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Abbas S. The challenges of implementing infection prevention and antimicrobial stewardship programs in resource-constrained settings. ANTIMICROBIAL STEWARDSHIP & HEALTHCARE EPIDEMIOLOGY : ASHE 2024; 4:e45. [PMID: 38628374 PMCID: PMC11019578 DOI: 10.1017/ash.2024.35] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Revised: 02/07/2024] [Accepted: 02/10/2024] [Indexed: 04/19/2024]
Abstract
The burden of healthcare-associated infections (HAIs) and antimicrobial resistance (AMR) is disproportionately high in low and middle-income countries. Barriers to implementing effective antimicrobial stewardship and infection prevention programs include the lack of a structural framework, consensus guidelines, educational opportunities, trained personnel, funding, and access to resources such as manpower, information technology, and diagnostics. Socioeconomic instability with supply chain interruptions, poor skilled staff retention, absence of mandates, and inadequate support to enforce existing policies further aggravates the situation. Failure to implement measures to tackle AMR and HAIs effectively will result in repercussions globally.
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Affiliation(s)
- Salma Abbas
- Department of Internal Medicine, Shaukat Khanum Memorial Cancer Hospital and Research Center, Lahore, Punjab, Pakistan
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2
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Ncube NBQ, Chivese T, Mukumbang FC, Bradley HA, Schneider H, Laing R. A combined strategies intervention on the World Health Organization prescribing indicators: A quasi-randomised trial. Afr J Prim Health Care Fam Med 2024; 16:e1-e8. [PMID: 38426778 PMCID: PMC10913181 DOI: 10.4102/phcfm.v16i1.3943] [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: 12/02/2022] [Revised: 08/16/2023] [Accepted: 08/22/2023] [Indexed: 03/02/2024] Open
Abstract
BACKGROUND Irrational medicine use is a global problem that may potentiate antimicrobial resistance. AIM This study aims to assess prescribing practices and the effect of a prescription audit and feedback coupled with small-group education intervention on prescribing indicators. SETTING The study was conducted in public-sector healthcare facilities in Eswatini. METHODS A cluster quasi-randomised controlled study was conducted from 2016 to 2019 using the World Health Organization/ International Network for Rational Use of Drugs (WHO/INRUD) prescribing indicators at baseline, post-intervention and post-follow-up. A 6-month unblinded intervention was tested in 32 healthcare facilities, randomly allocated to intervention (16) and control (16) arms. Prescribing practices were assessed post-intervention, and 6 months after the intervention, through an audit of 100 randomly selected prescriptions from each facility. Comparisons of WHO or INRUD prescribing indicators were conducted using the intention-to-treat analysis at the two times. RESULTS At baseline, in both arms, rational prescribing standards were met by the number of medicines per prescription and the use of injections. Antibiotic use was above 50% in both arms. After adjustment for baseline antibiotics use, region and level of care, there were no significant differences in all prescribing indicators between the two arms, post-intervention and at 6 months follow-up. CONCLUSION In a lower middle-income setting with a high prevalence of irrational prescribing practices, a prescription audit, feedback and small-group education intervention had no benefits in improving rational prescribing.Contribution: Multifaceted strategies, strengthening of pharmacy and therapeutics committees, and holistic monitoring of medicine use are recommended to promote rational medicine use.
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Affiliation(s)
- Nondumiso B Q Ncube
- Department of Community and Health Sciences, School of Public Health, University of the Western Cape, Cape Town.
