.3%) were for cystitis and 10.6% were for asymptomatic bacteriuria.

Conclusions: Our results clearly identified immediate antimicrobial stewardship strategies that aim to improve prophylactic antimicrobial prescribing in Australian residential-aged care facilities are required.

Read the full paper here .

Citation : Bennett, N., Malloy, MJ., James, R., Fang, X., Thursky, K., & Worth, LJ. (2022). Prophylactic Antimicrobial Prescribing in Australian Residential Aged-Care Facilities: Improvement is Required. Drugs Real World Outcomes. DOI: 10.1007/s40801-022-00323-5.

Improving management of urinary tract infections in residential aged care facilities

Sun, 07 Aug 2022 23:35:32 GMT

Improving management of urinary tract infections in residential aged care facilities

Lyn-Li Lim, Noleen Bennett

Abstract

Antimicrobial resistance rates are higher in Australian residential aged care facilities (RACFs) than other community or hospital settings. This is driven by antibiotic overuse and misuse. Urinary tract infection (UTI) is consistently the most common infection treated with antibiotics in Australian RACFs. The aim of this article is to provide an overview of how general practitioners (GPs) can support appropriate UTI management in RACFs following antimicrobial stewardship (AMS) principles. GPs are well placed to improve UTI management in RACFs. In this article, criteria for suspected, proven, recurrent and relapsed UTI are outlined, in addition to key AMS practices for the assessment, prevention, treatment and review of UTIs. Included are recommendations for the judicious use of urine dipstick testing, a widespread and longstanding practice in RACFs, and first-line empirical antibiotic prescribing for suspected UTIs.

Read the full paper here .

Citation: Lim, L. L., & Bennett, N. (2022). Improving management of urinary tract infections in residential aged care facilities. Australian journal of general practice, 51(8), 551-557. DOI: https://doi.org/ 10.31128/AJGP-05-22-6413 .

Opportunities for nurse involvement in surgical antimicrobial stewardship strategies: A qualitative study

Sun, 30 Jan 2022 07:06:55 GMT

Opportunities for nurse involvement in surgical antimicrobial stewardship strategies: A qualitative study

Courtney Ierano, Arjun Rajkhowa, Fiona Gotterson, Caroline Marshall, Trisha Peel, Darshini Ayton, Karin Thursky

Abstract

Background

Multi-disciplinary antimicrobial stewardship teams are a common strategy employed to optimise antimicrobial prescribing. Nurses play a pivotal role in patient care and safety; however, their role and potential opportunities across surgical antimicrobial stewardship are not well-established. This study aims to highlight health professional perspectives of the nurse's role and relevant opportunities for nurses to engage in and lead surgical antimicrobial stewardship initiatives.

Methods

An exploratory, multi-site, collective qualitative case study. Transcribed audio-recordings of focus groups with health professionals underwent thematic analysis, with mapping to established frameworks.

Results

Four key themes were identified; surgical antimicrobial prophylaxis is not prioritised for quality improvement, but nurses perceive benefits from surgical antimicrobial prophylaxis education and training; professional hierarchy hinders nurse engagement and leadership in antimicrobial stewardship; nurses are consistently engaged with patient care throughout the surgical journey; and clarity of roles and accountability for surgical antimicrobial prophylaxis review and follow-up can bolster quality improvement initiatives.

Discussion

Many opportunities exist for nurse engagement in surgical antimicrobial stewardship. Identification of barriers and enablers support theoretically informed strategies i.e., education and guideline accessibility; multidisciplinary collaborations; executive support for nursing capacity building and the standardisation of surgical antimicrobial prophylaxis workflow and documentation.

Conclusions

Nurses are critical to patient safety and to supporting antimicrobial stewardship, in the operating theatre, and throughout the patient's surgical journey. Applying theoretical frameworks to understand barriers and enablers to nurses’ contribution to antimicrobial stewardship has given insights to inform interventions to support nurse engagement.

Tweetable abstract : Nurses are critical for patient safety. Many opportunities exist to support them as surgical antimicrobial stewards.

Read the full paper here .

Citation : Ierano, C., Rajkhowa, A., Gotterson, F., Marshall, C., Peel, T., Ayton, D., & Thursky, K. (2022). Opportunities for nurse involvement in surgical antimicrobial stewardship strategies: A qualitative study. International Journal of Nursing Studies, 128, 104186. DOI: https://doi.org/10.1016/j.ijnurstu.2022.104186 .

A systems thinking approach for antimicrobial stewardship in primary care

Thu, 30 Dec 2021 07:46:56 GMT

Sajal K. Saha, David C.M. Kong, Danielle Mazza & Karin Thursky

Abstract

Introduction

The establishment of antimicrobial stewardship (AMS) in primary care is central to substantially reduce the antimicrobial use and the associated risk of resistance. This perspective piece highlights the importance of systems thinking to set up and facilitate AMS programs in primary care.

