HAI Outcomes, Treatment & Surveillance in Aged Care

In the first blog in this series, we looked at the infections your residents are most likely to encounter - urinary tract infections (UTIs), respiratory tract infections, skin and soft tissue infections, and gastrointestinal illnesses - and how the seasons shape their patterns. Now learn how aged care providers in Australia can reduce HAI harm through effective surveillance using McGeer criteria, bedside decision-making with Loeb criteria, and antimicrobial stewardship best practice.

The outcomes of healthcare-associated infections (HAIs) in aged care are serious, but they’re not inevitable. How your facility responds - through effective surveillance, sound clinical decision-making, and a genuine commitment to antimicrobial stewardship (AMS) - determines how much of that harm can be prevented.

Infections pose a higher risk of serious harm for aged care residents than for younger, healthier people. This isn’t pessimism; it’s physiology and understanding it equips your team to act faster and smarter.

Several factors compound to worsen outcomes:

Treating infections in aged care is not simply a matter of prescribing the right antibiotic. It requires clinical judgement on whether an antibiotic is needed at all, which agent is appropriate, and the duration of treatment.

The Loeb criteria, developed by Dr Mark Loeb and colleagues and published in 2001, set the minimum clinical threshold for initiating antibiotics in aged care residents. Unlike surveillance tools, the Loeb criteria are designed for real-time bedside decision-making, often before diagnostic results are available. They exist precisely because clinicians sometimes feel pressure to “do something” before the clinical picture is clear.

For your nursing team, the practical lesson is straightforward: document specifically. “Temperature 38.2°C at 1430hrs, febrile for the second consecutive assessment, new onset of dysuria and frequency reported” gives a prescriber something to work with. “Seems a bit unwell, possible UTI” doesn’t, and that kind of documentation drives inappropriate prescribing.

Treatment by infection type:

Good treatment starts with good detection - and that’s where surveillance comes in.

The McGeer criteria, originally developed by Dr Allison McGeer in 1991 and significantly revised in 2012, are the internationally recognised standardised definitions of infection for long-term care settings. They were designed specifically for aged care residents - a population for whom standard hospital-based criteria don’t apply. The 2012 revision tightened the UTI and RTI definitions and added new criteria for norovirus gastroenteritis and C. diff.

It’s worth being clear about what the McGeer criteria are, and what they aren’t. They are a “retrospective surveillance tool”. They help you determine whether an HAI occurred, estimate incidence and prevalence, and benchmark your facility’s infection rates over time. They are not a real-time clinical decision tool at the bedside - that’s the role of the Loeb criteria.

The distinction matters in practice. A resident can have a genuine infection without meeting the McGeer surveillance criteria. Conversely, meeting the criteria doesn’t automatically mean an antibiotic was indicated. Using McGeer correctly means applying it consistently, documenting clearly, and using the data to identify patterns: which infections, which units, which residents, and which time of year.

For Australian facilities, participation in the Aged Care National Antimicrobial Prescribing Survey (AC-NAPS), coordinated by the National Centre for Antimicrobial Stewardship (NCAS-Australia), is one of the most effective steps your facility can take. It benchmarks your prescribing against peer facilities and provides your governing body with meaningful data to act on. New Zealand facilities should use local surveillance and audit tools and engage with regional antimicrobial stewardship initiatives where available

Surveillance without action is just paperwork. The facilities that achieve the best HAI outcomes integrate surveillance data into a clear governance loop: regular review by your Infection Prevention and Control (IPC) and AMS committee, feedback to prescribers on prescribing patterns, and quality improvement projects linked to your findings.

Under Outcome 5.2, Action 5.2.1 of the Strengthened Aged Care Quality Standards (effective 1 November 2025), providers are explicitly required to implement both an AMS system and IPC processes for clinical care — including processes to prevent, identify, and manage UTIs, and to review the use of invasive devices such as urinary catheters. The Aged Care Quality and Safety Commission (ACQSC) expects to see evidence of compliance.

The good news is that multi-component programs work. Interventions that combine education, monitoring, feedback, and at least four coordinated components consistently reduce HAI rates in residential settings. No single measure is enough — but when your team, governance structures, surveillance system, and AMS program are aligned, the difference is measurable.

HAIs in aged care are serious — but how your facility responds makes the difference. Use the Loeb criteria at the bedside to guide antibiotic decision-making. Use the McGeer criteria to track infection patterns across your facility. Join AC-NAPS. Build a governance loop that actually closes. When surveillance, AMS, and your IPC program work together, you don’t just manage infections - you prevent them.

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For further information on this topic, see the HUB, the IPS website. EVE, our “bot”, will answer a quick question, or email support@infectioncontrol.care if you need help.

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