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Hassan SK, Dahmash EZ, Madi T, Tarawneh O, Jomhawi T, Alkhob W, Ghanem R, Halasa Z. Four years after the implementation of antimicrobial stewardship program in Jordan: evaluation of program's core elements. Front Public Health 2023; 11:1078596. [PMID: 37325334 PMCID: PMC10262748 DOI: 10.3389/fpubh.2023.1078596] [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: 10/25/2022] [Accepted: 05/09/2023] [Indexed: 06/17/2023] Open
Abstract
Objectives To combat antimicrobial resistance, the World Health Organization (WHO) urged healthcare organizations in Low- and Middle-Income Countries (LMICs) to implement the core elements of the antimicrobial stewardship (AMS) programs. In response, Jordan took action and developed a national antimicrobial resistance action plan (NAP) in 2017 and commenced the AMS program in all healthcare facilities. It is paramount to evaluate the efforts to implement the AMS programs and understand the challenges of implementing a sustainable and effective program, in Low-Middle Income Country (LMIC) contexts. Therefore, the aim of this study was to appraise the compliance of public hospitals in Jordan to the WHO core elements of effective AMS programs after 4 years of commencement. Methods A cross-sectional study in public hospitals in Jordan, using the WHO AMS program core elements for LMICs was carried out. The questionnaire comprised 30 questions that covered the program's six core elements: leadership commitment, accountability and responsibility, AMS actions, education and training, monitoring, and evaluation, and reporting and feedback. A five-point Likert scale was employed for each question. Results A total of 27 public hospitals participated, with a response rate of 84.4%. Adherence to core elements ranged from (53%) in the leadership commitment domain to (72%) for AMS procedure application (actions). Based on the mean score, there was no significant difference between hospitals according to location, size, and specialty. The most neglected core elements that emerged as top priority areas were the provision of financial support, collaboration, access, as well as monitoring and evaluation. Conclusion The current results revealed significant shortcomings in the AMS program in public hospitals despite 4 years of implementation and policy support. Most of the core elements of the AMS program were below average, which requires hospital leadership commitment, and multifaceted collaborative actions from the concerned stakeholders in Jordan.
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Affiliation(s)
- Samar Khaled Hassan
- Department of Accreditation, Healthcare Accreditation Council, Amman, Jordan
| | - Eman Zmaily Dahmash
- Department of Chemical and Pharmaceutical Sciences, School of Life Sciences, Pharmacy and Chemistry, Kingston University London, Kingston upon Thames, United Kingdom
| | - Thaira Madi
- Department of Accreditation, Healthcare Accreditation Council, Amman, Jordan
| | - Omar Tarawneh
- Department of Consultation, Healthcare Accreditation Council, Amman, Jordan
| | - Tuqa Jomhawi
- Department of Accreditation, Healthcare Accreditation Council, Amman, Jordan
| | - Worood Alkhob
- Department of Accreditation, Healthcare Accreditation Council, Amman, Jordan
| | - Rola Ghanem
- Laboratory Directorate, Ministry of Health, Amman, Jordan
| | - Zina Halasa
- Clinical Pharmacy Directorate, Ministry of Health, Amman, Jordan
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Zhou S, Nagel JL, Kaye KS, LaPlante KL, Albin OR, Pogue JM. Antimicrobial Stewardship and the Infection Control Practitioner: A Natural Alliance. Infect Dis Clin North Am 2021; 35:771-787. [PMID: 34362543 DOI: 10.1016/j.idc.2021.04.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Antibiotic overuse and misuse has contributed to rising rates of multidrug-resistant organisms and Clostridioides difficile. Decreasing antibiotic misuse has become a national public health priority. This review outlines the goals of antimicrobial stewardship, essential members of the program, implementation strategies, approaches to measuring the program's impact, and steps needed to build a program. Highlighted is the alliance between antimicrobial stewardship programs and infection prevention programs in their efforts to improve antibiotic use, improve diagnostic stewardship for C difficile and asymptomatic bacteriuria, and decrease health care-associated infections and the spread of multidrug-resistant organisms.