Areas covered

The challenges that primary care faces to incorporate AMS programmes is multifactorial: an implementation framework, relevant resources, team composition, and system structures remain under-researched, and these issues are often overlooked and/or neglected in most parts of the world. Progress in the field remains slow in developed countries but potentially limited in low- and middle-income countries.

Expert opinion

The key AMS strategies to optimize antimicrobial use in primary care are increasingly known; however, health system components that impact effective implementation of AMS programs remain unclear. We highlight the importance of systems thinking to identify and understand the resource arrangements, system structures, dynamic system behaviors, and intra- and interprofessional connections to optimally design and implement AMS programs in primary care. An AMS systems thinking systemigram (i.e. a visual representation of overall architecture of a system) could be a useful tool to foster AMS implementation in primary care.

Read the full paper here .

Citation : Saha, S. K., Kong, D. C. M., Mazza, D., & Thursky, K. (2022). A systems thinking approach for antimicrobial stewardship in primary care. Expert Review of Anti-Infective Therapy, 20(6), 819-827. DOI: https://doi.org/10.1080/14787210.2022.2023010 .

Consensus guidelines for antifungal stewardship, surveillance and infection prevention, 2021

Wed, 22 Dec 2021 03:51:20 GMT

Anna Khanina, Shio Yen Tio, Michelle R. Ananda-Rajah, Sarah E. Kidd, Eloise Williams, Lynette Chee, Karen Urbancic, Karin A. Thursky and Australasian Antifungal Guidelines Steering Committee

Abstract

Invasive fungal diseases (IFD) are serious infections associated with high mortality, particularly in immunocompromised patients. The prescribing of antifungal agents to prevent and treat IFD is associated with substantial economic burden on the health system, high rates of adverse drug reactions, significant drug–drug interactions and the emergence of antifungal resistance. As the population at risk of IFD continues to grow due to the increased burden of cancer and related factors, the need for hospitals to employ antifungal stewardship (AFS) programmes and measures to monitor and prevent infection has become increasingly important. These guidelines outline the essential components, key interventions and metrics, which can help guide implementation of an AFS programme in order to optimise antifungal prescribing and IFD management. Specific recommendations are provided for quality processes for the prevention of IFD in the setting of outbreaks, during hospital building works, and in the context of Candida auris infection. Recommendations are detailed for the implementation of IFD surveillance to enhance detection of outbreaks, evaluate infection prevention and prophylaxis interventions and to allow benchmarking between hospitals. Areas in which information is still lacking and further research is required are also highlighted.

Read the full paper here .

Citation : Khanina, A., Tio, S. Y., Ananda-Rajah, M. R., Kidd, S. E., Williams, E., Chee, L., Urbancic, K., Thursky, K. A., & Australasian Antifungal Guidelines Steering, C. (2021, 2021/11/01). Consensus guidelines for antifungal stewardship, surveillance and infection prevention, 2021. Internal Medicine Journal, 51 (S7), 18-36. DOI: https://doi.org/https://doi.org/10.1111/imj.15586 .

NCAS AAW 2021: AMS in aged care

Mon, 22 Nov 2021 06:47:57 GMT

Antimicrobial Awareness Week 2021 - webinar

ANTIMICROBIAL STEWARDSHIP IN AGED CARE

Chair: A/Prof. Noleen Bennett (NCAS & VICNISS, Melbourne Health)

Quality use of antimicrobials in residential aged care services: An update from the Aged Care Quality and Safety Commission

Dr. Lyn-li Lim (Aged Care Quality and Safety Commission)

Basic principles of antimicrobial use

Ms. Xin Fang (NCAS, Melbourne Health)

The Royal Commission into Aged Care and the implications for AMS

Dr. Janet Sluggett (Registry of Senior Australians, South Australian Health and Medical Research Institute)

National Infection Surveillance Program for Aged Care (NISPAC)

A/Prof. Leon Worth (VICNISS, Melbourne Health)

Preliminary results: Barriers and enablers to the implementation of a national infection and antimicrobial surveillance system

Ms. Eliza Watson (NISPAC, Melbourne Health)

Recommended resources for IPC and AMS

A/Prof. Noleen Bennett (NCAS & VICNISS, Melbourne Health)

NCAS AAW 2021: How to use data

Fri, 19 Nov 2021 23:15:45 GMT

Antimicrobial Awareness Week 2021 - webinar

HOW TO USE DATA – SUCCESS STORIES, PITFALLS AND OPPORTUNITIES

Chair: Prof. Karin Thursky (NCAS, Department of Infectious Diseases, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne)

