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Cassim J, Essack SY, Chetty S. Building an antimicrobial stewardship model for a public-sector hospital: a pre-implementation study. J Med Microbiol 2024; 73. [PMID: 39018101 DOI: 10.1099/jmm.0.001853] [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] [Indexed: 07/18/2024] Open
Abstract
Introduction. Antimicrobial resistance (AMR) is recognized as an important global health risk, associated with increased mortality, morbidity and healthcare costs. Antimicrobial stewardship (AMS) involves a coherent set of processes that promote the rational use of antimicrobials.Gap statement. An AMS programme should be adapted and developed according to the available resources of a facility. This requires an analysis of the core AMS elements that are already in place and the resources available.Aim. This study aimed to assess the readiness of a tertiary healthcare facility and staff towards implementing an antimicrobial stewardship programme (ASP).Methodology. This study focused on two aspects during an AMS pre-implementation phase. A situational or strengths, weaknesses, opportunities, and threats analysis was conducted based on (1) a questionnaire on attitudes and perceptions of pharmacists, clinicians and nurses towards AMR and AMS and (2) a situational analysis on the readiness of the facility.Results. The questionnaire, which was available for completion between September 2021 and December 2021, was sent to a total of 3100 healthcare professionals (HCPs). Thirty-two (1.0 %) HCPs comprising 2 pharmacists, 16 clinicians and 14 nurses completed the questionnaire. Of the total participants, 31 (96.9 %) viewed AMR as a problem in South African hospitals and 29 (90.6 %) perceived AMR as a problem at their facility. The majority (n = 29, 90.6 %) of the participants were familiar with the term AMS, and 26 (81.3 %) participants agreed to willingly participate in any initiatives involving antimicrobial use at the facility. The situational analysis depicted existing strengths in terms of AMS structures such as the formation of an AMS committee and information and technology systems at the HCP's disposal. Weaknesses included the limited number of AMS activities being carried out and poor participation from HCPs within the AMS team.Conclusion. A pre-implementation phase in the building of an ASP can greatly assist in finding gaps for improvement, which can then be addressed in the implementation phase. Furthermore, the pre-implementation phase provides a baseline to measure improvements once the implementation phase has been instituted.
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Affiliation(s)
- Jowhara Cassim
- Discipline of Pharmaceutical Sciences, College of Health Sciences, University of KwaZulu-Natal, Westville Campus, Durban 4041, South Africa
| | - Sabiha Yusuf Essack
- Discipline of Pharmaceutical Sciences, College of Health Sciences, University of KwaZulu-Natal, Westville Campus, Durban 4041, South Africa
- Antimicrobial Research Unit, College of Health Sciences, University of KwaZulu-Natal, Durban 4041, South Africa
| | - Sarentha Chetty
- Discipline of Pharmaceutical Sciences, College of Health Sciences, University of KwaZulu-Natal, Westville Campus, Durban 4041, South Africa
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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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Vonken L, Schneider F, Lejeune B, Noordink A, Kremers S, de Bruijn GJ. Perceptions of antibiotic resistance among hospital healthcare professionals in high-income countries: A systematic review of causes, consequences, and solutions. Prev Med 2024; 182:107953. [PMID: 38614411 DOI: 10.1016/j.ypmed.2024.107953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Revised: 04/08/2024] [Accepted: 04/10/2024] [Indexed: 04/15/2024]
Abstract
OBJECTIVE Antibiotic resistance (ABR) is a major threat to public health. Hospital healthcare professionals are important stakeholders in curbing ABR. To be able to encourage healthcare professionals to act against ABR, information on their perceptions is needed. Yet, summary evidence on how healthcare professionals perceive ABR causes, consequences, and solutions is outdated. This review aims to elucidate these perceptions. METHODS We searched MEDLINE, EMBASE, PsycINFO, and CINAHL for literature published until July 6th, 2022, and used Web of Science and Scopus to identify reports citing included studies. Reports of quantitative original research from high-income countries were included if they investigated hospital healthcare professionals' perceptions about ABR. Descriptive data and data on perceptions about causes, consequences, and solutions regarding ABR were extracted. PROSPERO registration: CRD42022359249. RESULTS The database search and citation tracking yielded 13,551 and 694 papers respectively. Forty-eight reports from 46 studies were included in the review. These studies were performed between 1999 and 2023 and included between 8 and 1362 participants. Healthcare professionals perceived ABR as a problem that is more severe nationally than locally and they primarily recognize ABR as a distant and abstract problem. Studies mostly concurred on prescribing behavior as a cause and a solution for ABR, while external causes and solutions (e.g., in agriculture) elicited less agreement. CONCLUSIONS Studies with a primary focus on the perceptions of healthcare professionals about ABR are limited. Healthcare professionals perceive prescribing behavior as a major cause of ABR and a focus area for ABR solutions.
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Affiliation(s)
- Lieve Vonken
- Department of Health Promotion, Care and Public Health Research Institute CAPHRI, Maastricht University, P. Debyelaan 1, 6229 HA Maastricht, the Netherlands.
| | - Francine Schneider
- Department of Health Promotion, Care and Public Health Research Institute CAPHRI, Maastricht University, P. Debyelaan 1, 6229 HA Maastricht, the Netherlands.
| | - Barbara Lejeune
- Library and Archives Department, University of Antwerp; Universiteitsplein 1, 2610 Antwerp, Belgium.
| | - Annika Noordink
- Department of Health Promotion, Care and Public Health Research Institute CAPHRI, Maastricht University, P. Debyelaan 1, 6229 HA Maastricht, the Netherlands
| | - Stef Kremers
- Department of Health Promotion, Care and Public Health Research Institute CAPHRI, Maastricht University, P. Debyelaan 1, 6229 HA Maastricht, the Netherlands.
| | - Gert-Jan de Bruijn
- Department of Communication Studies, University of Antwerp; Sint-Jacobsstraat 2, 2000 Antwerpen, Belgium.
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Alkadhimi A, Dawood OT, Khan AH. The role of community pharmacists and their perception towards antimicrobial stewardship in Baghdad, Iraq. HEALTH CARE SCIENCE 2024; 3:114-123. [PMID: 38939617 PMCID: PMC11080847 DOI: 10.1002/hcs2.92] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Revised: 02/23/2024] [Accepted: 03/07/2024] [Indexed: 06/29/2024]
Abstract
Background This study aimed to assess the role of community pharmacists and their perception toward antimicrobial stewardship, in addition to identifying factors influencing their perception and practices in community pharmacy. Methods A cross-sectional study was carried out among community pharmacists regarding antimicrobial stewardship. Convenience sampling was used to obtain the required sample from a community pharmacy in Baghdad. In total, 381 participants have completed the survey. Results The majority of the participants (85.6%) strongly agreed/agreed that "antimicrobial stewardship programs reduce the problems of antibiotic resistance"; and 85.5% of them strongly agreed/agreed that community pharmacists required adequate training on antibiotics use. In addition, high percent of community pharmacists (88.4%) strongly agreed/agreed that pharmacists have a responsibility to take a prominent role in antimicrobial stewardship programs and infection-control programs in the health system. The total score of perception was significantly influenced by older age groups, postgraduate degrees, and experience of 6-10 years (p < 0.001). This study also showed that 65.4% of pharmacists always/often advise patients to continue the full course of antimicrobials, and 64.9% of them reported always/often considering clinical and safety parameters before dispensing antibiotics. The role of pharmacists was significantly influenced by the younger age group, females, higher degree in pharmacy, experience of 3-5 years, and medical complex pharmacy (p < 0.001). Conclusion Community pharmacists have a good perception toward antimicrobial stewardship programs, but their role is still limited. More efforts are needed to design better strategies for antimicrobial stewardship in community pharmacy.
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Affiliation(s)
- Akram Alkadhimi
- Discipline of Clinical Pharmacy, School of Pharmaceutical SciencesUniversiti Sains MalaysiaPenangMalaysia
| | | | - Amer H. Khan
- Discipline of Clinical Pharmacy, School of Pharmaceutical SciencesUniversiti Sains MalaysiaPenangMalaysia
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Chetty S, Swe-Han KS, Mahabeer Y, Pillay A, Essack SY. Interprofessional education in antimicrobial stewardship, a collaborative effort. JAC Antimicrob Resist 2024; 6:dlae054. [PMID: 38562216 PMCID: PMC10984567 DOI: 10.1093/jacamr/dlae054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 03/05/2024] [Indexed: 04/04/2024] Open
Abstract
Introduction Antimicrobial stewardship (AMS) education and interprofessional collaboration are integral to the success of a stewardship programme. An interactive interprofessional AMS workshop, designed to encourage workplace interprofessional collaboration was piloted in a tertiary hospital. Objectives To obtain feedback to determine the suitability and sustainability of the AMS workshop. Methods Feedback was elicited through a predesigned questionnaire containing both open-ended and closed questions on the content and structure of the workshop. Results The survey had a 70% (n = 16) overall response rate. All participants agreed that the goals of the workshop were met and that the knowledge and skills gained from the workshop would help them in their AMS roles. All participants indicated that the workshop content, and the level at which it was pitched, met their expectations and that it had improved their knowledge and skills. All agreed that they found it advantageous and enjoyed learning as an interprofessional group. Open feedback showed that the workshop was found to be useful and would potentially result in improved patient care, dissemination of knowledge, improved teamwork and organizational culture. Conclusions The positive feedback and changes made following the workshop demonstrated that a targeted AMS educational workshop adds value to an antimicrobial stewardship programme.