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Affiliation(s)
- Shiwei Zhou
- Division of Infectious Diseases, Department of Internal Medicine, Michigan Medicine, F4171A University Hospital South, 1500 East Medical Center Drive, Ann Arbor, MI 48109, USA
| | - Jerod L Nagel
- Department of Pharmacy, Michigan Medicine, University of Michigan College of Pharmacy, 428 Church Street, Ann Arbor, MI 48109, USA
| | - Keith S Kaye
- Division of Infectious Diseases, Department of Internal Medicine, Michigan Medicine, 5510A MSRB 1, SPC 5680, 1150 West Medical Center Drive, Ann Arbor, MI 48109-5680, USA
| | - Kerry L LaPlante
- Infectious Diseases Research Program, Providence Veterans Affairs Medical Center, Providence, RI, USA; Center of Innovation in Long-Term Support Services, Providence Veterans Affairs Medical Center, Veterans Affairs Medical Center (151), Building 7, 830 Chalkstone Avenue, Providence, RI 02908, USA; College of Pharmacy, University of Rhode Island, University of Rhode Island College of Pharmacy, Suite 255A-C, 7 Greenhouse Road Suite, Kingston, RI 02881, USA; Department of Health Services Policy & Practice, Center for Gerontology & Health Care Research, Brown University School of Public Health, Providence, RI, USA; Division of Infectious Diseases, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Owen R Albin
- Division of Infectious Diseases, Department of Internal Medicine, Michigan Medicine, University Hospital South F4009, 1500 East Medical Center Drive, Ann Arbor, MI 48109, USA
| | - Jason M Pogue
- Department of Clinical Pharmacy, University of Michigan College of Pharmacy, 428 Church Street, Ann Arbor, MI 48109, USA.
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Assi M, Abbas S, Nori P, Doll M, Godbout E, Bearman G, Stevens MP. Infection Prevention and Antimicrobial Stewardship Program Collaboration During the COVID-19 Pandemic: a Window of Opportunity. Curr Infect Dis Rep 2021; 23:15. [PMID: 34426728 PMCID: PMC8374122 DOI: 10.1007/s11908-021-00759-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/13/2021] [Indexed: 01/08/2023]
Abstract
PURPOSE OF REVIEW We describe the similarities between antimicrobial stewardship programs (ASPs) and infection prevention programs (IPPs), and we discuss how these similarities lend themselves to synergy between programs. We also discuss how the COVID-19 pandemic has generated further opportunities for future collaborations that could benefit both programs. RECENT FINDINGS The COVID-19 pandemic has created new needs, such as real-time data and access to personnel important to both programs, such as information technologists and infectious diseases specialists. It has also increased concerns about rising rates of antimicrobial resistance and healthcare-associated infections, both of which overlap significantly and are key focus areas for both ASPs and IPPs. These emergent issues have highlighted the need for enhanced program infrastructure and new team models. The shift towards telecommunication and telework has facilitated the creation of enhanced infrastructures for collaboration on activities ranging from data access and reporting to providing telehealth services to remote hospitals. These enhanced infrastructures can be leveraged in future collaborative efforts between ASPs and IPPs. SUMMARY Collaboration between IPPs and ASPs can mitigate setbacks experienced by health systems during the current pandemic, enhance the performance of both programs in the post-pandemic era and increase their preparedness for future pandemic threats. As health systems plan for the post-pandemic era, they should invest in opportunities for synergy between ASPs and IPPs highlighted during the pandemic.
