Environmental Swabbing and Antimicrobial Stewardship Monitoring

[Narelle Robertson]

Dear Team,

I am seeking some guidance regarding infection prevention and control practices within our residential aged care facility and would appreciate being pointed in the right direction to relevant resources, recommendations or training.
I have a few questions relating to environmental monitoring and antimicrobial stewardship (AMS) that I am hoping you may be able to assist with.

1. Environmental swabbing and surface testing
We are interested in exploring environmental surface testing as part of our ongoing infection prevention and control quality improvement activities.
• What are the current recommendations for environmental surface swabbing in residential aged care facilities?
• If we wanted to undertake annual testing of high-touch surfaces, such as bathroom surfaces following cleaning, what would be the recommended approach?
• Which surfaces should be prioritised, and what testing methods or equipment would be appropriate?
• How would we go about sourcing the required testing kits, and would samples need to be processed by an accredited laboratory?
• Are there any specific guidelines or resources available to help facilities establish an appropriate environmental monitoring program?
We are particularly interested in understanding how we can objectively assess cleaning effectiveness and use the results to support continuous improvement, rather than undertaking testing without a clear purpose or interpretation framework.

2. Tracking antimicrobial use and associated costs
I would also appreciate clarification regarding the concept of tracking the cost of antibiotic (A/B) use within a facility as part of antimicrobial stewardship.
• What information should a residential aged care facility collect to monitor antibiotic use and associated costs?
• Does this generally involve tracking the total expenditure on antibiotics, individual prescriptions, courses of treatment, or antibiotic use per resident?
• Are there recommended measures or benchmarking tools that can help facilities compare antibiotic use over time?
• Are there any existing resources, templates or reporting tools suitable for residential aged care facilities to monitor both antibiotic consumption and financial costs?

Our aim is to ensure we are monitoring antimicrobial use appropriately and identifying opportunities to improve prescribing practices while maintaining safe and effective resident care.

thanks Narelle Robertson

[Carrie Spinks]

Hi Narelle,

1. Australian guidance, including the Aged Care Infection Prevention and Control Guide (2024) and the Australian Guidelines for the Prevention and Control of Infection in Healthcare, supports a risk-based approach to environmental hygiene in residential aged care. Routine monitoring should focus on visual inspections, cleaning audits and, where appropriate, fluorescent gel markers or ATP bioluminescence testing to assess cleaning effectiveness. Routine microbiological surface swabbing is not established as a standard requirement for aged care and should generally be reserved for specific purposes, such as outbreak investigations, suspected environmental contamination or targeted surveillance where results will inform infection prevention and control actions. Testing should be guided by a clear rationale, appropriate sampling methods and expert advice, as detecting microorganisms on a surface does not necessarily indicate an infection risk.

2. This question came up in May this year – here is the response:

In Australia, aged care homes are required to monitor antimicrobial use and effects primarily to ensure clinical safety and reduce antimicrobial resistance, rather than specifically to monitor the direct financial cost of the drugs. However, monitoring for appropriate use and adverse events inherently involves looking at the financial cost-effectiveness of antimicrobials (in this case antibiotics), as inappropriate use is considered a waste of resources.

Direct Medication Costs: Cost of expensive, broad-spectrum antibiotics compared to more appropriate, targeted, and generally cheaper agents.

Hence, reviewing the cost of all antibiotics against the cost of those that were prescribed inappropriately – will provide the cost of wasted resources. If high, this will highlight the need for change to ensure clinical safety.

e.g.
AB costs total= $3000
AB inappropriate agent or prescribed costs = $2000

3000-2000 = 1000

If correct prescribing had occurred the cost of AB should have been $1000
$2000 is high demonstrating high wasted resource use and high inappropriate prescribing.

Laboratory/Diagnostic Costs: Identifying costs associated with unnecessary pathology tests or prolonged investigation can also be reviewed.

Hope that helps

Regards Carrie

[Diane Piper]

I am also interested in this as well if anyone has information that would be great.

[Kelly Barton]

Hi Narelle,
Swabbing of surfaces is very expensive and as Carrie pointed out not necessary unless you have issues you need to solve. If you really want to go down this path, then you need goals around what it is you want to achieve. We did a project a few years ago where we changed the cleaning system, and to validate our choices we did environmental swabbing. We used ATP swabbing, which just measures the amount of debris on the surface, rather than the microbiological burden. Happy to chat offline if you want more information around this.

As for antibiotic use & costs, not sure how you would go about this in residential aged care as the residents have scripts that are for each individual, rather than like in hospital where you an imprest system in pharmacy which is a pre-determined, fixed stock level of medications- which is easier to track numbers and costs. And just looking at narrow spectrum vs broad does not give a clear picture of appropriateness, as broad-spectrum antibiotics are recommended as first choice in certain circumstances in the therapeutic guidelines, or by the resistance patterns in microbiology results. If you are not already using the National Antimicrobial Prescribing Survey (NAPS) platform I would suggest that is a much more effective way of conducting AMS activities. The platform is undergoing revision and updating, and I am personally very excited about updated aged care module that is scheduled to come out early next year (I am lucky enough to have done some of the pilot testing).

Good luck!

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