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Affiliation(s)
- Sarentha Chetty
- Department of Pharmacy and Pharmacology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg 2193, South Africa
- Discipline of Pharmaceutical Sciences, School of Health Sciences, Westville Campus, University of KwaZulu-Natal, Durban 4041, South Africa
| | - Khine Swe Swe-Han
- Department of Medical Microbiology, School of Laboratory Medicine and Medical Sciences, College of Health Science, Nelson Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa
- Department of Medical Microbiology, National Health Laboratory Service, Durban, South Africa
| | - Yesholata Mahabeer
- Department of Medical Microbiology, School of Laboratory Medicine and Medical Sciences, College of Health Science, Nelson Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa
- Department of Medical Microbiology, National Health Laboratory Service, Durban, South Africa
| | - Ashendri Pillay
- Department of Paediatrics and Child Health, University of Kwa-Zulu-Natal, Durban, South Africa
- Paediatric Infectious Diseases Unit, Inkosi Albert Luthuli Central Hospital, Durban, South Africa
| | - Sabiha Y Essack
- Antimicrobial Research Unit, College of Health Sciences, University of KwaZulu-Natal, Durban 4041, South Africa
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Sumon SA, Anwar MMU, Akther FM, Priyanka AS, Tamanna T, Rahman A, Islam MS, Harun MGD. Perceptions of antibiotic stewardship programmes and determinants of antibiotic prescribing patterns among physicians in tertiary hospitals in Bangladesh: implications for future policy and practice. J Hosp Infect 2024; 144:56-65. [PMID: 38070709 DOI: 10.1016/j.jhin.2023.11.010] [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: 10/19/2023] [Revised: 11/16/2023] [Accepted: 11/20/2023] [Indexed: 01/11/2024]
Abstract
BACKGROUND The concerning growth of antimicrobial resistance (AMR) renders common infections life-threatening due to irrational antibiotic use and a lack of effective antimicrobial stewardship programmes (ASPs). AIM To investigate the awareness, perceptions and practices of physicians regarding ASPs, AMR and antibiotic prescribing in tertiary care hospitals in Bangladesh. METHODS This hospital-based cross-sectional survey was conducted in 11 tertiary care hospitals across Bangladesh between September 2020 and January 2021. A semi-structured questionnaire was administered through face-to-face interviews for data collection. Descriptive and multi-variate analyses were performed using STATA Version 13. RESULTS In total, 559 physicians were enrolled in this survey. Overall, 40.6% [95% confidence interval (CI) 36.5-44.8] of physicians reported being aware of ASPs, and this figure was higher in public hospitals compared with private hospitals (43.8% vs 27.1%). None of the study hospitals had any ASP initiatives. More than half (55.1%) of the participants were willing to receive feedback from an ASP on their antibiotic selection. Only 30.9% of respondents stated that they wait for the findings of microbiological tests before prescribing antibiotics, although challenges included empiric use of broad-spectrum antibiotics, delayed laboratory results and the existence of drug-resistant patients. In contrast, physicians aware of ASPs were 33% (adjusted odds ratio 0.67, 95% CI 0.45-0.98; P=0.033) less likely to wait for laboratory results before prescribing antibiotics. However, 42.5% of physicians considered patient affordability of purchasing antibiotics when prescribing. CONCLUSIONS Physicians' fundamental knowledge of ASPs and rational antibiotic prescription were found to fall short of the standard. Context-specific and integrated ASP activities, availability and use of guidelines, and improved laboratory facilities are required to battle AMR in Bangladesh.
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Affiliation(s)
- S A Sumon
- Infectious Diseases Division, icddr,b, Dhaka, Bangladesh.
| | - M M U Anwar
- Department of Population Sciences, University of Dhaka, Dhaka, Bangladesh
| | - F M Akther
- Infectious Diseases Division, icddr,b, Dhaka, Bangladesh
| | - A S Priyanka
- Infectious Diseases Division, icddr,b, Dhaka, Bangladesh
| | - T Tamanna
- Infectious Diseases Division, icddr,b, Dhaka, Bangladesh
| | - A Rahman
- Communicable Disease Control, Directorate General of Health Services, Dhaka, Bangladesh
| | - M S Islam
- School of Population Health, University of New South Wales, Sydney, Australia
| | - M G D Harun
- Infectious Diseases Division, icddr,b, Dhaka, Bangladesh
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Afzal S, Khan FU, Aqeel MT, Ullah M, Bajwa M, Akhtar M, Majid M. Impact of a pharmacist-led educational intervention on knowledge, attitude, and practice toward the rational use of antibiotics among healthcare workers in a secondary care hospital in Punjab, Pakistan. Front Pharmacol 2024; 14:1327576. [PMID: 38348350 PMCID: PMC10859775 DOI: 10.3389/fphar.2023.1327576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Accepted: 12/28/2023] [Indexed: 02/15/2024] Open
Abstract
Introduction: Growing antimicrobial resistance (AMR) and decreasing efficacy of the available antimicrobials have become a significant public health concern. The antimicrobial stewardship program (ASP) ensures the appropriate use of antimicrobials and mitigates resistance prevalence through various interventions. One of the core components of the ASP is to educate healthcare workers (HWs). Therefore, this study aims to identify the impact of a pharmacist-led educational intervention targeting knowledge, attitude, and practices regarding rational antibiotic use among healthcare professionals in a secondary care hospital in Punjab. Methods: This is a single-center, questionnaire-based, pre-post interventional study conducted over a six-month time period. Data analysis was conducted using SPSS version 26. Results: Regarding the pre-interventional knowledge, attitude, and practice (KAP) score of the respondents, 90.3% had a good knowledge score, 81.5% had a positive attitude, and 72.3% of HWs (excluding doctors) had a good practice score. Additionally, 74.6% of the doctors had a good practice score. After educational intervention, there was a significant improvement in the knowledge, attitude, and practice of the respondent HWs (p-value <0.001). Furthermore, males have higher knowledge scores compared to females in the pre- and post-intervention stages (p-value <0.05), and doctors differ from nurses regarding knowledge scores in both pre- and post-intervention stages. Conclusion: Considering educational programs as the backbone of the ASP, it is imperative to sustain efforts in the ongoing educational programs of HWs to foster high awareness and adherence to the ASP among HWs.
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Affiliation(s)
- Shairyar Afzal
- Faculty of Pharmacy, Hamdard University, Islamabad, Pakistan
- Department of Pharmacy, District Head Quarter Hospital Jhelum, Jhelum, Pakistan
| | - Farman Ullah Khan
- Faculty of Pharmacy, Hamdard University, Islamabad, Pakistan
- Pharmacy Administration and Clinical Pharmacy Xian Jiaotong University, Xi’an, China
| | | | - Matti Ullah
- Faculty of Pharmacy, Hamdard University, Islamabad, Pakistan
| | - Mishal Bajwa
- Department of Pharmacy, Quaid-i-Azam University, Islamabad, Pakistan
| | - Masoom Akhtar
- Faculty of Pharmacy, Hamdard University, Islamabad, Pakistan
| | - Muhammad Majid
- Faculty of Pharmacy, Hamdard University, Islamabad, Pakistan
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Lagadinou M, Tsami E, Deligakis A, Paraskevas T, Michailides C, Velissaris D, Gkentzi D, Marangos M. Knowledge and Attitudes of Healthcare Workers towards Antibiotic Use and Antimicrobial Resistance in Two Major Tertiary Hospitals in Western Greece. Antibiotics (Basel) 2023; 12:1583. [PMID: 37998785 PMCID: PMC10668655 DOI: 10.3390/antibiotics12111583] [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: 09/24/2023] [Revised: 10/16/2023] [Accepted: 10/30/2023] [Indexed: 11/25/2023] Open
Abstract
Antibiotic resistance (ABR) and antimicrobial stewardship arethe two sides of the same coin that constitute a public health hydra. This study aimed to assessthe knowledge and attitude of healthcare workers (HCWs), on antibiotic use and antimicrobial resistance in Western Greece. A total of 200 healthcare workers (doctors, nurses, and others) from the two largest tertiary hospitals in Western Greece were included in our survey. HCWs seem not to decide based on patient opinion in order to prescribe antibiotics. Approximately 97% of them are aware of their main adverse effects. Remarkably, 25% of respondents prescribe antibiotics due to diagnostic uncertainty, and 32.5% of them prescribe antibiotics based on their experience. HCWs statedthat they do not report adverse effects often. Inappropriate antibiotic prescriptions were mentioned as the main reason for bacterial resistance to antimicrobials. Monitoring the patient's treatment progress, using electronic prescriptions, and adhering to international guidelines were suggested as solutions to the problem. Post Hoc analysis showed that nursing staff apply to the national guidelines (p: 0.011) and use electronic prescriptions (p: 0.003) less often compared to consultants, doctor directors, and trainees. The findings of our survey may be useful for the development of future national education programs and interventions thatmay improve healthcare workers' knowledge and ability to manage antibiotics.