Optimising audit and feedback: recent evidence from implementation research

Prof. Jill Francis (School of Health Sciences, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne)

CASE STUDIES

How to optimise antimicrobial allergy documentation

A/Prof. Jason Trubiano (Austin Hospital, Melbourne)

How big is this problem? Quantifying paediatric infections using activity-based management data

Dr. Brendan McMullan (Sydney Children's Hospital)

An innovative AMS program for children in remote and regional areas: optimising antibiotic use through early intravenous-to-oral conversion

Dr. Minyon Avent (State-wide AMS Program, Queensland Health)

Repurposing disease surveillance to capture social drivers of AMR

Dr. Teresa Wozniak (CSIRO)

Applying big data to general practice: implementation of AMS

Dr. Brian Hur (NCAS & APCAH, Faculty of Veterinary and Agricultural Sciences, University of Melbourne)

Evaluating the implementation of a pilot quality improvement program to support appropriate antimicrobial prescribing in general practice

Dr. Ruby Biezen (Department of General Practice & NCAS, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne)

Embedding clinical trials in the electronic medical record to improve antibiotic use

Dr. Coen Butters (John Hunter Children’s Hospital, Newcastle)

Q&A

The National Antimicrobial Prescribing Survey and the Clinical Care Standards

Dr. Rodney James (NCAS, Melbourne Health), Ms. Xin Fang (NCAS, Melbourne Health) and Ms. Fiona Doukas (Australian Commission on Safety and Quality in Health Care)

NCAS AAW 2021: Veterinary AMS

Thu, 18 Nov 2021 06:35:59 GMT

Antimicrobial Awareness Week 2021 - webinar

VETERINARY ANTIMICROBIAL STEWARDSHIP

Chair: Prof. James Gilkerson (NCAS & APCAH, Faculty of Veterinary and Agricultural Sciences, University of Melbourne)

Antimicrobial stewardship trial in companion animal veterinary practice

Dr. Kirsten Bailey and Dr. Laura Hardefeldt (NCAS & APCAH, Faculty of Veterinary and Agricultural Sciences, University of Melbourne)

How veterinary laboratories can contribute to antimicrobial stewardship

Dr. Ri Scarborough (NCAS & APCAH, Faculty of Veterinary and Agricultural Sciences, University of Melbourne)

Know your audience! Evidence-based ways to talk to pet owners about responsible antibiotic use

Dr. Ri Scarborough (NCAS & APCAH, Faculty of Veterinary and Agricultural Sciences, University of Melbourne)

Unravelling the spread of antimicrobial (and biocide) resistance(s) in a veterinary hospital through environmental surveillance

Dr. Marc Marenda (Faculty of Veterinary and Agricultural Sciences, University of Melbourne)

Antimicrobial stewardship in Australia: the role of qualitative research in programme development

Thu, 18 Nov 2021 03:35:53 GMT

Karin A Thursky, Laura Y Hardefeldt, Arjun Rajkhowa, Courtney Ierano, Jaclyn Bishop, Lesley Hawes, Ruby Biezen, Sajal K Saha, Leslie Dowson, Kirsten E Bailey, Ri Scarborough, Stephen B Little, Fiona Gotterson, Brian Hur, Anna Khanina, Karen Urbancic, Helen K Crabb, Suzanna Richards, Anna Sri, Rodney James, David C M Kong, Caroline Marshall, Danielle Mazza, Trisha Peel, Rhonda L Stuart, Jo-Anne Manski-Nankervis, N Deborah Friedman, Noleen Bennett, Thomas Schulz, Helen Billman-Jacobe, Evette Buono, Leon Worth, Ann Bull, Michael Richards, Darshini Ayton, James R Gilkerson, Glenn F Browning, Kirsty L Buising, National Centre for Antimicrobial Stewardship

Abstract

Antimicrobial stewardship (AMS) in Australia is supported by a number of factors, including enabling national policies, sectoral clinical governance frameworks and surveillance programmes, clinician-led educational initiatives and health services research. A One Health research programme undertaken by the National Centre for Antimicrobial Stewardship (NCAS) in Australia has combined antimicrobial prescribing surveillance with qualitative research focused on developing antimicrobial use-related situational analyses and scoping AMS implementation options across healthcare settings, including metropolitan hospitals, regional and rural hospitals, aged care homes, general practice clinics and companion animal and agricultural veterinary practices. Qualitative research involving clinicians across these diverse settings in Australia has contributed to improved understanding of contextual factors that influence antimicrobial prescribing, and barriers and facilitators of AMS implementation. This body of research has been underpinned by a commitment to supplementing ‘big data’ on antimicrobial prescribing practices, where available, with knowledge of the sociocultural, technical, environmental and other factors that shape prescribing behaviours. NCAS provided a unique opportunity for exchange and cross-pollination across the human and animal health programme domains. It has facilitated synergistic approaches to AMS research and education, and implementation of resources and stewardship activities. The NCAS programme aimed to synergistically combine quantitative and qualitative approaches to AMS research. In this article, we describe the qualitative findings of the first 5 years.