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Affiliation(s)
- Mariam Assi
- Department of Internal Medicine, Virginia Commonwealth University Health System, Richmond, VA USA
| | - Salma Abbas
- Shaukat Khanum Memorial Cancer Hospital and Research Center, Peshawar, Pakistan
| | - Priya Nori
- Department of Medicine, Division of Infectious Diseases, Montefiore Medical Center, Albert Einstein College of Medicine, 3411 Wayne Avenue 4H, Bronx, NY 10467 USA
| | - Michelle Doll
- Healthcare Infection Prevention Program, Virginia Commonwealth University Health System, North Hospital, 1300 E. Marshall Street, P. O. Box 980019, Richmond, VA 23298 USA
| | - Emily Godbout
- Healthcare Infection Prevention Program, Virginia Commonwealth University Health System, North Hospital, 1300 E. Marshall Street, P. O. Box 980019, Richmond, VA 23298 USA
| | - Gonzalo Bearman
- Healthcare Infection Prevention Program, Virginia Commonwealth University Health System, North Hospital, 1300 E. Marshall Street, P. O. Box 980019, Richmond, VA 23298 USA
| | - Michael P. Stevens
- Healthcare Infection Prevention Program, Virginia Commonwealth University Health System, North Hospital, 1300 E. Marshall Street, P. O. Box 980019, Richmond, VA 23298 USA
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Involving antimicrobial stewardship programs in COVID-19 response efforts: All hands on deck. Infect Control Hosp Epidemiol 2020; 41:744-745. [PMID: 32167442 PMCID: PMC7137534 DOI: 10.1017/ice.2020.69] [Citation(s) in RCA: 74] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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The learning hospital: From theory to practice in a hospital infection prevention program. Infect Control Hosp Epidemiol 2020; 41:86-97. [DOI: 10.1017/ice.2019.318] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
AbstractThe learning hospital is distinguished by ceaseless evolution of erudition, enhancement, and implementation of clinical best practices. We describe a model for the learning hospital within the framework of a hospital infection prevention program and argue that a critical assessment of safety practices is possible without significant grant funding. We reviewed 121 peer-reviewed manuscripts published by the VCU Hospital Infection Prevention Program over 16 years. Publications included quasi-experimental studies, observational studies, surveys, interrupted time series analyses, and editorials. We summarized the articles based on their infection prevention focus, and we provide a brief summary of the findings. We also summarized the involvement of nonfaculty learners in these manuscripts as well as the contributions of grant funding. Despite the absence of significant grant funding, infection prevention programs can critically assess safety strategies under the learning hospital framework by leveraging a diverse collaboration of motivated nonfaculty learners. This model is a valuable adjunct to traditional grant-funded efforts in infection prevention science and is part of a successful horizontal infection control program.
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Gentry EM, Kester S, Fischer K, Davidson LE, Passaretti CL. Bugs and Drugs: Collaboration Between Infection Prevention and Antibiotic Stewardship. Infect Dis Clin North Am 2019; 34:17-30. [PMID: 31836329 DOI: 10.1016/j.idc.2019.10.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Overall goals of antibiotic stewardship and infection prevention programs are to improve patient safety as it pertains to risk of infection or multidrug-resistant organism (MDRO) acquisition. Although the focus of day-to-day activities may differ, the themes of surveillance, education, clinician engagement, and multidisciplinary interactions are prevalent in both programs. Synergistic work between programs has yielded benefits in prevention of MDROs, surgical site infections, Clostridioides difficile infection, and reducing inappropriate testing and treatment for asymptomatic bacteriuria. Collaboration between programs can help maximize resources and minimize redundant work to keep issues related to bugs and drugs at bay.
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Affiliation(s)
- Erin M Gentry
- Antimicrobial Support Network, Carolinas Medical Center, Department of Pharmacy Services, Atrium Health, 1000 Blythe Boulevard, Charlotte, NC 28203, USA.
| | - Shelley Kester
- Infection Prevention, Division of Quality, Atrium Health, 1616 Scott Avenue, Charlotte, NC 28203, USA
| | - Kristin Fischer
- Department of Medicine, Division of Infectious Diseases, Atrium Health, 1540 Garden Terrace, Suite 209, Charlotte, NC 28203, USA
| | - Lisa E Davidson
- Antimicrobial Support Network, Internal Medicine, Division of Infectious Diseases, Atrium Health, 1540 Garden Terrace, Suite 211, Charlotte, NC 28203, USA
| | - Catherine L Passaretti
- Health System Infection Prevention, Internal Medicine, Division of Infectious Diseases, Atrium Health, 1616 Scott Avenue, Charlotte, NC 28203, USA
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