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Affiliation(s)
- Maria Lagadinou
- Department of Internal Medicine, University General Hospital of Patras, 26504 Patras, Achaia, Greece; (T.P.); (C.M.); (D.V.); (M.M.)
- Department of Medical School, University of Patras, 26504 Greece, Achaia, Greece;
| | - Elpida Tsami
- Department of Surgery, “Saint Andrew” General Hospital of Patras, 26334 Patras, Achaia, Greece; (E.T.); (A.D.)
| | - Apostolos Deligakis
- Department of Surgery, “Saint Andrew” General Hospital of Patras, 26334 Patras, Achaia, Greece; (E.T.); (A.D.)
| | - Themistoklis Paraskevas
- Department of Internal Medicine, University General Hospital of Patras, 26504 Patras, Achaia, Greece; (T.P.); (C.M.); (D.V.); (M.M.)
| | - Christos Michailides
- Department of Internal Medicine, University General Hospital of Patras, 26504 Patras, Achaia, Greece; (T.P.); (C.M.); (D.V.); (M.M.)
| | - Dimitrios Velissaris
- Department of Internal Medicine, University General Hospital of Patras, 26504 Patras, Achaia, Greece; (T.P.); (C.M.); (D.V.); (M.M.)
- Department of Medical School, University of Patras, 26504 Greece, Achaia, Greece;
| | - Despoina Gkentzi
- Department of Medical School, University of Patras, 26504 Greece, Achaia, Greece;
- Department of Pediatrics, University General Hospital of Patras, 26504 Patras, Achaia, Greece
| | - Markos Marangos
- Department of Internal Medicine, University General Hospital of Patras, 26504 Patras, Achaia, Greece; (T.P.); (C.M.); (D.V.); (M.M.)
- Department of Medical School, University of Patras, 26504 Greece, Achaia, Greece;
- Department of Infectious Diseases, University General Hospital of Patras, 26504 Patras, Achaia, Greece
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Gillani SW, Shahwan MKS, Szollosi DE. A questionnaire based survey among pharmacy practitioners to evaluate the level of knowledge and confidence towards antimicrobial stewardship. Pharm Pract (Granada) 2023; 21:2757. [PMID: 37090455 PMCID: PMC10117304 DOI: 10.18549/pharmpract.2023.1.2757] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 11/02/2022] [Indexed: 04/08/2023] Open
Abstract
Objective Our study aimed to assess the knowledge, understanding and confidence of the practicing pharmacists in UAE as an antimicrobial Stewards. Antimicrobial resistance threatens the achievements of modern medicine globally, and it's highly required for the AMS principles to be implemented in our communities. Methods A cross-sectional online- questionnaire based survey was used among UAE pharmacy practitioners from different areas of practice who are holding pharmaceutical degrees and/or licensed pharmacists. The questionnaire was sent to the participants via social media platforms. The questionnaire was validated, and reliability assessment was made prior to the conduct. Results A total of 117 pharmacists responded to this study, out of which (70.9%, n=83) were females. Pharmacists which are from various practice fields participated in the survey, but the majority were pharmacists in Hospital pharmacies or Clinical pharmacists (47%, n=55), also community pharmacists (35.9%, n=42), while only (16.9%, n=20) ware from other areas of pharmacy including industrial pharmacy and academia. The majority of participants 88.9% (n= 104) were interested in pursuing their career as an Infectious disease pharmacist or getting a certificate in antimicrobial stewardship. The mean scores in the knowledge towards antimicrobial resistance was 3.75 (poor: 1-1.6, moderate: 1.7-3.3. Good 3.4-5), indicates that the pharmacists have a good level of knowledge towards AMR. A total of 84.3% of participants succeeded in Identifying the correct intervention for antibiotic resistance. The findings also showed that the total mean score of hospital pharmacists (mean=10.6±1.12), and the average of the scores of community pharmacists (mean=9.8±1.38), were non-significant between the different area of practice. 52.3% of the participants had a training on antimicrobial stewardship during their experiential rotation which reflected on their confidence in their performance and knowledge assessment (p value < 0.05). Conclusion The study concluded good knowledge and high confidence levels among practicing pharmacists in UAE. However, the findings also identify areas of improvement in the practicing pharmacist, and the significant relationship between the knowledge and confidence scores reflects the ability of the practicing pharmacists to integrate the AMS principles within the UAE, which aligns with the attainability of the improvement.
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Affiliation(s)
- Syed Wasif Gillani
- Associate Professor, Department of Pharmacy Practice, College of Pharmacy, Gulf Medical University.
| | | | - Doreen E Szollosi
- Assistant Dean of Academic Affairs, Associate Professor of Pharmaceutical Sciences, University of Saint Joseph, School of Pharmacy & Physician Assistant Studies, Lourdes 106, 1678 Asylum Avenue, West Hartford, CT 06117.
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Ayton D, Watson E, Betts JM, Doyle J, Teh B, Valoppi G, Cotta M, Robertson M, Peel T. Implementation of an antimicrobial stewardship program in the Australian private hospital system: qualitative study of attitudes to antimicrobial resistance and antimicrobial stewardship. BMC Health Serv Res 2022; 22:1554. [PMID: 36536350 PMCID: PMC9764684 DOI: 10.1186/s12913-022-08938-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 12/06/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Antimicrobial Stewardship (AMS) is a key method to tackle antimicrobial resistance (AMR). In Australia, private hospitals have a higher rate of inappropriate prescribing and non-compliance with antimicrobial guidelines, yet this phenomenon is poorly described. Private hospitals make up 49% of hospitals in Australia, making it vital to understand AMS in this setting. METHODS This study aimed to explore capabilities, opportunities and motivations for AMR and AMS with stakeholders at an Australian private hospital, and identify barriers and enablers 5 years post-implementation of an AMS program comparing with pre-implementation findings. A mixed-methods study was performed, involving three focus groups with stakeholders. All doctors, nurses and pharmacists at the hospital were invited to complete a survey on their experiences with and awareness of AMR, AMS and antimicrobial prescribing. RESULTS Thirteen staff took part in the focus groups, 100 staff responded to the survey. Staff understood the importance of the AMS program, but active engagement was low. Staff felt more thorough feedback and monitoring could improve prescribing behaviour, but acknowledged difficulty in private hospitals in changing habits of staff who valued autonomy in making prescribing decisions. Half of respondents felt the current AMS restrictions should continue. Executive engagement may be needed to drive system changes across a complex network. CONCLUSION AMS awareness increased post-implementation, but staff remained sceptical of its benefits. Engagement and education of medical consultants regarding local benefits of AMS must improve. Enhanced understanding of feedback provision, methods for engagement, and advocacy from leadership will ensure success and longevity for the program.
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Affiliation(s)
- Darshini Ayton
- grid.1002.30000 0004 1936 7857Health and Social Care Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC Australia ,grid.1002.30000 0004 1936 7857Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC Australia
| | - Eliza Watson
- grid.1002.30000 0004 1936 7857Department of Infectious Diseases, Alfred Hospital and Central Clinical School, Monash University, Level 2, 85 Commercial Road, VIC Melbourne, 3004 Australia
| | - Juliana M. Betts
- grid.1002.30000 0004 1936 7857Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC Australia
| | - Joseph Doyle
- grid.1002.30000 0004 1936 7857Department of Infectious Diseases, Alfred Hospital and Central Clinical School, Monash University, Level 2, 85 Commercial Road, VIC Melbourne, 3004 Australia ,grid.414539.e0000 0001 0459 5396Epworth HealthCare, Melbourne, VIC Australia
| | - Benjamin Teh
- grid.414539.e0000 0001 0459 5396Epworth HealthCare, Melbourne, VIC Australia ,grid.1055.10000000403978434Department of Infectious Diseases, Peter MacCallum Cancer Centre, Melbourne, Australia ,grid.1008.90000 0001 2179 088XSir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, VIC Australia
| | - Glenn Valoppi
- grid.414539.e0000 0001 0459 5396Epworth HealthCare, Melbourne, VIC Australia ,Slade Pharmacy, Melbourne, VIC Australia
| | - Menino Cotta
- grid.1003.20000 0000 9320 7537UQCCR, Faculty of Medicine, The University of Queensland, Brisbane, QLD Australia
| | - Megan Robertson
- grid.414539.e0000 0001 0459 5396Epworth HealthCare, Melbourne, VIC Australia
| | - Trisha Peel
- grid.1002.30000 0004 1936 7857Department of Infectious Diseases, Alfred Hospital and Central Clinical School, Monash University, Level 2, 85 Commercial Road, VIC Melbourne, 3004 Australia
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Kumar KS, Saranya S, Rani NV. Community Pharmacists' Knowledge, Attitude, and Nonprescription Dispensing Practices of Antibiotics: An Explorative Study in a Selected City of South India. J Res Pharm Pract 2022; 11:51-58. [PMID: 36798105 PMCID: PMC9926913 DOI: 10.4103/jrpp.jrpp_48_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2021] [Accepted: 03/24/2022] [Indexed: 12/15/2022] Open
Abstract
Objective This study aimed to assess the community pharmacists' knowledge of antibiotics, their attitude toward antibiotic usage and antibiotic resistance, and their nonprescription dispensing practices of antibiotics. Methods A cross sectional-questionnaire-based study was conducted among 75 community pharmacists practicing in a selected city of South India. Data on their age, years of experience, and educational qualifications were obtained. A modified, 33-items, prevalidated structured questionnaire was used to assess the community pharmacists knowledge, attitude, and nonprescription antibiotic dispensing practices knowledge, attitudes and practices (KAP). The responses obtained were expressed in descriptive statistics. The association between years of experience and their KAP was assessed using Pearson's correlation. Findings Most pharmacists (60%) agreed that antibiotics are used for bacterial infections, and 35% believed that antibiotics could be given for pain and inflammation. Fourty-one percentage of pharmacists agreed that dispensing antibiotics without prescription increases the risk of antibiotic resistance. Seventy-two percentage agreed that they are responsible for taking a prominent role in antimicrobial resistance and infection-control programs in healthcare. Only 46% of pharmacists stated that they always dispensed antibiotics only with a prescription, and 56% dispensed antibiotics for longer than the doctor prescribed. Amoxicillin, metronidazole, and cephalexin were the most commonly dispensed antibiotics without a prescription. The most common reason for dispensing antibiotics without a prescription was the fear of losing customers. Conclusion The study identified an average KAP interquartile range 1 among community pharmacists, indicating a lack of awareness of antibiotic resistance and dispensing antibiotics without a prescription.