Read the full paper here .

Citation : Thursky, K. A., Hardefeldt, L. Y., Rajkhowa, A., Ierano, C., Bishop, J., Hawes, L., Biezen, R., Saha, S. K., Dowson, L., Bailey, K. E., Scarborough, R., Little, S. B., Gotterson, F., Hur, B., Khanina, A., Urbancic, K., Crabb, H. K., Richards, S., Sri, A., James, R., Kong, D. C. M., Marshall, C., Mazza, D., Peel, T., Stuart, R. L., Manski-Nankervis, J.-A., Friedman, N. D., Bennett, N., Schulz, T., Billman-Jacobe, H., Buono, E., Worth, L., Bull, A., Richards, M., Ayton, D., Gilkerson, J. R., Browning, G. F., Buising, K. L., & National Centre for Antimicrobial, S. (2021). Antimicrobial stewardship in Australia: the role of qualitative research in programme development. JAC-Antimicrobial Resistance, 3(4), dlab166. DOI: https://doi.org/10.1093/jacamr/dlab166 .

Water distribution systems in pig farm buildings: critical elements of design and management

Mon, 15 Nov 2021 07:39:20 GMT

Stephen Little, Andrew Woodward, Glenn Browning and Helen Billman-Jacobe

Summary

The piped water systems within buildings on pig farms provide pigs with continuous access to drinking water, and on many farms are also used for short periods to medicate growing pigs with antibiotics to help keep them healthy and productive. We surveyed managers of 25 medium to large pig farms across eastern and southern Australia to investigate critical elements of the design and management of water systems that impact water provision to pigs. We found wide variation in the configuration, length, and pipe materials and diameters of water systems in buildings across farms. In many buildings, main pipelines were larger in diameter than required. While this helps ensure that drinkers always provide plenty of water to pigs, it means water flows through pipes very slowly. We also found that in many buildings the number of pigs per drinker was above the recommended maximum, cleaning and disinfection of water systems was not done on many farms, and few managers were aware of the risks to water quality and pig health. We have identified important aspects of water provision to pigs for which recommendations could be added to industry guidelines used by pig farm managers.

Abstract

Drinking water distribution systems (WDSs) within buildings on pig farms have critical elements of their design and management that impact water provision to pigs, water quality, the efficacy of in-water antimicrobial dosing, and, thus, pig health and performance. We used a mixed-methods approach to survey managers of 25 medium to large single-site and multi-site pig farming enterprises across eastern and southern Australia. We found wide variation in the configuration (looped or branched) and total length of WDSs within buildings across farms and in pipe materials and diameters. Within many conventional buildings and some eco-shelters, WDSs were ‘over-sized’, comprising large-diameter main pipelines with high holding volumes, resulting in slow velocity water flows through sections of a WDS’s main pipeline. In over half of the weaner buildings and one-third of grower/finisher buildings, the number of pigs per drinker exceeded the recommended maximum. Few farms measured flow rates from drinkers quantitatively. WDS sanitization was not practiced on many farms, and few managers were aware of the risks to water quality and pig health. We identified important aspects of water provision to pigs for which valuable recommendations could be added to industry guidelines available to pig farm managers.

Read the full paper here .

Citation : Little, S., Woodward, A., Browning, G., & Billman-Jacobe, H. (2021). Water distribution systems in pig farm buildings: critical elements of design and management. Animals, 11(11). DOI: https://doi.org/10.3390/ani11113268 .

Pet owners and antibiotics: knowledge, opinions, expectations, and communication preferences

Fri, 29 Oct 2021 03:24:04 GMT

Ri Scarborough, Laura Hardefeldt, Glenn Browning and Kirsten Bailey

Abstract

Despite the important role of antimicrobial use in companion animals in the global challenge presented by antimicrobial resistance (AMR), very few studies have quantified pet owner factors that can contribute to suboptimal veterinary antimicrobial use. We conducted an online survey of pet owners, asking about their experiences with veterinarians, their opinions on antibiotic use and knowledge of antibiotics, and their communication preferences regarding judicious prescribing. Just over half (54%) of the 558 pet owners had received antibiotics for their pet at their last non-routine veterinary consultation and most owners were happy (83%) with the antibiotic prescribing decision of their veterinarian. A quarter (25%) indicated that they had been surprised, disappointed or frustrated when a veterinarian had not given their pet antibiotics; 15% had explicitly requested them. Owners placed a higher priority on their pet receiving the most effective treatment than on treatment being cheap or convenient. Most respondents recognized the limitations of antibiotic therapy and the risks associated with antibiotic use, but 50% believed the risks were confined to the treated animal; only a minority was aware of inter-species transfer of bacteria. Pet owners indicated that they would find judicious prescribing messages focused on the direct risks of antibiotics to their pet more compelling than those about public health. Our findings suggest that veterinary communications about responsible antibiotic use should focus on pet owners’ priorities and address or bypass their gaps in understanding regarding antibiotic resistance.

