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Hassan N, Ali Alomari AM, Kunjavara J, Singh K, Joy GV, Mannethodi K, Al Lenjawi B. Are Nurses Aware of Their Contribution to the Antibiotic Stewardship Programme? A Mixed-Method Study from Qatar. Healthcare (Basel) 2024; 12:1516. [PMID: 39120219 PMCID: PMC11311588 DOI: 10.3390/healthcare12151516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 01/23/2024] [Accepted: 01/29/2024] [Indexed: 08/10/2024] Open
Abstract
The antibiotic stewardship programme (ASP) is a new concept initiated by WHO, but nurses are not yet ready to adopt the program. The training and empowerment of nurses are the best strategies for enhancing their knowledge and engagement in ASP. This mixed-method study was used to assess perceived roles and barriers of nurses' involvement in ASP. An online survey was conducted among 420 clinical nurses to identify their role, and 23 individual interviews were performed among nurses and infection control practitioners to explore the barriers and recommendations to overcome the identified barriers. The majority of the nurses agreed with the sixteen identified roles in ASP, of which 'antibiotic dosing and de-escalation' (82.61%), 'IV to PO conversion of antibiotic, outpatient antibiotic therapy' (85.23%), and 'outpatient management, long-term care, readmission' of the patients (81.19%) had the lowest agreement from the participants. The major themes generated through the qualitative interviews were a lack of knowledge about ASP, poor communication between multidisciplinary teams, lack of opportunity and multidisciplinary engagement, lack of formal education and training about ASP, lack of ASP competency and defined roles in policy, role conflict or power/position, availability of resources, and lack of protected time. Nurses play an integral role in the successful implementation of antibiotic stewardship programs. The empowerment of nurses will help them to adopt the unique role in ASP. Nurses can significantly contribute to antibiotic stewardship efforts and improve patient outcomes through addressing these challenges.
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Affiliation(s)
- Nesiya Hassan
- Nursing and Midwifery Research Department, Hamad Medical Corporation, Doha 00974, Qatar
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Castro-Sánchez E. Overview of the Participation of Nurses in Antimicrobial Stewardship Activities. Clin Ther 2024; 46:469-473. [PMID: 38825552 DOI: 10.1016/j.clinthera.2024.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 04/25/2024] [Accepted: 05/03/2024] [Indexed: 06/04/2024]
Abstract
Antibiotic resistance is a planetary threat demanding maximum attention from health and social care services worldwide due to the clinical, economic, and human costs. Interventions to address resistance-antimicrobial stewardship (AMS) programs-are multipronged and require the close collaboration of all health care workers involved in antimicrobial decisions and use. Nurses have traditionally been absent from such engagement. This Commentary highlights existing evidence of the need for, and impact of, nursing involvement and leadership in AMS. In addition, four barriers (ie, foundational, ownership, education, and leadership) to the increased involvement of nurses in AMS are discussed, with implications and potential solutions.
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Affiliation(s)
- Enrique Castro-Sánchez
- College of Business, Arts and Social Sciences, Brunel University London, Uxbridge, United Kingdom; National Institute for Health Research Health Protection Research Unit in Healthcare Associated Infection and Antimicrobial Resistance at Imperial College London, South Kensington, London, United Kingdom; Universitat de les Illes Balears, Palma, Illes Balears, Spain; Valencia International University, Valencia, Spain.
