Aged care antimicrobial surveillance project

Project Summary

The aged care pilot project was conducted over the 15-month period, November 2022 to February 2024, to investigate the feasibility, usefulness, acceptability, and barriers of real-time volume-based surveillance of antimicrobial usage in South Australian Residential Aged Care Facilities (RACFs). Antimicrobials are a group of medicines that are used to treat and prevent infections. Antimicrobials may stop working if the organisms causing the infection become resistant to the antimicrobial(s). Resistance can happen if antimicrobials are used too much or if they are used incorrectly.

Surveillance in the aged care setting is important, and a current gap in antimicrobial surveillance nationally. Older adults are at a high risk of getting antimicrobial-resistant infections because of their older age, weaker immune systems and other health problems they may already have¹. Close living environments for older adults in RACFs and regular contact with potentially infected or colonised healthcare staff can also increase the risk of infections that are resistant to antimicrobials². Studies have also shown that antimicrobial use within RACFs is often inappropriate or they are used too much³.

Project Findings:

  • A cross-sectional electronic survey investigating antimicrobial prescription, supply, administration, and documentation was disseminated in June 2023 to all 237 RACFs in South Australia. The results of this survey are currently under a journal peer-review process. It is hoped that the survey findings will help highlight the complexities of antimicrobial surveillance in the RACF setting.
  • Defined Daily Doses (DDDs) per 1000 resident days and Days of Therapy (DOTs) per 1000 resident days were identified as the most suitable data metrics for monitoring antimicrobial usage in the RACF setting. DDDs and DOTs are used in the existing hospital NAUSP surveillance.
  • Most RACFs in South Australia are using a transitional electronic National Residential Medication Chart (NRMC). The transitional electronic NRMC was identified as the most suitable data source for obtaining antimicrobial administration data from RACFs.
  • Other locations for the documentation of antimicrobial administration included paper-based NRMCs, Interim Medication Charts (used on discharged from hospital) and Medication Authority Forms (used by external healthcare providers).
  • Feedback was received from RACF staff who completed this survey, with responses indicating overall support for an antimicrobial surveillance program.

Further information

For further information of the aged care pilot project contact the NAUSP team


  1. Australian Commission on Safety and Quality in Health Care, AURA 2021: Fourth Australian report on antimicrobial use and resistance in human health. 2021, ACSQHC: Sydney.
  2. Rogers, G.B., L.E. Papanicolas, and S.L. Wesselingh, Antibiotic stewardship in aged care facilities. The Lancet Infectious Diseases, 2018. 18(10): p. 1061-1063.
  3. National Centre for Antimicrobial Stewardship and Australian Commission on Safety and Quality in Health Care, 2019 Aged Care National Antimicrobial Prescribing Survey Report. 2020: Sydney: ACSQHC.