Read the full paper here .

Citation : Scarborough, R., Hardefeldt, L., Browning, G., & Bailey, K. (2021). Pet owners and antibiotics: knowledge, opinions, expectations, and communication preferences. Antibiotics, 10(11). DOI: https://doi.org/10.3390/antibiotics10111326 .

Implementation of a cellulitis management plan in three Australian regional health services to address an evidence–practice gap in antibiotic prescribing

Fri, 22 Oct 2021 06:45:57 GMT

Jaclyn Bishop, Mark Jones, James Farquharson, Kathrine Summerhayes, Roxanne Tucker, Mary Smith, Raquel Cowan, N. Deborah Friedman, Thomas Schulz, David Kong and Kirsty Buising

Abstract

Despite the availability of evidence-based guidelines, antibiotics for cellulitis remain inappropriately prescribed. This evidence–practice gap is more evident in low-resource settings, such as rural hospitals. This implementation study developed and introduced a cellulitis management plan to improve antibiotic prescribing for cellulitis in three health services in regional Australia. Appropriateness of antibiotic prescribing for cellulitis at Day 1 was the primary outcome measure. Adults with ICD-10-AM codes for lower-limb cellulitis admitted as inpatients of the three health services between May and November 2019 (baseline, n = 165) and March and October 2020 (post-implementation, n = 127) were included in the assessment. The uptake of the cellulitis management plan was 29.1% (37/127). The appropriateness of antibiotic prescribing for cellulitis at Day 1 was similar at baseline (78.7%, 144/183) and in the intention-to-treat post-implementation group (81.8%, 126/154) [95% CI −5.6% to 11.3%, p = 0.50]. Commencement of the cellulitis management plan resulted in a non-statistically significant increase in antibiotic appropriateness at Day 1 compared to when a cellulitis management plan was not commenced (88.1% vs. 79.5%; 95% CI −5.6% to 19.8%; p = 0.20) Evaluation of more real-world strategies to address evidence–practice gaps, such as the appropriateness of antibiotic prescribing for cellulitis, is required.

Read the full paper here .

Citation : Bishop, J., Jones, M., Farquharson, J., Summerhayes, K., Tucker, R., Smith, M., Cowan, R., Friedman, N. D., Schulz, T., Kong, D., & Buising, K. (2021). Implementation of a Cellulitis Management Plan in Three Australian Regional Health Services to Address an Evidence–Practice Gap in Antibiotic Prescribing. Antibiotics, 10(11). DOI: https://doi.org/10.3390/antibiotics10111288 .

Antimicrobial Awareness Week 2021

Wed, 01 Sep 2021 08:26:37 GMT

Antimicrobial Awareness Week aims to increase public awareness of the threat of antimicrobial resistance and the importance of efforts to improve antimicrobial use in all healthcare settings. NCAS will host a webinar series on antimicrobial stewardship research and practice on 18-22 November. The webinars will cover antimicrobial stewardship in veterinary medicine, using data for antimicrobial stewardship, and antimicrobial stewardship in aged care.

Dates: 18-22 November 2021

Format: Webinar

It’s not just about quantity: The importance of qualitative research to AMS

Tue, 24 Nov 2020 06:26:47 GMT

Antimicrobial Awareness Week 2020 - webinar

It’s not just about quantity: The importance of qualitative research to AMS

Chair: A/Prof. Mark Davis

General public awareness and action on the reduction of AMR: Which publics and what can they do?

A/Prof. Mark Davis (School of Social Sciences, Monash University, Melbourne)

Antimicrobial resistance and culturally and linguistically diverse communities in Australia

Prof. Andrea Whittaker (School of Social Sciences, Monash University, Melbourne)

Fears, formulations and fractious patients: Influences on antimicrobial use in Australian dogs and cats

Dr. Ri Scarborough (National Centre for Antimicrobial Stewardship, University of Melbourne, Melbourne)

AMS capacity building

Tue, 24 Nov 2020 05:48:39 GMT

Antimicrobial Awareness Week 2020 - webinar

AMS capacity building

Chair: Ron Cheah

What is a DOT? Do we like it a lot?