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Precha N, Sukmai S, Hengbaru M, Chekoh M, Laohaprapanon S, Makkaew P, Dom NC. Knowledge, attitudes, and practices regarding antibiotic use and resistance among health science and non-health science university students in Thailand. PLoS One 2024; 19:e0296822. [PMID: 38180959 PMCID: PMC10769033 DOI: 10.1371/journal.pone.0296822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 12/19/2023] [Indexed: 01/07/2024] Open
Abstract
Antibiotic-resistant bacteria (ARB) have been recognized as one of the global health issues affecting humans, animals, and the environment. A lack of knowledge, negative attitudes, and irrational drug use can make significant contributions to the spread of ARB. This study aimed to assess the knowledge, attitudes, and practices (KAP) regarding antibiotic use and resistance among health science (HS) and non-health science (NHS) students and to determine the factors that influence their KAP concerning antibiotic use and resistance. A cross-sectional study was conducted among 404 HS and NHS students in Southern Thailand from December 2021 to March 2022. The students who fulfilled the study inclusion criteria responded to a questionnaire that had five dimensions. Descriptive statistics were used to analyze the qualitative variables, and Fisher's exact test was applied to compare the demographic variables, KAP responses between the HS and NHS students. The KAP regarding antibiotic use and resistance for each variable were compared using the Mann-Whitney U test and Kruskal-Wallis H test. Spearman's correlation test was used to estimate the correlation between the variables and KAP. A total of 404 (HS,162; NHS,242) students completed the self-administered questionnaire. The students' highest score was for attitude, followed by practice and knowledge. Our findings revealed that the HS students had higher levels of KAP correlated with antibiotic use and resistance than the NHS students (P < 0.001). The higher KAP scores were among the more senior students, which indicates that instruction on antibiotics was effective in their curriculum. Antibiotic use and resistance knowledge and attitudes should be conveyed to all university students via academic curriculum. Such interventions could set the standard for rational antibiotic use as well as long-term prevention and control of antibiotic-resistant bacteria.
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Affiliation(s)
- Nopadol Precha
- Department of Environmental Health and Technology, School of Public Health, Walailak University, Nakhon Si Thammarat, Thailand
- Excellent Center for Dengue and Community Public Health, Walailak University, Nakhon Si Thammarat, Thailand
| | - Suppachai Sukmai
- Department of Environmental Health and Technology, School of Public Health, Walailak University, Nakhon Si Thammarat, Thailand
| | - Muhammadsarif Hengbaru
- Department of Environmental Health and Technology, School of Public Health, Walailak University, Nakhon Si Thammarat, Thailand
| | - Muhammadkaddfee Chekoh
- Department of Environmental Health and Technology, School of Public Health, Walailak University, Nakhon Si Thammarat, Thailand
| | - Sawanya Laohaprapanon
- Department of Environmental Health and Technology, School of Public Health, Walailak University, Nakhon Si Thammarat, Thailand
| | - Prasert Makkaew
- Department of Environmental Health and Technology, School of Public Health, Walailak University, Nakhon Si Thammarat, Thailand
- Excellent Center for Dengue and Community Public Health, Walailak University, Nakhon Si Thammarat, Thailand
| | - Nazri Che Dom
- Centre of Environmental Health and Safety Studies, Facultyof Health Sciences, Universiti Teknologi MARA (UiTM), Selangor, Malaysia
- Integrated Mosquito Research Group (I-MeRGe), Universiti Teknologi MARA (UiTM), Selangor, Malaysia
- Institute for Biodiversity and Sustainable Development (IBSD), Universiti Teknologi MARA (UiTM), Selangor, Malaysia
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Zhao W, Guo W, Sun P, Yang Y, Ning Y, Liu R, Xu Y, Li S, Shang L. Bedside nurses' antimicrobial stewardship practice scope and competencies in acute hospital settings: A scoping review. J Clin Nurs 2023; 32:6061-6088. [PMID: 37186422 DOI: 10.1111/jocn.16731] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 03/15/2023] [Accepted: 04/11/2023] [Indexed: 05/17/2023]
Abstract
AIM To identify and map bedside nurses' practice scope and competencies regarding antimicrobial stewardship in acute hospital settings, and develop a competency framework for them. BACKGROUND Antimicrobial stewardship requires multidisciplinary engagement including nursing. However, bedside nurses' antimicrobial stewardship practice scope and competencies in acute hospital settings remain unclear. DESIGN Scoping review. METHODS Using a five-stage framework proposed by Arksey and O'Malley and following the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews guidelines. RESULTS A total of 1422 records were retrieved, and 41 studies were included. In addition to the six practices recommended, this review summarized bedside nurses' contributions to five additional fields as well. Correspondingly, the competencies required by bedside nurses were summarized into eight domains: specialized knowledge, safety medication administration, leadership, education, diagnostic stewardship, infection prevention and control, professional development and professional quality. CONCLUSION Nurses' practice scope overlaps greatly with routine nursing practice in antimicrobial stewardship, confirming the evidence that nurses are ideal partners in antimicrobial stewardship. This review developed a competency framework at both basic and advanced levels. Among them, professional knowledge is the foundation, while professional quality motivates nurses to participate. In addition to competency assessment, it can also be used for training and human resource deployment based on seniority or professional level. This could bridge the knowledge gap and improve the engagement of nurses in heavy workload situations. RELEVANCE TO CLINICAL PRACTICE This practice scope will provide opportunities for nurses to engage in antimicrobial stewardship. Moreover, nursing competencies identified in this field could facilitate the development of competency-based education interventions, talent assessments, training and recruitment programs. DATA RESOURCES PubMed, EMBASE, Web of Science, CINHAL, PsycINFO, Cochrane Library, ProQuest and Scopus were searched from inception to November 2022, with an updated search in March 2023. IMPACT This scoping review provides evidence for best nursing practice scope and competency in antimicrobial stewardship in hospitals. However, it is also in line with the commitment of all nurses in the global community to combat antimicrobial resistance, which has become a global threat. An antimicrobial stewardship competency framework for bedside nurses was developed at both the basic and advanced levels. It would facilitate talent assessment, training, recruitment and human resource management by guiding the development of competency-based education interventions. PATIENT OR PUBLIC CONTRIBUTION No Patient or Public Contribution.
