Open Access Highly Accessed Research article

Antimicrobial stewardship in residential aged care facilities: need and readiness assessment

Ching Jou Lim1, Megan Kwong2, Rhonda L Stuart34, Kirsty L Buising256, N Deborah Friedman7, Noleen Bennett8, Allen C Cheng109, Anton Y Peleg119, Caroline Marshall25* and David CM Kong1

Author Affiliations

1 Centre for Medicine Use and Safety, Monash University, 381 Royal Parade, Parkville, VIC 3052, Australia

2 Department of Medicine, University of Melbourne, Royal Melbourne Hospital, 4th Floor, Clinical Sciences Building, Royal Parade, Parkville, VIC 3050, Australia

3 Monash Infectious Diseases, Monash Health, Clayton, VIC, Australia

4 Department of Medicine, Monash University, Clayton, VIC, Australia

5 Victorian Infectious Diseases Service, Royal Melbourne Hospital, Parkville, VIC, Australia

6 Department of Infectious Diseases, St Vincent’s Hospital, Fitzroy, VIC, Australia

7 Department of Infectious Diseases, Barwon Health, Geelong, VIC, Australia

8 Victorian Healthcare Associated Infection Surveillance System Co-ordinating Centre, North Melbourne, VIC, Australia

9 Department of Infectious Diseases, Alfred Health, Melbourne, VIC, Australia

10 Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia

11 Department of Microbiology, Monash University, Clayton, VIC, Australia

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BMC Infectious Diseases 2014, 14:410  doi:10.1186/1471-2334-14-410

Published: 23 July 2014



Information about the feasibility, barriers and facilitators of antimicrobial stewardship (AMS) in residential aged care facilities (RACFs) has been scant. Exploring the prevailing perceptions and attitudes of key healthcare providers towards antibiotic prescribing behaviour, antibiotic resistance and AMS in the RACF setting is imperative to guide AMS interventions.


Semi-structured interviews and focus groups were conducted with key RACF healthcare providers until saturation of themes occurred. Participants were recruited using purposive and snowball sampling. The framework approach was applied for data analysis.


A total of 40 nurses, 15 general practitioners (GPs) and 6 pharmacists from 12 RACFs were recruited. Five major themes emerged; perceptions of current antibiotic prescribing behaviour, perceptions of antibiotic resistance, attitude towards and understanding of AMS, perceived barriers to and facilitators of AMS implementation, and feasible AMS interventions. A higher proportion of GPs and pharmacists compared with nurses felt there was over-prescribing of antibiotics in the RACF setting. Antibiotic resistance was generally perceived as an issue for infection control rather than impacting clinical decisions. All key stakeholders were supportive of AMS implementation in RACFs; however, they recognized barriers related to workload and logistical issues. A range of practical AMS interventions were identified, with nursing-based education, aged-care specific antibiotic guidelines and regular antibiotic surveillance deemed most useful and feasible.


Areas of antibiotic over-prescribing have been identified from different healthcare providers’ perspectives. However, concern about the clinical impact of antibiotic resistance was generally lacking. Importantly, information gathered about feasibility, barriers and facilitators of various AMS interventions will provide important insights to guide development of AMS programs in the RACF setting.

Antibiotic prescribing; Antibiotic resistance; Antimicrobial stewardship; Residential care; Qualitative research