Nadine Hillock (National Antimicrobial Utilisation Surveillance Program, South Australian Expert Advisory Group on Antimicrobial Resistance, SA Health, Adelaide)

Measuring antibiotic stewardship across primary healthcare: An umbrella review in medical care and a systematic review in dental care

Dr. Leanne Teoh (University of Melbourne, Melbourne)

A multidisciplinary approach to antimicrobial stewardship in a specialist hospital for women and newborns

Vi Pham, Dr. Sushena Krishnaswamy and Sharon Heap (Royal Women’s Hospital, Melbourne)

Improving patients’ knowledge and understanding of their antimicrobial therapy

Dr. Kim Yeoh (Royal Melbourne Hospital, Melbourne)

Urinalysis practices and subsequent antibiotic prescribing in a geriatric inpatient setting

Dr. Nupur Goyal and Dr. LynLi Lim (Eastern Health, Melbourne)

Understanding and responding to antimicrobial resistance in Timor Leste: Towards a One Health approach

Dr. Shawn Ting (Menzies School of Health Research, Charles Darwin University, Darwin)

Antimicrobial stewardship pharmacy technicians: ‘Tech-ing’ AMS to the next level

AMS technician: The hidden gem – Experiences from Monash Health and Eastern Health

Marnie Horne-Spalling (Monash Health, Melbourne), Sonia Koning (Eastern Health, Melbourne) and Erika Roberts (Monash Health, Melbourne)

Antimicrobial stewardship as part of the MDT: Sharing best practice and highlighting how pharmacy technicians add value in this field

Julie Chatters (East Suffolk and North Essex Foundation Trust NHS, UK) and Leanne Nixon (East Suffolk and North Essex Foundation Trust NHS, UK)

Paediatrics

Mon, 23 Nov 2020 06:16:38 GMT

Antimicrobial Awareness Week 2020 - webinar

Paediatrics

Chair: A/Prof. Penelope Bryant

Introduction to paediatric AMS research

A/Prof. Penelope Bryant (Royal Children’s Hospital & Murdoch Children Research Institute, Melbourne)

Paediatric AMS in Australia in 2020 – stumbling blocks and opportunities

Dr. Brendan McMullan (Sydney Children’s Hospital & University of Melbourne)

Approaches to antibiotic stewardship in febrile neutropenia: Balancing risks and benefits

Dr. Gabrielle Haeusler (Peter MacCallum Cancer Centre & Royal Children’s Hospital, Melbourne)

Surgical antimicrobial prophylaxis prescribing

Mon, 23 Nov 2020 03:50:06 GMT

Antimicrobial Awareness Week 2020 - webinar

Surgical antimicrobial prophylaxis (SAP) prescribing

Chair: Dr. Rodney James

Surgical antimicrobial prophylaxis – is there low-hanging fruit left to pick?

Kristin Xenos (Australian Commission on Safety and Quality in Health Care, Sydney)

Dissecting the Surgical NAPS

Dr. Rodney James, Xin Fang and Dr. Courtney Ierano (National Centre for Antimicrobial Stewardship, Melbourne Health & University of Melbourne, Melbourne)

Mind the gap: Clinical trials targeting barriers to prophylaxis guideline uptake in surgery

A/Prof. Trisha Peel (Alfred Hospital and Monash University, Melbourne)

Tailored SAP tools: Collaborations with the NSW Clinical Excellence Commission

Semun (Sim) Galimam (Wyong Hospital & Central Coast Local Health District, Hamlyn Terrace, New South Wales)

Infections in the immunocompromised

Fri, 20 Nov 2020 07:30:34 GMT

Antimicrobial Awareness Week 2020 - webinar

Infections in the immunocompromised

Chair: Prof. Monica Slavin

The impact and scaling of antibiotic allergy de-labelling in Australia

A/Prof. Jason Trubiano (Austin Health, Peter MacCallum Cancer Centre & University of Melbourne, Melbourne)

Improving outcomes of cytomegalovirus infection in recipients of haematopoietic stem cell transplant

Dr. Michelle Yong (Peter MacCallum Cancer Centre & University of Melbourne, Melbourne)

Antifungal stewardship in Australia

Anna Khanina (Peter MacCallum Cancer Centre, Melbourne)

The role of the antimicrobial stewardship nurse practitioner

Belinda Lambros (Peter MacCallum Cancer Centre, Melbourne)

COVID-19, regional AMS and antibiotic development

Fri, 20 Nov 2020 03:42:48 GMT

Antimicrobial Awareness Week 2020 - webinar

COVID-19, regional AMS and antibiotic development

Chair: Dr. Krispin Hajkowicz

Antibiotic stewardship in suspected and confirmed COVID-19

Dr. Krispin Hajkowicz (Royal Brisbane and Women's Hospital, Brisbane)