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Affiliation(s)
- K. Sarath Kumar
- Department of Pharmacy Practice, Sri Ramachandra Faculty of Pharmacy, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India
| | - S. Saranya
- Department of Pharmacy Practice, Sri Ramachandra Faculty of Pharmacy, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India
| | - Nagasubramanian Vanitha Rani
- Department of Pharmacy Practice, Sri Ramachandra Faculty of Pharmacy, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India,Address for correspondence: Dr. Nagasubramanian Vanitha Rani, E-mail:
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Gillani SW, Shahwan MKS, Szollosi DE. A questionnaire based survey among pharmacy practitioners to evaluate the level of knowledge and confidence towards antimicrobial stewardship. Pharm Pract (Granada) 2022; 20:2757. [PMID: 36793910 PMCID: PMC9891779 DOI: 10.18549/pharmpract.2022.4.2757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 11/02/2022] [Indexed: 12/13/2022] Open
Abstract
Objective Our study aimed to assess the knowledge, understanding and confidence of the practicing pharmacists in UAE as an antimicrobial Stewards. Antimicrobial resistance threatens the achievements of modern medicine globally, and it's highly required for the AMS principles to be implemented in our communities. Methods A cross-sectional online- questionnaire based survey was used among UAE pharmacy practitioners from different areas of practice who are holding pharmaceutical degrees and/or licensed pharmacists. The questionnaire was sent to the participants via social media platforms. The questionnaire was validated, and reliability assessment was made prior to the conduct. Results A total of 117 pharmacists responded to this study, out of which (70.9%, n=83) were females. Pharmacists which are from various practice fields participated in the survey, but the majority were pharmacists in Hospital pharmacies or Clinical pharmacists (47%, n=55), also community pharmacists (35.9%, n=42), while only (16.9%, n=20) ware from other areas of pharmacy including industrial pharmacy and academia. The majority of participants 88.9% (n= 104) were interested in pursuing their career as an Infectious disease pharmacist or getting a certificate in antimicrobial stewardship. The mean scores in the knowledge towards antimicrobial resistance was 3.75 (poor: 1-1.6, moderate: 1.7-3.3, Good: 3.4-5), indicates that the pharmacists have a good level of knowledge towards AMR. A total of 84.3% of participants succeeded in Identifying the correct intervention for antibiotic resistance. The findings also showed that the total mean score of hospital pharmacists (mean=10.6±1.12), and the average of the scores of community pharmacists (mean=9.8±1.38), were non-significant between the different area of practice. 52.3% of the participants had a training on antimicrobial stewardship during their experiential rotation which reflected on their confidence in their performance and knowledge assessment (p value < 0.05). Conclusion The study concluded good knowledge and high confidence levels among practicing pharmacists in UAE. However, the findings also identify areas of improvement in the practicing pharmacist, and the significant relationship between the knowledge and confidence scores reflects the ability of the practicing pharmacists to integrate the AMS principles within the UAE, which aligns with the attainability of the improvement.
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Affiliation(s)
- Syed Wasif Gillani
- Associate Professor, Department of Pharmacy Practice, College of Pharmacy, Gulf Medical University.
| | | | - Doreen E Szollosi
- Assistant Dean of Academic Affairs, Associate Professor of Pharmaceutical Sciences, University of Saint Joseph, School of Pharmacy & Physician Assistant Studies, Lourdes 106, 1678 Asylum Avenue, West Hartford, CT 06117.
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Setiawan E, Cotta MO, Abdul-Aziz MH, Sosilya H, Widjanarko D, Wardhani DK, Roberts JA. Indonesian healthcare providers' perceptions and attitude on antimicrobial resistance, prescription and stewardship programs. Future Microbiol 2022; 17:363-375. [PMID: 35212232 DOI: 10.2217/fmb-2021-0193] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Background: A successful antimicrobial stewardship program (ASP) is sustained through improving antimicrobial prescribing by changing prescribing behavior. This requires a better understanding of hospital stakeholders' views regarding antimicrobial resistance (AMR), antimicrobial use and participation in ASP activities. Objectives: Identify perceptions and attitudes among physicians and pharmacists in a public hospital toward AMR, prescription and ASP. Methods: A questionnaire consisting of 45 items was distributed to physicians and pharmacists in a 320-bed public hospital. All responses were formatted into the Likert scale. Results: A total of 78 respondents (73% response rate) completed the questionnaire. The majority of the respondents perceived AMR within hospital as less of a severe problem, and factors outside hospital were considered to be greater contributors to AMR. In addition, interprofessional conflict was identified as a serious concern in relation to implementing ASP. Conclusion: This finding indicates the need to address existing perceptions and attitudes toward ASP activities that may hamper its successful implementation in Indonesia.
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Affiliation(s)
- Eko Setiawan
- University of Queensland Centre for Clinical Research (UQCCR), Faculty of Medicine, The University of Queensland, Brisbane, 4006, Australia.,Department of Clinical & Community Pharmacy, and Center for Medicines Information & Pharmaceutical Care (CMIPC), Faculty of Pharmacy, University of Surabaya, 60293, Surabaya, East Java, Indonesia
| | - Menino O Cotta
- University of Queensland Centre for Clinical Research (UQCCR), Faculty of Medicine, The University of Queensland, Brisbane, 4006, Australia
| | - Mohd Hafiz Abdul-Aziz
- University of Queensland Centre for Clinical Research (UQCCR), Faculty of Medicine, The University of Queensland, Brisbane, 4006, Australia
| | - Hernycane Sosilya
- Dr Mohamad Soewandhie Public Hospital, 60142, Surabaya, East Java, Indonesia
| | - Doddy Widjanarko
- Dr Mohamad Soewandhie Public Hospital, 60142, Surabaya, East Java, Indonesia.,Faculty of Medicine, Hang Tuah University, 60111, Surabaya, East Java, Indonesia
| | - Dian K Wardhani
- Dr Mohamad Soewandhie Public Hospital, 60142, Surabaya, East Java, Indonesia
| | - Jason A Roberts
- University of Queensland Centre for Clinical Research (UQCCR), Faculty of Medicine, The University of Queensland, Brisbane, 4006, Australia.,Departments of Pharmacy & Intensive Care Medicine, Royal Brisbane & Women's Hospital, Brisbane, 4029, Australia.,Division of Anesthesiology Critical Care Emergency & Pain Medicine, Nîmes University Hospital, University of Montpellier, Nîmes, 30029, France
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Aworh MK, Kwaga JKP, Okolocha EC. Assessing knowledge, attitude, and practices of veterinarians towards antimicrobial use and stewardship as drivers of inappropriate use in Abuja, Nigeria. ONE HEALTH OUTLOOK 2021; 3:25. [PMID: 34930491 PMCID: PMC8690525 DOI: 10.1186/s42522-021-00058-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 11/09/2021] [Indexed: 05/05/2023]
Abstract
INTRODUCTION Antimicrobial resistance (AMR) has recently gained worldwide recognition, as the emergence of multi-drug resistant organisms has led to increased mortality and economic burden. This study aimed to assess knowledge, attitudes, and practices of veterinarians towards rational antimicrobial prescribing and identify factors influencing use. METHODS We interviewed veterinary doctors in Abuja, Nigeria using a 50-point questionnaire distributed via WhatsApp mobile application. The questionnaire inquired about their experiences, knowledge, attitudes, and practices towards AMR and stewardship. We analyzed the data by calculating frequencies and proportions. RESULTS Of 220 registered veterinarians, 144 (65.5%) participated in the survey. Most (52.8%) were within the age group 30 - 39 years; males (72.2%), with a Master's degree (42.4%) and worked in public service (44.4%). Three-quarters (75.7%) had good knowledge of antimicrobials; 47.2% had received training on stewardship while 88.9% reported that they believed that overuse of antimicrobials was the major contributory factor towards AMR. Antimicrobial stewardship regulations are important in veterinary practice. Veterinarians were aware of the occurrence of resistant pathogens and agreed that restricting antimicrobial use in animal health care was necessary to reduce AMR. CONCLUSION Most respondents referred to the veterinary formulary (VF) when in doubt of the appropriate antimicrobial agent to administer. We recommend that the VF be updated following the WHO list of critically-important-antimicrobials (CIA) and veterinarians educated not to use these CIAs in the treatment of food animals.
