Mar 29
Antimicrobial Stewardship: Navigating The Challenges
3 Knotty Challenges Of AMS Programs In Australian Aged Care Facilities
Introduction
Antimicrobial Stewardship (AMS) is a set of coordinated strategies aimed at improving the use of antimicrobial medications in the primary treatment of infection. These are such drugs as antibiotics, antifungals, antivirals and antiparasitics. The primary aim of AMS is to ensure these drugs are used only, when necessary, the correct drug is chosen at the right dose and duration, and that prescribing practices are continuously monitored and improved. AMS is particularly important in aged care because older adults are often more susceptible to infections due to a weakened immune system and other underlying health conditions. The high use of antimicrobials in these settings significantly increases the risk of Antimicrobial Resistance (AMR). Here, bacteria, viruses, fungi, and parasites develop resistance to the medications used to treat them, leading to harder-to-treat infections, prolonged illness, and increased risk of mortality.
Despite the critical need for AMS, Australian aged care facilities have faced significant challenges in implementing and running these programs effectively over the past year. These challenges can be broadly categorised into three critical areas:
Critical Challenge #1: Limited Resources
This is a consistently reported obstacle to the effective management of antimicrobial usage in aged care.
- Financial Constraints: Many aged care facilities operate with tight budgets, making it difficult to allocate resources specifically for AMS initiatives over the day-to-day running of the facility. The complex funding models used in aged care can hinder the demonstration of an immediate return on investment required to secure dedicated funding for AMS. Prioritising AMS can be a challenge with extra financial pressures such as maintaining staffing levels and upgrading facilities.
- Staffing Shortages: Many facilities face significant staffing shortages, leaving the existing workforce overstretched. Implementing a new program into a facility such as AMS, requires dedicated time and effort for the additional tasks required. Activities such as reviewing prescriptions, providing staff education, and collecting data, appear as an added burden to busy facility staff and managers alike. Many facilities, particularly smaller ones or those in rural and
remote areas, lack the resources to employ dedicated AMS personnel
, specialist nurses or pharmacists available to champion and monitor AMS initiatives. This means the AMS responsibilities often fall to existing staff who may already have a full workload with resident care duties.
- Diagnostic Limitations: Inadequate access to accurate diagnostic tools can hinder effective AMS implementation. This can lead to “guesswork prescribing” and an over-reliance on broad-spectrum antibiotics when treatment of an infection is understood to require immediate action. This contributes more significantly to the development of antibiotic resistance compared to targeted, narrow-spectrum antibiotics. Furthermore, access to clinical pharmacists and infectious disease specialists can be limited, especially in rural and remote areas. Pharmacists play a vital role in reviewing medication charts and advising on antibiotic use, infectious disease specialists provide guidance on complex cases and AMS policies. The data deficit, including limited data on infection indications when prescribing antibiotics and a lack of surveillance on non-prescription antimicrobials, further compounds this issue.
Despite these limitations, some Australian facilities have taken steps to address this challenge. This includes facility leadership prioritising AMS within their budgets, forming strategic partnerships with larger healthcare networks or universities for additional resources and expertise, and introducing innovative technology solutions to streamline processes even with limited staff.
Critical Challenge #2: Staff Resistance To Change
Resistance from healthcare professionals within the facility to adopting AMS programs is another significant hurdle.
- Habitual Prescribing Practices: Healthcare professionals may rely on familiar, dated prescribing practices rather than familiarising themselves with, and adopting new, evidence-based guidelines promoted by AMS.
- Lack of Awareness and Education: Not all staff members fully understand the importance of reducing antibiotic use and the serious consequences of antimicrobial resistance. A lack of knowledge about AMS principles and the rationale behind prudent antibiotic use can lead to resistance.
- Consequences of Staff Resistance: Resistance among staff can lead to continued inappropriate antibiotic prescribing, increasing infection risks for residents and directly contributing to higher rates of antimicrobial resistance. This can undermine all the goals of AMS programs and jeopardise patient safety.
