Improving Antibiotic Use in Nursing Homes by Infection Prevention and Control and Antibiotic Stewardship (IMAGINE): Protocol for a Before-and-After Intervention and Implementation Study (Preprint)

Abstract

BACKGROUND Despite the extensive utilization of antibiotics and the growing challenge of antimicrobial resistance, there has been a lack of substantial initiatives aimed at diminishing the prevalence of infections in nursing homes and enhancing the detection of urinary tract infections (UTIs). OBJECTIVE This study aims to systematise and enhance efforts to prevent healthcare associated infections, mainly UTIs and reduce antibiotic inappropriateness by implementing a multifaceted intervention targeting healthcare professionals in nursing homes. METHODS Before-and-after intervention study carried out in a minimum of 12 nursing homes in each of the eight European participating countries (Denmark, Greece, Hungary, Lithuania, Poland, Slovakia, Slovenia, and Spain). A mean of four professionals consisting of nurses, doctors, healthcare assistants, or healthcare helpers are actively involved in each nursing home. Over the initial three-month period, professionals in each nursing home are registering information on urinary tract infections as well as infection and prevention control measures by means of the Audit Project Odense method. The audit will be repeated after implementing a multifaceted intervention. The intervention will consist of feedback and discussion of the results from the first registration, training on the implementation of infection and prevention control techniques provided by experts, appropriateness of the diagnostic approach and antibiotic prescribing for UTIs, and provision of information materials on infection control and antimicrobial stewardship targeted to staff, residents, and relatives. RESULTS A total of 108 nursing homes have participated in the pilot study and the first registration audit. The results of the first audit registration are expected to be published in autumn of 2024. The final results will be published by the end of 2025. CONCLUSIONS This is a European Union-funded project aimed at contributing to the battle against antimicrobial resistance through improvement of the quality of management of common infections based on evidence-based interventions tailored to the nursing home setting and a diverse range of professionals. We expect an increase in the number of hygiene activities implemented, a reduction in the number of inappropriately managed UTIs, and a reduction in the number of UTIs after the intervention. CLINICALTRIAL European Commission (EU4H-2021-PJ-14), Grant Agreement No. 101079838.