Education and regular Feedback for Antimicrobial Stewardship in nursing homes: EduFAST study protocol

The aging population has led to an increased number of people in nursing homes (NHs). The use of antimicrobials in this setting carries an increased risk of adverse events and interactions, particularly in individuals with advanced age, comorbidities, and polypharmacy. Antimicrobial Stewardship Programs (ASPs) have been shown to reduce the consumption of these drugs, improve prescribing practices, and have a positive ecological impact. However, the implementation of ASPs in NHs remains limited.

To develop and evaluate the impact of EduFAST web platform, which is designed to train professionals, monitor activities and provide ASP teams with periodic feedback and indicators of antimicrobial use and microbial resistance in NHs.

Quasi-experimental, multicenter, before-and-after study. The intervention phase will last 12 months and involves implementing ASP strategies (educational measures, indicator monitoring and periodic feedback) via the EduFAST web platform. Information will be collected on the use of the web platform, user satisfaction, knowledge gained and the number of website visits. To assess the impact of EduFAST's implementation, the following data will be recorded: clinical variables; antimicrobial consumption and prescription profiles; and the incidence of infections caused by multidrug-resistant bacteria and Clostridioides difficile. Additionally, the presence and concentration of antimicrobials, multidrug-resistant microorganisms and resistance genes in wastewater from the participating centers will be recorded to evaluate the correlation between clinical samples, antimicrobial consumption and wastewater findings, as well as the environmental impact of the intervention. The intervention's impact will be analyzed through interrupted time series analysis, trend analysis, mixed linear regression models and correlation analysis for data obtained from wastewater samples.

The aim of this project is to facilitate the implementation and sustainability of ASPs through the development of a national-level website. Wastewater analysis will provide insight into the correlation between antimicrobial consumption, microbial resistance, and the environment from a one-health perspective.