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Affiliation(s)
- Mabel Kamweli Aworh
- Department of Veterinary and Pest Control Services, Federal Ministry of Agriculture and Rural Development, New Secretariat, Area 11, Garki, Abuja, Nigeria.
- Nigeria Field Epidemiology and Laboratory Training Programme, Abuja, Nigeria.
- Department of Veterinary Public Health and Preventive Medicine, Ahmadu Bello University, Zaria, Nigeria.
| | - Jacob Kwada Paghi Kwaga
- Department of Veterinary Public Health and Preventive Medicine, Ahmadu Bello University, Zaria, Nigeria
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Saleh D, Abu Farha R, Alefishat E. Impact of Educational Intervention to Promote Jordanian Community Pharmacists' Knowledge and Perception Towards Antimicrobial Stewardship: Pre-Post Interventional Study. Infect Drug Resist 2021; 14:3019-3027. [PMID: 34408446 PMCID: PMC8364398 DOI: 10.2147/idr.s324865] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Accepted: 07/22/2021] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE The aim of this study was to assess the impact of an online educational workshop on improving the knowledge, and perception of community pharmacists in Jordan towards the antimicrobial stewardship (AMS) and enhancing their ability to appropriately select correct antibiotic therapy. METHODS This is a pre-post study that was conducted in Jordan in December 2020. An electronic questionnaire was used to assess the awareness, perception of community pharmacists towards AMS, and their ability to appropriately select correct antibiotic before and after the educational workshop. The two-days' workshop was conducted on Zoom application. Analysis was conducted using Wilcoxon signed-rank test, McNemar's test using SPSS version 22. RESULTS During the study period, 100 community pharmacists attended the educational workshop. Pharmacists' knowledge was assessed prior to their participation which revealed a relatively good knowledge score with a median score of 6/10 (IQR = 4); their scores have improved significantly following the educational workshop with a median score of 7/10 (IOR = 2), p-value<0.001. Although one-third of the participants knew the definition of AMS prior to the workshop, almost half of the respondents (n = 56, 56%) knew the definition after the educational workshop. Regarding community pharmacist's ability to appropriately select correct antibiotic therapy, they showed a significant improvement in selecting the optimal antimicrobial for the virtual cases following the workshop (p-value < 0.05). Perceptions towards AMS were consistently positive before and after the workshop. CONCLUSION This study revealed the benefit of AMS-focused workshops for improving community pharmacists' knowledge and appropriate antibiotic prescribing. Thus, efforts are required to implement more AMS educational workshops for community pharmacists.
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Affiliation(s)
- Doaa Saleh
- Department of Clinical Pharmacy and Therapeutics, Faculty of Pharmacy, Applied Science Private University, Amman, Jordan
| | - Rana Abu Farha
- Department of Clinical Pharmacy and Therapeutics, Faculty of Pharmacy, Applied Science Private University, Amman, Jordan
| | - Eman Alefishat
- Department of Pharmacology, College of Medicine and Health Science, Khalifa University of Science and Technology, Abu Dhabi, United Arab Emirates
- Center for Biotechnology, Khalifa University of Science and Technology, Abu Dhabi, United Arab Emirates
- Department Biopharmaceutics and Clinical Pharmacy, Faculty of Pharmacy, The University of Jordan, Amman, Jordan
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Lee MJ, Moon SM, Kim B, Park SY, Park JY, Koo H, Lee H, Song KH, Lee H, Park JS, Lee MS, Choi SM, Kim CJ, Chang HH, Kim TH, Park SH, Kim ES, Kim HB. Status of antimicrobial stewardship programmes in Korean hospitals including small to medium-sized hospitals and the awareness and demands of physicians: a nationwide survey in 2020. J Glob Antimicrob Resist 2021; 26:180-187. [PMID: 34153526 DOI: 10.1016/j.jgar.2021.06.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 05/26/2021] [Accepted: 06/03/2021] [Indexed: 12/26/2022] Open
Abstract
OBJECTIVES This study aimed to identify the status of antimicrobial stewardship programmes (ASPs) in small to medium-sized Korean hospitals as well as the awareness and demands about ASPs of physicians. METHODS A questionnaire was designed based on a questionnaire from a previous nationwide survey in 2018 targeting large hospitals in Korea and modified to reflect the results of in-depth interviews with non-infectious diseases (IDs) physicians at secondary care hospitals. The survey targeted all hospitals with ≥150 beds in South Korea and was performed in May-June 2020. Only one ASP-associated physician per hospital participated in the survey. RESULTS The survey response rate was 31.9% (217/680). ID specialists comprised the majority of medical personnel participating in ASPs in tertiary care hospitals. Conversely, in secondary and primary care hospitals there was no predominant medical personnel for ASPs and the median full-time equivalent was 0 for all types of medical personnel. Tertiary care hospitals, more than secondary and primary care hospitals, tended to perform ASP activities more actively. 'Workforce for ASPs', 'Establishment of healthcare fees for ASPs' and 'Development of tools for ASPs' were the most important required support for ASP improvement. CONCLUSION The level of ASP establishment was more limited in primary care hospitals than in secondary and tertiary care hospitals in Korea. To improve ASPs in Korean hospitals, a supporting workforce and the establishment of a healthcare fee for ASPs appear to be necessary.
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Affiliation(s)
- Myung Jin Lee
- Department of Internal Medicine, Inje University Sanggye-Paik Hospital, Seoul, South Korea
| | - Song Mi Moon
- Division of Infectious Diseases, Department of Internal Medicine, Hallym University Sacred Heart Hospital, Anyang, South Korea
| | - Bongyoung Kim
- Department of Internal Medicine, Hanyang University College of Medicine, 222-1, Wangsimni-ro, Seongdong-gu, Seoul 04763, South Korea.
| | - Se Yoon Park
- Division of Infectious Diseases, Department of Internal Medicine, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, South Korea
| | - Ji Young Park
- Department of Pediatrics, Chung-Ang University Hospital, Seoul, South Korea
| | - Hyunsook Koo
- Division of Healthcare Associated Infection Control, Bureau of Healthcare Safety and Immunization, Korea Disease Control and Prevention Agency, Cheongju, South Korea
| | - Hyungmin Lee
- Division of Antimicrobial Resistance Control, Bureau of Healthcare Safety and Immunization, Korea Disease Control and Prevention Agency, Cheongju, South Korea
| | - Kyoung-Ho Song
- Division of Infectious Diseases, Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, 82 Gumi-ro, 173 beon-gil, Bundang-gu, Seongnam 13620, Gyeonggi-do, South Korea
| | - Hyunju Lee
- Department of Pediatrics, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, South Korea
| | - Jeong Su Park
- Department of Laboratory Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, South Korea
| | - Mi Suk Lee
- Division of Infectious Diseases, Department of Internal Medicine, Kyung Hee University School of Medicine, Seoul, South Korea
| | - Su-Mi Choi
- Division of Infectious Diseases, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Chung-Jong Kim
- Division of Infectious Diseases, Department of Internal Medicine, Ewha Womans University College of Medicine, Seoul, South Korea
| | - Hyun-Ha Chang
- Division of Infectious Diseases, Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, South Korea
| | - Tae Hyong Kim
- Division of Infectious Diseases, Department of Internal Medicine, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, South Korea
| | - Sun Hee Park
- Division of Infectious Diseases, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Eu Suk Kim
- Division of Infectious Diseases, Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, 82 Gumi-ro, 173 beon-gil, Bundang-gu, Seongnam 13620, Gyeonggi-do, South Korea.
| | - Hong Bin Kim
- Division of Infectious Diseases, Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, 82 Gumi-ro, 173 beon-gil, Bundang-gu, Seongnam 13620, Gyeonggi-do, South Korea
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Akbar Z, Saleem Z, Shaukat A, Farrukh MJ. Perception and practices of community pharmacists towards antimicrobial stewardship in Lahore, Pakistan. J Glob Antimicrob Resist 2021; 25:157-161. [PMID: 33789207 DOI: 10.1016/j.jgar.2021.03.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 02/02/2021] [Accepted: 03/02/2021] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVES Antimicrobial resistance is a major health concern worldwide. Community pharmacists can play an important role in rational antibiotic use. This study aimed to evaluate the perception and practices of community pharmacists regarding antimicrobial stewardship (AMS) in Lahore, Pakistan. METHODS A descriptive cross-sectional study was conducted among community pharmacists in Lahore from 1 November 2017 to 31 December 2017. A self-administered questionnaire was used for data collection. Non-probability convenience sampling was performed to select community pharmacists. Descriptive statistics were applied and Mann-Whitney U-tests and Kruskal-Wallis tests were performed to compare independent groups using SPSS v.20.0. A P-value of <0.05 was considered statistically significant. Perception and practice scores were determined to access community pharmacist knowledge regarding AMS. A score of 0.5-1 was considered to be very good. RESULTS The overall response rate was 70.9%. Sex, age, work experience and education level did not significantly influence the perception and practices of community pharmacists. Experienced pharmacists showed a better response to AMS. The majority of pharmacists strongly agreed that they educate patients on the use of antimicrobials and resistance-related issues. CONCLUSION It was concluded that community pharmacists in Lahore have good perception regarding AMS and they are practicing it well. But there are several gaps in their practices that must be filled, such as dispensing without a prescription and dispensing for a longer duration than prescribed. Additionally, there should be strict implementation of guidelines for dispensing antibiotics in order to rationalise antibiotic use and decrease antimicrobial resistance.
