Time point (months) | Study period | |||||||||||||||||||
Facility | Resident | Resident follow-up (month) | Close-out | |||||||||||||||||
Enrolment | Allocation | Enrolment | ||||||||||||||||||
Enrolment | -t2 | -t1 | 0 | 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 | 10 | 11 | 12 | 13 | 14 | 15 | 16 | 16 months |
Facility eligibility screen and recruitment | X | |||||||||||||||||||
Facility allocation | X | |||||||||||||||||||
Resident eligibility screen and enrolment | X | X | X | X | X | X | X | X | X | X | X | X | X | X | X | X | X | |||
Interventions | ||||||||||||||||||||
AMS programme* | ||||||||||||||||||||
Control (usual care) | ||||||||||||||||||||
Assessments | ||||||||||||||||||||
Facility assessment | ||||||||||||||||||||
Facility characteristics (occupancy and speciality units) | X | |||||||||||||||||||
Staffing (nursing, medical and pharmacy) | X | |||||||||||||||||||
Infectious disease education and practices | X | |||||||||||||||||||
Baseline resident assessment† | ||||||||||||||||||||
Demographic and clinical characteristics | X | |||||||||||||||||||
Prior antimicrobial use | X | |||||||||||||||||||
Prior hospitalisations | X | |||||||||||||||||||
Advance care directives | X | |||||||||||||||||||
Monthly resident assessment | ||||||||||||||||||||
Clinical characteristics | X | X | X | X | X | X | X | X | X | X | X | X | X | X | X | X | ||||
Suspected infections‡ | X | X | X | X | X | X | X | X | X | X | X | X | X | X | X | X | ||||
Diagnoses | X | X | X | X | X | X | X | X | X | X | X | X | X | X | X | X | ||||
Investigations§ | X | X | X | X | X | X | X | X | X | X | X | X | X | X | X | X | ||||
Microbiology | ||||||||||||||||||||
AMR organisms | X | X | X | X | X | X | X | X | X | X | X | X | X | X | X | X | ||||
Antimicrobial susceptibility | X | X | X | X | X | X | X | X | X | X | X | X | X | X | X | X | ||||
Systemic antimicrobial use | ||||||||||||||||||||
Administration (dose, route and duration) | X | X | X | X | X | X | X | X | X | X | X | X | X | X | X | X | ||||
Indication | X | X | X | X | X | X | X | X | X | X | X | X | X | X | X | X | ||||
Appropriateness¶ | X | X | X | X | X | X | X | X | X | X | X | X | X | X | X | X | ||||
Hospitalisation | X | X | X | X | X | X | X | X | X | X | X | X | X | X | X | X | ||||
Transfer to another facility, home or death | X | X | X | X | X | X | X | X | X | X | X | X | X | X | X | X | X | |||
Biospecimen collection** | ||||||||||||||||||||
Nasal, rectal±wound specimen | X | X | X | X | X | X | X | X | X | X | X | X | X | X | X | X |
*Excluding the transition (‘wash-out’) phase.
†Baseline resident characteristics will be performed for all new residents over the 16-month trial.
‡Suspected infections include urinary tract infections, respiratory tract infections, skin and soft tissue infections, and Clostridioides difficile infections.
§Investigations include radiology, urinalysis and urine, sputum, nasal/throat, rectal/faecal, wound and blood cultures.
¶Appropriateness is assessed according to minimum signs and symptoms for initiation of antimicrobials as specified in the intervention bundle, and antimicrobial recommendations as per the Australian Therapeutic Guidelines.
**Specific timing to be determined.
AMR, antimicrobial resistant; AMS, antimicrobial stewardship.