Lessons learned from the early adoption and evidence for COVID-19 therapeutics

Prof. Jason Roberts (CRE Reduce, University of Queensland, Brisbane)

Antimicrobial stewardship in rural and remote Queensland

Jacinta Shanahan (Queensland State-wide Antimicrobial Stewardship Program, Brisbane)

The CARB-X award – accelerated development of last-resort antibiotics to treat multidrug-resistant infections

Dr. Mark Blaskovich (Centre for Superbug Solutions, Institute for Molecular Bioscience, University of Queensland, Brisbane)

National Antimicrobial Prescribing Survey (NAPS) (international projects)

Thu, 19 Nov 2020 22:48:36 GMT

Antimicrobial Awareness Week 2020 - webinar

Thinking big: Scaling up a small antimicrobial stewardship initiative into a successful national and international program - the National Antimicrobial Prescribing Survey

Chair: Caroline Chen

10 years on: Scaling the NAPS from a single survey to a successful national and international program

Caroline Chen (National Centre for Antimicrobial Stewardship & Guidance Group, Royal Melbourne Hospital, Melbourne)

NAP-ping outside the box: Beyond international border, beyond the general population

Yoshiko Nakamachi and Dr. Miranda So (Sinai Health-University Health Network Antimicrobial Stewardship Program, Toronto, Canada)

Implementation of the NAPS in Malaysia

A/Prof. Sasheela Sri La Sri Ponnampalavanar (University Malaya Medical Centre, Kuala Lumpur, Malaysia)

Experience of the NAPS program in developing countries

Dr. Rodney James (National Centre for Antimicrobial Stewardship & Guidance Group, Royal Melbourne Hospital, Melbourne)

International One Health AMR and AMS capacity building

Thu, 19 Nov 2020 06:45:39 GMT

Antimicrobial Awareness Week 2020 - webinar

International One Health AMR and AMS capacity building

Chair: Prof. Kirsty Buising

Regional capacity building and training approaches to support prevention and surveillance of antimicrobial resistance

Prof. Kirsty Buising (Doherty Institute, University of Melbourne)

Approach to addressing AMR in Papua New Guinea

Ms. Judith Nui (Fleming Fund Fellowship Program, Papua New Guinea)

WHO antimicrobial resistance and stewardship programs in the Western Pacific Region

Dr. Soccoro Escalante (Essential Medicines and Health Technologies, Division of Health Systems and Services, WHO Western Pacific Regional Office, Manila)

One Health perspectives on regional AMR programs

Dr. Joanna McKenzie (Massey University, New Zealand)

Passive AMR surveillance in poultry specimens 2018-2019 in Nepal

Tulsi Gompo (Fleming Fund Fellowship Program, Nepal)

A practical approach to AMR capacity building and training in Pacific Island Countries

Tebuka Toatu (The Pacific Community [SPC], Fiji)

One Health data analytics and decision-support

Thu, 19 Nov 2020 01:13:22 GMT

Antimicrobial Awareness Week 2020 - webinar

One Health data analytics and decision-support

Chair: Prof. Karin Thursky

Using EHR to monitor appropriateness of antimicrobial prescribing (and moving to

big data for surveillance)

Prof. Karin Thursky (National Centre for Antimicrobial Stewardship, University of Melbourne, Melbourne)

Guidance GP: Pilot of a quality improvement program for antimicrobial stewardship in general practice

A/Prof. Jo-Anne Manski-Nankervis (Department of General Practice, University of Melbourne, Melbourne)

Use of administrative data to support infection surveillance and health services research: Limitations and opportunities

Jake Valentine (National Centre for Infections in Cancer, Peter MacCallum Cancer Centre, Melbourne)

Use of machine learning to support meaningful passive data extraction in community veterinary practices

Dr. Brian Hur (National Centre for Antimicrobial Stewardship, University of Melbourne, Melbourne)

Antimicrobial stewardship in the community

Wed, 18 Nov 2020 21:07:04 GMT

Antimicrobial Awareness Week 2020 - webinar

Antimicrobial stewardship (AMS) in the community

Chair: A/Prof. Noleen Bennett

Infographics about antibiotics: Making facts accessible

Dr. Oliver van Hecke (University of Oxford, Oxford, UK)

Co-creation of AMS information sheets with health professionals and consumers: Creating resources that fit the needs of the community

Dr. Ruby Biezen (Department of General Practice & National Centre for Antimicrobial Stewardship, University of Melbourne, Melbourne)

The Royal Commission into Aged Care Quality and Safety: Helpful for AMS?