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Affiliation(s)
- Zunaira Akbar
- Riphah Institute of Pharmaceutical Sciences, Riphah International University, Lahore, Pakistan.
| | - Zikria Saleem
- Faculty of Pharmacy, The University of Lahore, Pakistan
| | | | - Muhammad Junaid Farrukh
- Department of Clinical Pharmacy, Faculty of Pharmaceutical Sciences, UCSI University, Kuala Lumpur, Malaysia
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El-Sokkary R, Kishk R, Mohy El-Din S, Nemr N, Mahrous N, Alfishawy M, Morsi S, Abdalla W, Ahmed M, Tash R. Antibiotic Use and Resistance Among Prescribers: Current Status of Knowledge, Attitude, and Practice in Egypt. Infect Drug Resist 2021; 14:1209-1218. [PMID: 33790591 PMCID: PMC8007586 DOI: 10.2147/idr.s299453] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Accepted: 03/03/2021] [Indexed: 11/23/2022] Open
Abstract
Introduction The problem of antimicrobial resistance (AMR) is rising worldwide. One of the most significant factors influencing antimicrobial resistance in low- and middle-income countries is the lack of the skills and knowledge of health care providers for proper antimicrobial use. Aim To identify knowledge, characterize practices and describe the attitude of Egyptian prescribers towards antibiotic use. Methods A self-administered validated questionnaire was distributed among Egyptian prescribers. Results Five hundred Egyptian physicians responded to the questionnaire, 113 (22.6%) reported having Antibiotic Stewardship Program (ASP) at their workplace, 99 (19.8%) use international antibiotic guidelines as the main source for prescribing activity, 358 (71.6%) recorded adequate knowledge. Elder prescribers and those who work in private or university hospitals were significantly more knowledgeable (p=0.031 and 0.001, respectively). Forty-seven (9.4%) showed a positive attitude towards proper antibiotic prescription. The type of work institution; primary health clinics and private, or university hospital and the specialty are significantly associated with a positive attitude (p=0.009 and 0.015, respectively). Seventy-eight (15.6%) expressed a proper antibiotic prescription practice. Elder age, more experienced and trained prescribers showed more proper practice. The implementation of ASP and using proper sources of information were significantly associated with proper practice (p=0.012 and 0.008, respectively). Conclusion Egyptian prescribers have a good level of knowledge about antibiotics. However, low rates of positive attitude and proper practice towards the problem of AMR and ASP are recorded.
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Affiliation(s)
- Rehab El-Sokkary
- Medical Microbiology and Immunology, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Rania Kishk
- Microbiology and Immunology, Faculty of Medicine, Suez Canal University, Ismailia, Egypt
| | | | - Nader Nemr
- Endemic and Infectious Diseases, Faculty of Medicine, Suez Canal University, Ismailia, Egypt
| | - Nageh Mahrous
- Endemic and Infectious Diseases, Faculty of Medicine, Suez Canal University, Ismailia, Egypt
| | - Mostafa Alfishawy
- Infectious Diseases Consultants and Academic Researchers of Egypt (IDCARE), Cairo, Egypt
| | - Samar Morsi
- Medical Microbiology and Immunology, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Wael Abdalla
- General Surgery, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Mohamed Ahmed
- Obstetrics & Gynecology, Faculty of Medicine, Benha University, Benha, Egypt
| | - Rehab Tash
- Medical Microbiology and Immunology, Faculty of Medicine, Zagazig University, Zagazig, Egypt
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Khasawneh RA, Ababneh MA, Al-Azzam SI. Antimicrobial stewardship programs: perceptions and practices among Jordanian healthcare practitioners. JOURNAL OF PHARMACEUTICAL HEALTH SERVICES RESEARCH 2021. [DOI: 10.1093/jphsr/rmaa034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Abstract
Objective
Antimicrobial stewardship programs are of paramount importance in containing antibiotic resistance and combat the acquisition of multi-drug resistance strains. Healthcare practitioners, specifically physicians and clinical pharmacists are the direct clinical antibiotic prescribing authorities. Therefore, this study aimed to assess Jordanian practitioners' perceptions and practices towards antimicrobial stewardship programs.
Methods
This was a cross-sectional study, in which physicians and clinical pharmacists were approached to fill out a previously validated study instrument. A close-ended structured questionnaire comprising 34 questions covering aspects related to antimicrobial stewardship program perceptions, practices and participants' demographic data were used to collect pertinent information.
Key findings
A total of 286 participants were enrolled in the study. There was an overall positive perception towards antimicrobial stewardship programs, while practices related to this element was still suboptimal. Additional comparison of the overall perception scores among different demographic characteristics showed that long years of practice, postgraduate studies and practice in academic sectors yielded higher perception scores (P = 0.0335, 0.0328 and 0.0007, respectively).
Conclusion
There is an imminent need to enhance Jordanian practitioners' knowledge about antimicrobial stewardship programs. Clear recognition of integral antimicrobial stewardship programs' components must be coupled with highlight changes in current practices related to antimicrobials usage and prescription.
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Affiliation(s)
- Rawand A Khasawneh
- Department of Clinical Pharmacy, Faculty of Pharmacy, Jordan University of Science and Technology, Irbid, Jordan
| | - Mera A Ababneh
- Department of Clinical Pharmacy, Faculty of Pharmacy, Jordan University of Science and Technology, Irbid, Jordan
| | - Sayer I Al-Azzam
- Department of Clinical Pharmacy, Faculty of Pharmacy, Jordan University of Science and Technology, Irbid, Jordan
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Doctors' Perceptions, Attitudes and Practices towards the Management of Multidrug-Resistant Organism Infections after the Implementation of an Antimicrobial Stewardship Programme during the COVID-19 Pandemic. Trop Med Infect Dis 2021; 6:tropicalmed6010020. [PMID: 33562723 PMCID: PMC7930958 DOI: 10.3390/tropicalmed6010020] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 02/02/2021] [Accepted: 02/02/2021] [Indexed: 12/26/2022] Open
Abstract
Background: Greece is among the European countries with the highest consumption of antibiotics, both in community and hospital settings, including last-line antibiotics, such as carbapenems. We sought to explore doctors’ perceptions, attitudes and practices towards the management of patients with multidrug-resistant organism (MDRO) infections after the implementation of an antimicrobial stewardship programme (ASP) in a tertiary academic hospital during the COVID-19 pandemic. Methods: A self-administered, internet-based questionnaire survey was completed by doctors of the University Hospital of Heraklion in Crete, Greece. Results: In total, 202 (59.1%) hospital doctors fully completed the questionnaire. Most of them agreed that the prospective audit and feedback ASP strategy is more effective and educational than the preauthorization ASP strategy. ASP implementation prompted most respondents to monitor the continuously evolving microbiological data of their patients more closely and affected them towards a multidisciplinary and personalised care of patients with infections caused by MDROs and towards a more rigorous implementation of infection prevention and control measures. The vast majority of participants (98.5%) stated that ASP must be continued and further developed during the COVID-19 pandemic. Conclusion: The ASP implementation in our hospital had a beneficial impact on doctors’ perceptions, attitudes and practices with regard to the management of infections due to MDROs.
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Gotterson F, Buising K, Manias E. Nurse role and contribution to antimicrobial stewardship: An integrative review. Int J Nurs Stud 2020; 117:103787. [PMID: 33647845 DOI: 10.1016/j.ijnurstu.2020.103787] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2020] [Revised: 08/05/2020] [Accepted: 09/28/2020] [Indexed: 01/22/2023]
Abstract
AIM To examine existing published literature regarding nurses and antimicrobial stewardship, and their potential role and contribution, to identify what is known, to evaluate methodologies used in published research, and to review and integrate findings to inform practice and future priorities for research. DESIGN Integrative review. METHODOLOGY The approach to this review was informed by Whittemore and Knafl's integrative review methodology. Electronic databases were searched for papers published since the start of the database to November 2019, with abstracts available, related to humans and published in English. Papers were included regardless of practice setting (acute, aged, and primary care) and if they were research based, included nurses as participants and reported specifically on results from nurses or that had implications for nursing practice. Excluded were conference abstracts, and papers focussed solely on nurse prescriber, nurse practitioner, or nurse manager roles. RESULTS Fifty-two papers were included in the review. Identified themes were: i) nursing knowledge, learning needs and education; ii) nurse perceptions of the nursing role and motivations for involvement; iii) nursing brokerage and influence on information flow to and from patients; iv) nursing workflow, workload and workarounds; and v) nurse leadership. Methodological quality of the included papers varied, limiting transferability and applicability of findings for some of the included studies. CONCLUSION Formal inclusion of nurses in antimicrobial stewardship activities has been associated with improved nurse knowledge, nurse confidence, and in some cases improved clinical outcomes for patients. The review reinforces nursing values as a motivator of nursing actions, and reveals the complex yet significant influence of nurses on antimicrobial prescribing. Potential opportunities to enhance nurses' participation and contribution to antimicrobial stewardship include; formal acknowledgement of the nurse role, educating nurses so that they are aware of how they can contribute, collaborating with nurses in planning and implementing local stewardship activities, and ensuring nurse leaders are involved. However, evidence on this topic remains limited. Research is needed to facilitate greater understanding about the nature, scope and influence of the nurse role in antimicrobial stewardship, how nurses enact and carry out their role, and nurses' support needs. Tweetable abstract: Integrative review explores #nurse role in #antimicrobialstewardship. Nurse contribution, influence significant, but not well understood.
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Affiliation(s)
- Fiona Gotterson
- National Centre for Antimicrobial Stewardship, The Peter Doherty Institute for Infections and Immunity, 792 Elizabeth St, Melbourne, VIC 3000, Australia; Department of Medicine, Building 181, University of Melbourne, Grattan St, Melbourne, VIC 3010, Australia.
| | - Kirsty Buising
- National Centre for Antimicrobial Stewardship, The Peter Doherty Institute for Infections and Immunity, 792 Elizabeth St, Melbourne, VIC 3000, Australia; Department of Medicine, Building 181, University of Melbourne, Grattan St, Melbourne, VIC 3010, Australia; Victorian Infectious Diseases Service, The Peter Doherty Institute for Infections and Immunity, 792 Elizabeth St, Melbourne, VIC 3000, Australia
| | - Elizabeth Manias
- Deakin University, School of Nursing and Midwifery, Centre for Quality and Patient Safety Research, Institute for Health Transformation, 221 Burwood Highway, Burwood, VIC 3125, Australia; The Royal Melbourne Hospital, Department of Medicine, Royal Parade, Parkville, VIC 3052, Australia
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Perozziello A, Lescure FX, Truel A, Routelous C, Vaillant L, Yazdanpanah Y, Lucet JC. Prescribers' experience and opinions on antimicrobial stewardship programmes in hospitals: a French nationwide survey. J Antimicrob Chemother 2020; 74:2451-2458. [PMID: 31167027 DOI: 10.1093/jac/dkz179] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Revised: 03/19/2019] [Accepted: 04/04/2019] [Indexed: 01/02/2023] Open
Abstract
OBJECTIVES To assess prescribers' experiences and opinions regarding antimicrobial stewardship programme (ASP) activities. METHODS A cross-sectional paper-based survey was conducted among prescribers in 27 out of 35 randomly selected large hospitals in France. RESULTS All 27 investigated hospitals (20 non-university public, 4 university-affiliated and 3 private hospitals) had an ASP and an appointed antibiotic advisor (AA), with a median of 0.9 full-time equivalents per 1000 acute-care beds (IQR 0-1.4). Of the 1963 distributed questionnaires, 920 were completed (46.9%). Respondents were mainly attending physicians (658/918, 71.7%) and medical specialists (532/868, 61.3%). Prescribers identified two main ASP objectives: to limit the spread of resistance (710/913, 77.8%) and to improve patient care and prognosis (695/913, 76.1%). The presence of an AA constituted a core element of ASP (96.2% agreement between answers of ASP leader and respondents). Respondents acknowledged an AA's usefulness especially on therapeutic issues, i.e. choosing appropriate antibiotic (agreement 84.7%) or adapting treatment (89.6%), but less so on diagnostic issues (31.4%). Very few respondents reported unsolicited counselling and post-prescription controls. Three-quarters of prescribers identified local guidelines (692/918, 75.4%). Prescribers did not approve of measures counteracting their autonomy, i.e. automatic stop orders (agreement 23.4%) or pre-approval by AAs (28.8%). They agreed more with educational interventions (73.0%) and clinical staff meetings (70.0%). CONCLUSIONS Prescribers perceived ASP mainly through its 'on-demand' counselling activities. They preferred measures that did not challenge their clinical autonomy. High levels of antibiotic consumption in French hospitals bring into question the effectiveness of such an approach. However, limited ASP staffing and resources may preclude extended activities.
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Affiliation(s)
- A Perozziello
- IAME, UMR 1137, DeSCID team, Université Paris Diderot, Sorbonne Paris Cité, Paris, France
| | - F X Lescure
- IAME, UMR 1137, DeSCID team, Université Paris Diderot, Sorbonne Paris Cité, Paris, France.,Service de Maladies Infectieuses et Tropicales, Hôpital Bichat-Claude Bernard, AP-HP, Paris, France
| | - A Truel
- IAME, UMR 1137, DeSCID team, Université Paris Diderot, Sorbonne Paris Cité, Paris, France
| | - C Routelous
- Institut du Management/EA 7348 MOS Management des organisations en santé, Ecole des hautes études en santé publique, EHESP, Rennes, Sorbonne Paris Cité, Paris, France
| | - L Vaillant
- UHLIN, Hôpital Bichat-Claude Bernard, AP-HP, Paris, France
| | - Y Yazdanpanah
- IAME, UMR 1137, DeSCID team, Université Paris Diderot, Sorbonne Paris Cité, Paris, France.,Service de Maladies Infectieuses et Tropicales, Hôpital Bichat-Claude Bernard, AP-HP, Paris, France
| | - J C Lucet
- IAME, UMR 1137, DeSCID team, Université Paris Diderot, Sorbonne Paris Cité, Paris, France.,UHLIN, Hôpital Bichat-Claude Bernard, AP-HP, Paris, France
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Tahoon MA, Khalil MM, Hammad E, Morad WS, awad SM, Ezzat S. The effect of educational intervention on healthcare providers’ knowledge, attitude, & practice towards antimicrobial stewardship program at, National Liver Institute, Egypt. EGYPTIAN LIVER JOURNAL 2020. [DOI: 10.1186/s43066-019-0016-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Inappropriate use of antimicrobials results in rapid emergence of resistance, selection pressure on resistant microorganisms, adverse reactions, and treatment failures. An effective approach to improving antimicrobial use in healthcare settings is a structured antimicrobial management program known as antimicrobial stewardship (AMS). Education and training is considered a backbone element of AMS program .This study aimed to evaluate the impact of educational program on the knowledge, attitude, and practice (KAP) of healthcare providers (HCPs) towards antimicrobial stewardship before and after the educational program at the surgery department and surgical ICU, National Liver Institute hospital (NLI), Egypt.
Results
Among the 69 invited HCPs, 48 attended the educational program sessions with attendance response rate about 70%. Regarding pre-educational KAP score of the respondents’ physicians and pharmacists, 39.3% of them had good knowledge score, 85.7% of them had positive attitude, &and 31.8% of physicians had good practice score; however, 100% of the pharmacists had poor practice. Regarding the respondents’ nurse, the pre-education mean score of knowledge was 13.3/20, attitude 14.8/16, and practice 9.3/14. Following educational program, there was a significant improvement in knowledge, attitude, and practice of the respondents’ health care providers (P < 0.001); on the contrary, there was no significant improvement in the practice of pharmacists (P > 0.05).
Conclusion
The implemented educational program was successful in improving the knowledge, attitude, and practice of HCPs; therefore, continuous efforts are needed to implement more educational programs to increase awareness towards AMS among HCPs.
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Firouzabadi D, Mahmoudi L. Knowledge, attitude, and practice of health care workers towards antibiotic resistance and antimicrobial stewardship programmes: A cross-sectional study. J Eval Clin Pract 2020; 26:190-196. [PMID: 31115129 DOI: 10.1111/jep.13177] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2019] [Revised: 04/22/2019] [Accepted: 04/22/2019] [Indexed: 11/29/2022]
Abstract
RATIONALE AND AIMS Antibiotic development was a major breakthrough in defeating infections; however, their vast use has led to antimicrobial resistance (AMR) causing mortality, morbidity, and financial burden worldwide. Considering the limited introduction of newer antimicrobials to overcome resistance patterns, sufficient knowledge of their use can help manage this issue. Antimicrobial stewardship programmes (ASPs) with the mainstay of education can be a good resolution. The aim of this study was to seek aspects in which knowledge regarding antibiotics is lacking at our institutions. MATERIALS AND METHODS This cross-sectional study performed in Shiraz, South of Iran, was designed as a knowledge, attitude, and practice (KAP) study. A self-administered questionnaire consisting of 15 questions was designed and handed out to health care workers including infectious disease practitioners, surgeons, internal medicine specialists and residents, general practitioners, medical students, and microbiology lab technicians and PhD graduates. Difference in response to questions was evaluated between the practitioner and nonpractitioner groups. RESULTS Completed questionnaires were collected (n = 126). According to the results, most participants (88.1%) agreed on establishment of local guidelines. Majority (94.4%) also believed that education regarding antibiotics can help reduce AMR. Good patient care was not believed to be impaired by limiting use of antibiotics (72.2%). A significant difference in the practitioner and nonpractitioner groups' practice score was observed. CONCLUSION In our study, knowledge deficit was observed in some aspects of AMR. We can conclude that more practice and education are needed in ASP for the better performance in reducing resistant patterns.
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Affiliation(s)
- Dena Firouzabadi
- Department of Clinical Pharmacy, School of Pharmacy, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Laleh Mahmoudi
- Department of Clinical Pharmacy, School of Pharmacy, Shiraz University of Medical Sciences, Shiraz, Iran
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Hayat K, Rosenthal M, Gillani AH, Chang J, Ji W, Yang C, Jiang M, Zhao M, Fang Y. Perspective of Key Healthcare Professionals on Antimicrobial Resistance and Stewardship Programs: A Multicenter Cross-Sectional Study From Pakistan. Front Pharmacol 2020; 10:1520. [PMID: 31998124 PMCID: PMC6967405 DOI: 10.3389/fphar.2019.01520] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Accepted: 11/25/2019] [Indexed: 01/21/2023] Open
Abstract
Background: Antimicrobial resistance (AMR) is an increasing global threat, and hospital-based antimicrobial stewardship programs (ASPs) are one of the effective approaches to tackle AMR globally. This study was intended to determine the attitude of key healthcare professionals (HCPs), including physicians, nurses, and hospital pharmacists, towards AMR and hospital ASPs. Methods: A cross-sectional study design was used to collect data from HCPs employed in public teaching hospitals of Punjab, Pakistan, from January 2019 to March 2019. A cluster-stratified sampling method was applied. Descriptive statistics, Mann Whitney and Kruskal Wallis tests were used for analysis. Results: A response rate of 81.3% (881/1083) for the surveys was obtained. The majority of the physicians (247/410, 60.2%) perceived AMR to be a serious problem in Pakistani hospitals (p < 0.001). Most of the HCPs considered improving antimicrobial prescribing (580/881, 65.8%; p < 0.001) accompanied by the introduction of prospective audit with feedback (301/881, 75.8%; p < 0.001), formulary restriction (227/881, 57.2%; p = 0.004) and regular educational activities (300/881, 75.6%; p = 0.015) as effective ASP methods to implement hospital ASPs in Pakistan. A significant association was found between median AMR and ASP scores with age, years of experience, and types of HCPs (p < 0.05). Conclusions: The attitude of most of the HCPs was observed to be positive towards hospital-based ASPs regardless of their poor awareness about ASPs. The important strategies, including prospective audit with feedback and regular educational sessions proposed by HCPs, will support the initiation and development of local ASPs for Pakistani hospitals.
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Affiliation(s)
- Khezar Hayat
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi'an Jiaotong University, Xi'an, China.,Center for Drug Safety and Policy Research, Xi'an Jiaotong University, Xi'an, China.,Shaanxi Center for Health Reform and Development Research, Xi'an, China.,Institute of Pharmaceutical Sciences, University of Veterinary and Animal Sciences, Lahore, Pakistan
| | - Meagen Rosenthal
- Department of Pharmacy Administration, School of Pharmacy, University of Mississippi, Mississippi, MS, United States
| | - Ali Hassan Gillani
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi'an Jiaotong University, Xi'an, China
| | - Jie Chang
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi'an Jiaotong University, Xi'an, China.,Center for Drug Safety and Policy Research, Xi'an Jiaotong University, Xi'an, China.,Shaanxi Center for Health Reform and Development Research, Xi'an, China
| | - Wenjing Ji
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi'an Jiaotong University, Xi'an, China.,Center for Drug Safety and Policy Research, Xi'an Jiaotong University, Xi'an, China.,Shaanxi Center for Health Reform and Development Research, Xi'an, China
| | - Caijun Yang
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi'an Jiaotong University, Xi'an, China.,Center for Drug Safety and Policy Research, Xi'an Jiaotong University, Xi'an, China.,Shaanxi Center for Health Reform and Development Research, Xi'an, China
| | - Minghuan Jiang
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi'an Jiaotong University, Xi'an, China.,Center for Drug Safety and Policy Research, Xi'an Jiaotong University, Xi'an, China.,Shaanxi Center for Health Reform and Development Research, Xi'an, China
| | - Mingyue Zhao
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi'an Jiaotong University, Xi'an, China.,Center for Drug Safety and Policy Research, Xi'an Jiaotong University, Xi'an, China.,Shaanxi Center for Health Reform and Development Research, Xi'an, China
| | - Yu Fang
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi'an Jiaotong University, Xi'an, China.,Center for Drug Safety and Policy Research, Xi'an Jiaotong University, Xi'an, China.,Shaanxi Center for Health Reform and Development Research, Xi'an, China
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Tripathi P, Tripathi R, Albarraq A, Makeen H, Alqahtani S, Pancholi S. Knowledge and perceptions of antimicrobial stewardship program among health-care students in Saudi Arabia. SAUDI JOURNAL FOR HEALTH SCIENCES 2020. [DOI: 10.4103/sjhs.sjhs_192_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Hayat K, Li P, Rosenthal M, Xu S, Chang J, Gillani AH, Khan FU, Sarwar MR, Ji S, Shi L, Cheng A, Fang Y. Perspective of community pharmacists about community-based antimicrobial stewardship programs. A multicenter cross-sectional study from China. Expert Rev Anti Infect Ther 2019; 17:1043-1050. [PMID: 31714841 DOI: 10.1080/14787210.2019.1692655] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Background: Antimicrobial stewardship programs (ASPs) are commonly used worldwide to tackle antimicrobial resistance. The current study aimed to investigate the perspective of pharmacists on community-based ASPs in China.Methods: A multicenter cross-sectional study was conducted in the capital cities of three different provinces of China between March 2019 and July 2019. A systematic random sampling method was used to recruit respondents.Results: A response rate of 87.4% (416/476) was obtained. A large number of respondents (n = 308, 74.0%) believed that ASPs are vital to improving patient care (Median = 4, IQR = 2). Approximately one-third of the respondents (n = 142, 34.1%) always ask patients about their knowledge related to antimicrobials (Median = 4, IQR = 2). Additionally, a considerable number of respondents (n = 127, 30.5%) always, or often (n = 117, 28.1%) collaborated with other healthcare professionals (Median = 4, IQR = 2). Age, gender, and experience were observed to have a significant association (p < 0.05) with median scores of knowledge about antibiotics, perceptions, and practices on ASPs.Conclusions: The perceptions of pharmacists regarding ASPs were positive. However, gaps in knowledge about some aspects of antibiotics and participation in ASPs were found. The development of regional community-based ASPs is urgently required.
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Affiliation(s)
- Khezar Hayat
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi'an Jiaotong University, Xi'an, China.,Center for Drug Safety and Policy Research, Xi'an Jiaotong University, Xi'an, China.,Shaanxi Centre for Health Reform and Development Research, Xi'an, China.,Institute of Pharmaceutical Sciences, University of Veterinary and Animal Sciences, Lahore, Pakistan.,Research Institute for Drug Safety and Monitoring, Institute of Pharmaceutical Science and Technology, Xi'an, China
| | - Pengchao Li
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi'an Jiaotong University, Xi'an, China.,Center for Drug Safety and Policy Research, Xi'an Jiaotong University, Xi'an, China.,Shaanxi Centre for Health Reform and Development Research, Xi'an, China.,Research Institute for Drug Safety and Monitoring, Institute of Pharmaceutical Science and Technology, Xi'an, China
| | - Meagen Rosenthal
- Department of Pharmacy Administration, School of Pharmacy, University of Mississippi, Oxford, MS, USA
| | - Sen Xu
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi'an Jiaotong University, Xi'an, China.,Center for Drug Safety and Policy Research, Xi'an Jiaotong University, Xi'an, China.,Shaanxi Centre for Health Reform and Development Research, Xi'an, China.,Research Institute for Drug Safety and Monitoring, Institute of Pharmaceutical Science and Technology, Xi'an, China
| | - Jie Chang
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi'an Jiaotong University, Xi'an, China.,Center for Drug Safety and Policy Research, Xi'an Jiaotong University, Xi'an, China.,Shaanxi Centre for Health Reform and Development Research, Xi'an, China.,Research Institute for Drug Safety and Monitoring, Institute of Pharmaceutical Science and Technology, Xi'an, China
| | - Ali Hassan Gillani
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi'an Jiaotong University, Xi'an, China.,Center for Drug Safety and Policy Research, Xi'an Jiaotong University, Xi'an, China.,Shaanxi Centre for Health Reform and Development Research, Xi'an, China.,Research Institute for Drug Safety and Monitoring, Institute of Pharmaceutical Science and Technology, Xi'an, China
| | - Faiz Ullah Khan
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi'an Jiaotong University, Xi'an, China.,Center for Drug Safety and Policy Research, Xi'an Jiaotong University, Xi'an, China.,Shaanxi Centre for Health Reform and Development Research, Xi'an, China.,Institute of Pharmaceutical Sciences, University of Veterinary and Animal Sciences, Lahore, Pakistan
| | - Muhammad Rehan Sarwar
- Centre for Medicine use and safety, Faculty of Pharmacy and Pharmaceutical sciences, Monash University, Parkville, Victoria, Australia
| | - Shiyu Ji
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi'an Jiaotong University, Xi'an, China.,Center for Drug Safety and Policy Research, Xi'an Jiaotong University, Xi'an, China.,Shaanxi Centre for Health Reform and Development Research, