Ms Mary Smith1, Ms Marita Ticchi2, Ms Sue Atkins1, Dr Noleen Bennett3, Ms Donna Nair4, Ms Monika Samolyk2, Ms Lesley Stewart2, Dr Leon Worth3, Dr Jill Campbell5
1Grampians Region Infection Control Group, Horsham, VIC, Australia
2Regional Wounds Victoria, VIC, Australia
3VICNISS Coordinating Centre/National Centre for Antimicrobial Stewardship, Melbourne, VIC, Australia
4Barwon Health, Geelong, VIC, Australia
5Royal Brisbane & Women’s Hospital, Brisbane, QLD, Australia
The 2017 Aged Care National Antimicrobial Prescribing Survey identified widespread use of antimicrobials with about one third (29.5%) being prescribed for topical use. The second most frequently prescribed antimicrobial was clotrimazole (17.4%).
It was also identified that staff were not differentiating between incontinence associated dermatitis (IAD) with fungal infection, and that without. This led to inappropriate antimicrobial use including unnecessary prescribing, adhoc application and incomplete courses of antifungals.
The Grampians Region Infection Control Group and Regional Wounds Victoria saw the potential to improve antimicrobial stewardship as well as outcomes for residents by collaborating on the development of an educational resource for clinicians. Experts in the fields of skin integrity, antimicrobial stewardship and infectious diseases were invited to develop a clinical pathway that details best management of IAD, with or without infection.
The pathway developed provides prompts for the nurse to prevent and manage damage to skin integrity associated with incontinence. It outlines signs and symptoms, core elements for cleansing, protecting and restoring the skin, and targeted measures for medication therapy, microbiological testing and referral to a continence/wound consultant.
The implementation of the pathway will be piloted in some public aged care homes in Victoria. Post pilot, it will be refined as necessary and rolled out across the State. It is expected that this pathway will empower nurses in aged care to challenge inappropriate prescribing by general practitioners (GPs). It will also enhance communication with GPs to improve AMS in aged care.
Mary is one of two regional Infection Control Advisers in the Grampians Region, Victoria. The role involves on-site support to the agency infection control consultants, development of generic resources and provision of expert advice in the event of adverse events.
Marita forms part of the Regional Wounds Victoria team, servicing the Wimmera end of the Grampians subregion. Regional Wounds Victoria supports public sector residential aged care and community nurses to improve outcomes for regional Victorians living with chronic and complex wounds.
Mary and Marita share an office and frequent discussions around infection control and wound care. The results of the 2017 acNAPS highlighted frequent, inappropriate use of antifungal creams in the residential aged care sector. The idea of collaboration to develop a pathway to direct appropriate identification and treatment of incontinence associated dermatitis was born from one such discussion.