A/Prof. Noleen Bennett (National Centre for Antimicrobial Stewardship, University of Melbourne, Melbourne)

Optimising antimicrobial use in aged care homes

Dr. Leslie Dowson (National Centre for Antimicrobial Stewardship, Monash University, Melbourne)

Antimicrobial stewardship in general practice: A scoping review of the component parts

Dr. Lesley Hawes (National Centre for Antimicrobial Stewardship, Monash University, Melbourne)

Engaging the community pharmacist in promoting judicious antimicrobial use

Sajal Saha (National Centre for Antimicrobial Stewardship, Monash University, Melbourne)

Antimicrobial resistance in regional and remote Australia

Wed, 18 Nov 2020 06:25:50 GMT

Antimicrobial Awareness Week 2020 - webinar

Antimicrobial resistance (AMR) in regional and remote Australia

Chair: Dr. Teresa Wozniak

Geography and burden of AMR in northern Australia

Dr. Trent Yarwood (Queensland Health, State-wide Antimicrobial Stewardship Program, Brisbane), Dr. Teresa Wozniak (Menzies School of Health Research, Brisbane) and A/Prof. Asha Bowen (Telethon Kids Institute, Perth)

HOT North Antimicrobial Academy for Indigenous Health Care Providers

A/Prof. Asha Bowen (Telethon Kids Institute, Perth), Dr. Trent Yarwood (Queensland Health, State-wide Antimicrobial Stewardship Program, Brisbane) and Dr. Caitlyn White (Kimberley Aboriginal Medical Services, Broome)

National surveillance of AMR: Coordination and activities

Dr. Sonali Coulter (Queensland Health, Brisbane)

Developing a platform for tracking and responding to AMR in regional Australia – HOTspots

Dr. Teresa Wozniak and Mr. Will Cuningham (Menzies School of Health Research, Brisbane/Darwin)

Evaluation and implementation of HOTspots in northern Australia

Ms. Laura Goddard (National Centre for Epidemiology and Population Health, Australia National University, Canberra) and Ms. Amy Legg (AMS pharmacist Top End Health Service, Darwin)

Modelling the contribution of the social determinants of health to the spread of AMR

Dr. Karen McCulloch (Doherty Institute, University of Melbourne, Melbourne)

Influencing the national agenda on AMR

Panel

Opening plenary

Wed, 18 Nov 2020 01:56:57 GMT

Antimicrobial Awareness Week 2020 - webinar

Opening plenary

Chair: Prof. Karin Thursky

Opening remarks

Prof. Paul Kelly (Australian Chief Medical Officer, Department of Health)

Opening remarks

Dr. Mark Schipp (Australian Chief Veterinary Officer, Department of Agriculture, Water and the Environment)

Improving antimicrobial prescribing: Where to next?

Prof. Karin Thursky (National Centre for Antimicrobial Stewardship, University of Melbourne, Melbourne)

Antimicrobial use in animal health in Australia: What do we know and what do we still need to find out?

Prof. Glenn Browning (National Centre for Antimicrobial Stewardship, University of Melbourne, Melbourne)

Opportunities to enhance AMR surveillance using genomics

Prof. Ben Howden (Doherty Institute, University of Melbourne, Melbourne)

Telehealth antimicrobial stewardship at Goulburn Valley Health: Successfully implementing electronic post-prescription review

Mon, 16 Nov 2020 09:37:31 GMT

Antimicrobial Awareness Week 2020 – poster

Telehealth antimicrobial stewardship at Goulburn Valley Health: Successfully implementing electronic post-prescription review

Shady Ibrahim, Thomas Schulz

Goulburn Valley Health

Topical use of antimicrobials for surgical prophylaxis in Australian hospitals

Mon, 16 Nov 2020 09:22:39 GMT

Antimicrobial Awareness Week 2020 – poster

Topical use of antimicrobials for surgical prophylaxis in Australian hospitals

C. Ierano, R. Cheah, R. James, K. Thursky

University of Melbourne

Timing and duration of surgical prophylaxis

Fri, 13 Nov 2020 04:31:39 GMT

NCAS has prepared a guidance document titled Timing and duration of surgical prophylaxis to support quality improvement in surgical prophylaxis prescribing and address issues identified in the Surgical NAPS. Read here .

The Surgical National Antimicrobial Prescribing Survey: 2019 report

Fri, 13 Nov 2020 04:27:20 GMT

The 2019 Surgical NAPS Report has now been published by the Australian Commission on Safety and Quality in Health Care . Participation has continued to increase, with 144 public and private facilities contributing nationally. This report provides an analysis of procedural group specialty-level prescribing, highlighting differences across surgical specialty groups and offering targeted data to support targeted surgical AMS initiatives.

Participate in the NAPS program (coordinated by NCAS) here .

Improving patients’ knowledge and understanding of their antimicrobial therapy

Sun, 01 Nov 2020 13:20:23 GMT