To overcome staff resistance, facilities have implemented several effective strategies. Regular training and educational sessions are required to clearly explain the importance of responsible antibiotic use and update staff on the latest guidelines. Providing decision-support tools can make it easier for staff to follow AMS guidelines consistently. Implementing audits of antibiotic prescribing, providing feedback loops, and offering positive reinforcement can encourage and reinforce positive changes in prescribing practices. Engaging different staff groups with tailored education that aligns with their roles is also essential. Furthermore, clear, easily understood and consistent communication with residents and their families about the importance of correct antibiotic use is vital. Their expectations and misconceptions also need to be considered, and correct information explained. All these points are vital for fostering a culture of stewardship.
Critical Challenge #3: Complexity in Multidisciplinary Coordination
Coordinating AMS efforts across different healthcare disciplines within aged care facilities presents a considerable challenge.
- Differences in Knowledge and Priorities: Healthcare professionals from different disciplines (e.g., doctors, nurses, pharmacists, care workers) may have varying levels of understanding about AMS principles and may have different priorities in their daily work.
- Importance of Coordination: Effective AMS requires seamless collaboration and communication across all healthcare teams involved in resident care. Without clear coordination, confusion can arise, leading to inconsistent practices in antibiotic prescribing and administration throughout a facility. Ensuring consistency is necessary for safe and effective antibiotic use and can help reduce confusion and errors in prescribing.
- Strategies for Improvement: Facilities have worked to improve multidisciplinary coordination by introducing structured frameworks for collaboration among all relevant healthcare professionals in the facility. Regular interdisciplinary meetings and communication channels help keep everyone informed, aligned on goals, and facilitate problem -solving. Implementing standardised documentation systems can also streamline communication and ensure that all important information relating to antibiotic use is clearly and effectively shared across teams. Embedding AMS into the overall organisational culture and ensuring strong leadership buy-in and support for AMS initiatives are crucial to fostering a collaborative environment where prudent antibiotic use is a shared responsibility. Nurse-led stewardship programs have also shown positive results in empowering nurses as frontline advocates for responsible antibiotic use.
FAQ (Frequently Asked Questions)
- What exactly is antimicrobial stewardship?
Antimicrobial stewardship involves coordinated efforts to promote responsible antibiotic use—to reduce unnecessary prescriptions & combat antibiotic resistance effectively!
2. Why is AMS particularly important in aged care?
Older adults have weaker immune systems, making them vulnerable targets. Improper antibiotic usage increases risks significantly, making effective stewardship essential!
3. How can small facilities with limited budgets implement effective AMS?
Small facilities should focus on leadership prioritisation combined with strategic partnerships offering additional resources/expertise alongside adopting the affordable tech solutions available today!
4. What role do nurses play in successful AMS programs?
Nurses serve as frontline advocates promoting responsible prescribing practices; they're instrumental educators fostering awareness among colleagues & ensuring adherence consistently throughout daily routines!
5. Are there any government resources available supporting AMS initiatives?
Absolutely! The Australian government provides various educational tools/resources including self-assessment guides & national surveillance programs like NAPS specifically designed to support facility-level improvements nationwide.
Conclusion
In conclusion, implementing effective AMS programs in Australian aged care facilities is a complex undertaking due to limitations in resources and expertise, staff resistance to change, and the inherent complexities of multidisciplinary coordination. Overcoming these challenges is essential to protect the health and well-being of elderly residents and to combat the growing threat of antimicrobial resistance. By acknowledging these hurdles and collaboratively working towards innovative solutions, Australian aged care facilities can continue to make progress in antimicrobial stewardship. The Australian government also provides various educational tools and resources, including national surveillance programs like NAPS, to support facility-level improvements nationwide.
This blog is based on Australian information, but most is relevant to the New Zealand aged-care facility.