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Affiliation(s)
- Wenting Zhao
- Nursing College, Shanxi Medical University, Taiyuan, China
- Department of Infection Management, The First Hospital of Shanxi Medical University, Taiyuan, China
- Department of Nursing, Changzhi Medical College, Changzhi, China
| | - Wei Guo
- Nursing College, Shanxi Medical University, Taiyuan, China
| | - Pei Sun
- Nursing College, Shanxi Medical University, Taiyuan, China
| | - Yuanhui Yang
- Nursing College, Shanxi Medical University, Taiyuan, China
| | - Yan Ning
- Nursing College, Shanxi Medical University, Taiyuan, China
| | - Ru Liu
- Nursing College, Shanxi Medical University, Taiyuan, China
| | - Yufei Xu
- Nursing College, Shanxi Medical University, Taiyuan, China
| | - Shuhua Li
- Nursing College, Shanxi Medical University, Taiyuan, China
| | - Linping Shang
- Department of Infection Management, The First Hospital of Shanxi Medical University, Taiyuan, China
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Mittal N, Deswal H, Mittal R, Sharma S, Kaushik P. An educational program on antimicrobial resistance and stewardship for staff nurses in a public tertiary care hospital in India. Infect Dis Health 2023; 28:202-210. [PMID: 37080820 DOI: 10.1016/j.idh.2023.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Revised: 02/08/2023] [Accepted: 03/21/2023] [Indexed: 04/22/2023]
Abstract
BACKGROUND Nurses, the largest group among healthcare professionals, hold a pivotal position to positively influence antimicrobial management by virtue of being in constant touch with patients and their widespread engagement in multiple activities relating to antimicrobial use. However, the existing gap in nursing curriculum particularly in areas related to antimicrobial resistance and optimal use of these agents limits the clinical application of nurses' skills and pose barrier to their contribution towards achieving desirable outcomes in patient care. This training program was conducted to increase the nurses' awareness on antimicrobial resistance (AMR) and sensitize them on their role in optimal antimicrobial management and stewardship activities. METHODS Training comprised of 4 modules focussing on topics like key concepts on antimicrobials, AMR, infection prevention and control, antibiotic allergy, optimal use of antibiotics and antimicrobial stewardship (AS). The participants' knowledge at baseline and 1 week after program were assessed. RESULTS AND CONCLUSIONS 190 nurses participated in the program. Post program there was a consistent increase in the number of correct responses to all knowledge-based questions pertaining to 4 modules. A significant improvement in knowledge scores for all modules from baseline was also seen. The participants rated the overall quality of program as very good and agreed on its applicability in their practice. The training program was quite successful in educating nurses on critical issues related to AMR and AS. Nurses need to be constantly trained and sensitized for their potential contributions in the field of AMR and stewardship.
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Affiliation(s)
- Niti Mittal
- Pt. B D Sharma Postgraduate Institute of Medical Sciences, Rohtak, Haryana, India; Point Prevalence Survey (PPS), WHO-National Centre for Disease Control PPS Project, New Delhi, India.
| | - Himani Deswal
- Pt. B D Sharma Postgraduate Institute of Medical Sciences, Rohtak, Haryana, India
| | - Rakesh Mittal
- Pt. B D Sharma Postgraduate Institute of Medical Sciences, Rohtak, Haryana, India; Regional Centre for Faculty Development in Medical Education, India
| | - Sumit Sharma
- Pt. B D Sharma Postgraduate Institute of Medical Sciences, Rohtak, Haryana, India
| | - Pankaj Kaushik
- Pt. B D Sharma Postgraduate Institute of Medical Sciences, Rohtak, Haryana, India
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Hashad N, Stewart D, Perumal D, Abdulrazzaq N, Tonna AP. A theoretical exploration of perspectives of key stakeholders on the implementation of antimicrobial stewardship programmes: a qualitative study underpinned by the Consolidated Framework for Implementation Research. J Hosp Infect 2023:S0195-6701(23)00146-9. [PMID: 37211094 DOI: 10.1016/j.jhin.2023.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 05/05/2023] [Accepted: 05/09/2023] [Indexed: 05/23/2023]
Abstract
BACKGROUND While a plethora of studies report antimicrobial stewardship programme (ASP) implementation, these are limited by a lack of theoretical underpinning. This may lead to missing key factors that are likely to influence the successful or unsuccessful implementation. AIM The aim of this study was to explore key stakeholders' perspectives of ASP implementation in United Arab Emirates (UAE) hospitals, with a focus on facilitators and barriers. METHODS The study employed a qualitative approach using semi-structured interviews conducted with ASP stakeholders involved in clinical use of antimicrobials at the individual patient level and including ASP team members and non-members. An interview schedule based on published literature and grounded in the Consolidated Framework for Implementation Research (CFIR) was developed, reviewed, and piloted. Recruitment was via purposive and snowball sampling. Interviews were recorded, transcribed, and thematically analysed by two independent researchers using CFIR as a coding framework. FINDINGS Data saturation was achieved at thirty-one interviews. Multiple CFIR constructs were identified as implementation facilitators or barriers. Facilitators included external policy requirements (both national and international), leadership support, stakeholders' engagement, collaborative culture, effective communication, and forward planning. Barriers included blame culture, complexity of ASP implementation and a shortage of expert personnel. CONCLUSION Numerous facilitators and barriers to ASP implementation from a stakeholders' perspective were identified in this research. The value of early leadership engagement to support provision of required resources, a need for effective planning and establishment of multiple engagement techniques, and valuable communication with healthcare providers are the main recommendations emerging to support improvement in clinical practice.
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Affiliation(s)
- Nortan Hashad
- Pharmacy, Higher Colleges of Technology, Dubai, United Arab Emirates; School of Pharmacy and Life Sciences, Robert Gordon University, Aberdeen, United Kingdom
| | - Derek Stewart
- College of Pharmacy, QU Health, Qatar University, Doha, Qatar
| | - Dhayaneethie Perumal
- Commission of Academic Accreditation, Ministry of Education, Abu Dhabi, United Arab Emirates
| | - Najiba Abdulrazzaq
- Al Kuwait Hospital, Emirates Health Services, Dubai, United Arab Emirates
| | - Antonella Pia Tonna
- School of Pharmacy and Life Sciences, Robert Gordon University, Aberdeen, United Kingdom.
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Hendy A, Al-Sharkawi S, Hassanein SMA, Soliman SM. Effect of educational intervention on nurses' perception and practice of antimicrobial stewardship programs. Am J Infect Control 2023; 51:41-47. [PMID: 35561943 DOI: 10.1016/j.ajic.2022.05.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 04/26/2022] [Accepted: 05/01/2022] [Indexed: 02/05/2023]
Abstract
BACKGROUND Nurse involvement in antimicrobial stewardship programs is insufficient, which limits the programs' effectiveness. To evaluate the effect of the training programs on nurses' perception and practice of antimicrobial stewardship to embed it in practice. METHODS A quasi-experimental study without a control group was conducted on 115 nurses. A specifically validated and designed instrument was utilized to evaluate perception and practice before, after, and 2 months follow-up the training sessions. RESULTS The difference between the pre, post, and 2 months follow-up tests was highly significant for the dimensions of knowledge, perception, and practice (P < .01). Also, nurses reported a lack of knowledge, lack of training, high workload as barriers of AMS. Nurses suggested ways to overcome barriers such as physician and manager support, in-service training every 6 months, and saving time for training and education. CONCLUSIONS An educational intervention improved perception and practice among nurses related to antimicrobial stewardship and easily embedded it in practice.
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Affiliation(s)
- Abdelaziz Hendy
- Pediatric Nursing Department, Faculty of Nursing, Ain Shams University, Cairo, Egypt.
| | - Sabah Al-Sharkawi
- Faculty of Nursing, October University, Pediatric Department, Faculty of Nursing, Ain Shams University, Egypt
| | | | - Sahar M Soliman
- Department of Maternal & Neonatal Health Nursing, Faculty of Nursing, Ain Shams University, Egypt
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Danielis M, Regano D, Castaldo A, Mongardi M, Buttiron Webber T. What are the nursing competencies related to antimicrobial stewardship and how they have been assessed? Results from an integrative rapid review. Antimicrob Resist Infect Control 2022; 11:153. [PMID: 36474301 PMCID: PMC9727984 DOI: 10.1186/s13756-022-01189-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2022] [Accepted: 11/27/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Antimicrobial resistance issues, and the consequent demand for antimicrobial stewardship (AMS) programs, need to be investigated urgently and clearly. Considering the large amount of time nurses spend at patients' bedside, the aim of the present study was to examine recent literature on nursing competency in AMS. METHODS Drawing from Tricco and colleagues' seven-stage process, a rapid review was performed. MEDLINE, CINAHL and EMBASE databased were searched from December 1st, 2019 until December 31st, 2021. Article screening and study selection were conducted independently by three reviewers. Data were analyzed narratively and categorized adopting an inductive thematic coding. RESULTS Sixteen studies met the inclusion criteria and were included. Publications were mainly authored in USA (n = 4), Australia and New Zealand (n = 4) and Asia (n = 4), followed by Europe (n = 2) and Africa (n = 2). Ten studies were quantitative in design, followed by qualitative (n = 4) and mixed-methods studies (n = 2). Nursing competency in AMS seems to be influenced by a two-dimensional model: on the one hand, internal factors which consisted in knowledge, attitudes and practices and, on the other hand, external aspects which are at environmental level in terms of structures and processes. CONCLUSION This study provided a map of dimensions for researchers and practitioners to consider when planning clinical governance, educational activities, and research programs. Significant opportunities exist for nurses to contribute to practice, education, research, and policy efforts aimed at reducing antimicrobial resistance.
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Affiliation(s)
- Matteo Danielis
- ANIPIO, Società Scientifica Nazionale degli Infermieri Specialisti del Rischio Infettivo - National Association of Nurses for the Prevention of Hospital Infections, Bologna, Italy ,grid.5390.f0000 0001 2113 062XSchool of Nursing, Department of Medical Sciences, University of Udine, Viale Ungheria 20, 33100 Udine, Italy
| | - Domenico Regano
- ANIPIO, Società Scientifica Nazionale degli Infermieri Specialisti del Rischio Infettivo - National Association of Nurses for the Prevention of Hospital Infections, Bologna, Italy ,grid.6292.f0000 0004 1757 1758IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Albertoni 15, 40138 Bologna, Italy
| | - Anna Castaldo
- ANIPIO, Società Scientifica Nazionale degli Infermieri Specialisti del Rischio Infettivo - National Association of Nurses for the Prevention of Hospital Infections, Bologna, Italy ,IRCCS Fondazione Don Gnocchi, Via Capecelatro, 66, 20148 Milano, Italy
| | - Maria Mongardi
- ANIPIO, Società Scientifica Nazionale degli Infermieri Specialisti del Rischio Infettivo - National Association of Nurses for the Prevention of Hospital Infections, Bologna, Italy ,grid.5611.30000 0004 1763 1124Infectious Diseases Division, Diagnostics and Public Health Department, University of Verona, P. le L.A. Scuro 10, 37134 Verona, Italy
| | - Tania Buttiron Webber
- ANIPIO, Società Scientifica Nazionale degli Infermieri Specialisti del Rischio Infettivo - National Association of Nurses for the Prevention of Hospital Infections, Bologna, Italy ,grid.450697.90000 0004 1757 8650Medical Oncology, Galliera Hospital, Mura delle Cappuccine 14, 16128 Genoa, Italy
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