For more information on this and other topics, contact the HUB and be up to date from our extensive resources. Link
This blog is based on Australian information, but most is relevant to the New Zealand aged-care facility.
For more information on this and other topics, contact the HUB and be up to date from our extensive resources. Link
Lyndon Forrest
Managing Director | CEO
Lyndon is the Managing Director of Infection Prevention Services (IPS), bringing over 30 years' experience supporting aged care providers across Australia and New Zealand.
With a background spanning outbreak response, compliance, and infection risk management — alongside hands-on experience leading teams, managing multi-site operations, and navigating business turnaround — he understands both the clinical and organisational pressures aged care providers face. Lyndon holds a Master of Commerce (Industrial Relations), and applies that foundation to the people, process, and growth challenges that come with running a complex healthcare services business.
He is passionate about building the systems and capability that make infection prevention sustainable — not just compliant — and about helping organisations grow their confidence alongside their practice.
Lyndon's focus is straightforward: strengthen operations, develop the right people, and drive proactive infection prevention strategies that protect residents, staff, and communities for the long term.
Lyndon is the Managing Director of Infection Prevention Services (IPS), bringing over 30 years' experience supporting aged care providers across Australia and New Zealand.
With a background spanning outbreak response, compliance, and infection risk management — alongside hands-on experience leading teams, managing multi-site operations, and navigating business turnaround — he understands both the clinical and organisational pressures aged care providers face. Lyndon holds a Master of Commerce (Industrial Relations), and applies that foundation to the people, process, and growth challenges that come with running a complex healthcare services business.
He is passionate about building the systems and capability that make infection prevention sustainable — not just compliant — and about helping organisations grow their confidence alongside their practice.
Lyndon's focus is straightforward: strengthen operations, develop the right people, and drive proactive infection prevention strategies that protect residents, staff, and communities for the long term.
Erica Callaghan
Marketing Manager
Erica Callaghan is a dedicated professional with a rich background in agriculture and nutrient management. Growing up on her family's farm in Mid Canterbury, she developed a deep passion for farming. She currently resides on her partner's arable property in South Canterbury.
In 2017, Erica joined the Farm Sustainability team, focusing on nutrient management and environmental stewardship. In February 2024, she became the Manager of Marketing and Sales at Bug Control New Zealand - Infection Prevention Services, where her passion now includes improving infection prevention outcomes.
Outside of work, Erica loves cooking and traveling, often combining her culinary interests with her explorations in Italy and Vietnam. She enjoys entertaining family and friends and remains actively involved in farm activities, especially during harvest season.
Erica Callaghan is a dedicated professional with a rich background in agriculture and nutrient management. Growing up on her family's farm in Mid Canterbury, she developed a deep passion for farming. She currently resides on her partner's arable property in South Canterbury.
In 2017, Erica joined the Farm Sustainability team, focusing on nutrient management and environmental stewardship. In February 2024, she became the Manager of Marketing and Sales at Bug Control New Zealand - Infection Prevention Services, where her passion now includes improving infection prevention outcomes.
Outside of work, Erica loves cooking and traveling, often combining her culinary interests with her explorations in Italy and Vietnam. She enjoys entertaining family and friends and remains actively involved in farm activities, especially during harvest season.
Toni Sherriff
Clinical Nurse Specialist
Toni is a Registered Nurse with extensive experience in Infection Prevention and Control. Her career began as a kitchen hand and caregiver in Aged Care facilities, followed by earning a Bachelor of Nursing.
Toni has significant experience, having worked in Brisbane’s Infectious Diseases ward before returning home to New Zealand, where she continued her career as a Clinical Nurse Specialist in Infection Prevention and Control within Te Whatu Ora (Health NZ).
Toni brings her expertise and dedication to our team, which is instrumental in providing top-tier infection prevention solutions to our clients.
Toni is a Registered Nurse with extensive experience in Infection Prevention and Control. Her career began as a kitchen hand and caregiver in Aged Care facilities, followed by earning a Bachelor of Nursing.
Toni has significant experience, having worked in Brisbane’s Infectious Diseases ward before returning home to New Zealand, where she continued her career as a Clinical Nurse Specialist in Infection Prevention and Control within Te Whatu Ora (Health NZ).
Toni brings her expertise and dedication to our team, which is instrumental in providing top-tier infection prevention solutions to our clients.
Julie Hadfield
Accounts & Payroll
Julie is experienced in Accounts & Payroll Administration & after a long career in both the Financial & Local Government Sectors, is now working with our team. Julie brings her strong time management & organisational skills to our team, which is important to keep the company running in the background to enable the rest of our team to provide top notch service to all of our clients.
Julie is experienced in Accounts & Payroll Administration & after a long career in both the Financial & Local Government Sectors, is now working with our team. Julie brings her strong time management & organisational skills to our team, which is important to keep the company running in the background to enable the rest of our team to provide top notch service to all of our clients.
Andrea Murray
Content Editor
I attended Otago University in NZ and graduated as a Dental Surgeon. After 40 years in the profession, I retired in 2022. Infection prevention knowledge was part of everyday practice, dealing with sterilisation, hand hygiene, and cleaning.
Before retiring, I began doing some editing and proofreading for Bug Control as I am interested in the subject and in the English language. During the COVID-19 lockdown, I attended the ACIPC course "Introduction to Infection Prevention and Control", which increased my interest in the subject. I now work part-time as the Content Editor for the company.
I attended Otago University in NZ and graduated as a Dental Surgeon. After 40 years in the profession, I retired in 2022. Infection prevention knowledge was part of everyday practice, dealing with sterilisation, hand hygiene, and cleaning.
Before retiring, I began doing some editing and proofreading for Bug Control as I am interested in the subject and in the English language. During the COVID-19 lockdown, I attended the ACIPC course "Introduction to Infection Prevention and Control", which increased my interest in the subject. I now work part-time as the Content Editor for the company.
Personally, I lived in the UK for 10 years. My two children were born in Scotland, and now both are living in Europe, one in Amsterdam, Netherlands, and the other in Edinburgh, Scotland. I live close to Fairlie on the South Island of NZ, a beautiful part of the country, and I love being out of the city.
Princess
Customer Support
Princess began her career as a dedicated Customer Service Representative, honing her communication and problem-solving skills. She later transitioned into a Literary Specialist role, where she developed a keen eye for detail. Her journey then led her to a Sales Specialist position, where she excelled in client relations.
Now, as a Customer Support professional in Infection Prevention Services. Princess focuses on ensuring customer satisfaction, building loyalty, and enhancing the overall customer journey.
Princess began her career as a dedicated Customer Service Representative, honing her communication and problem-solving skills. She later transitioned into a Literary Specialist role, where she developed a keen eye for detail. Her journey then led her to a Sales Specialist position, where she excelled in client relations.
Now, as a Customer Support professional in Infection Prevention Services. Princess focuses on ensuring customer satisfaction, building loyalty, and enhancing the overall customer journey.
Dianne Newey
Senior Infection Prevention and Control Consultant
Dianne is a Senior Clinical Consultant at Infection Prevention Services (IPS), bringing over 35 years of nursing experience and a depth of clinical knowledge that most people would need two careers to accumulate.
Having served as Clinical Director at Royal Ryde Rehabilitation Hospital alongside a career spanning the full breadth of clinical practice, Dianne has seen it all — and more importantly, knows exactly what to do about it. She is the person in the room that everyone quietly hopes will speak first.
For more than seven years she has been a cornerstone of the IPS team, providing clinical advice, developing and reviewing policies and procedures, delivering monthly IPC webinars to IP Leads, and conducting environmental audits in aged care facilities across Australia and New Zealand. If infection prevention has a question, Dianne almost certainly has the answer — and she'll deliver it with a laugh that you'll hear from the other end of the corridor.
A true fountain of knowledge, wrapped in the kind of warmth and humour that only three decades of nursing can produce. Customers don't just trust Dianne — they look forward to hearing from her.
Dianne is a Senior Clinical Consultant at Infection Prevention Services (IPS), bringing over 35 years of nursing experience and a depth of clinical knowledge that most people would need two careers to accumulate.
Having served as Clinical Director at Royal Ryde Rehabilitation Hospital alongside a career spanning the full breadth of clinical practice, Dianne has seen it all — and more importantly, knows exactly what to do about it. She is the person in the room that everyone quietly hopes will speak first.
For more than seven years she has been a cornerstone of the IPS team, providing clinical advice, developing and reviewing policies and procedures, delivering monthly IPC webinars to IP Leads, and conducting environmental audits in aged care facilities across Australia and New Zealand. If infection prevention has a question, Dianne almost certainly has the answer — and she'll deliver it with a laugh that you'll hear from the other end of the corridor.
A true fountain of knowledge, wrapped in the kind of warmth and humour that only three decades of nursing can produce. Customers don't just trust Dianne — they look forward to hearing from her.
Caoimhe (Keva) Stewart
Clinical & Business Operations Manager
Caoimhe is the Clinical & Business Operations Manager at Infection Prevention Services (IPS), bringing a clinical background as a Registered Nurse across the UK and Australia — and an almost unsettling ability to make technology do exactly what she wants.
With experience in Occupational Health, Palliative Care, and Community Nursing, she understands the real challenges faced by healthcare teams. What she may lack in stature she more than makes up for in impact — Caoimhe is the kind of person who walks into a problem, sizes it up, and has three solutions before anyone else has finished reading the brief.
Customers love her. Not just because she delivers — though she always does — but because she genuinely cares about the outcome on the other side. She is passionate about creating seamless learning experiences and empowering organisations with the tools, knowledge, and support needed to strengthen infection prevention practices and improve care outcomes.
Small in size. Mighty in results. Completely irreplaceable.
Caoimhe is the Clinical & Business Operations Manager at Infection Prevention Services (IPS), bringing a clinical background as a Registered Nurse across the UK and Australia — and an almost unsettling ability to make technology do exactly what she wants.
With experience in Occupational Health, Palliative Care, and Community Nursing, she understands the real challenges faced by healthcare teams. What she may lack in stature she more than makes up for in impact — Caoimhe is the kind of person who walks into a problem, sizes it up, and has three solutions before anyone else has finished reading the brief.
Customers love her. Not just because she delivers — though she always does — but because she genuinely cares about the outcome on the other side. She is passionate about creating seamless learning experiences and empowering organisations with the tools, knowledge, and support needed to strengthen infection prevention practices and improve care outcomes.
Small in size. Mighty in results. Completely irreplaceable.
Bridgette Mackie
Clinical Nurse Educator
Bridgette is an experienced New Zealand Registered Nurse, qualified Healthcare Auditor, and Healthcare Educator with a strong background in clinical quality, competency assessment, and infection prevention. She has led large-scale OSCE and CAP training programmes for internationally qualified nurses, developed sector-specific educational resources, and coordinated HealthCERT audit preparation in the surgical sector.
Known for her engaging teaching style and genuine passion for supporting learners, Bridgette excels at making complex topics accessible and relevant. She blends operational leadership with a deep commitment to professional development and safe, effective practice.
Bridgette is an experienced New Zealand Registered Nurse, qualified Healthcare Auditor, and Healthcare Educator with a strong background in clinical quality, competency assessment, and infection prevention. She has led large-scale OSCE and CAP training programmes for internationally qualified nurses, developed sector-specific educational resources, and coordinated HealthCERT audit preparation in the surgical sector.
Known for her engaging teaching style and genuine passion for supporting learners, Bridgette excels at making complex topics accessible and relevant. She blends operational leadership with a deep commitment to professional development and safe, effective practice.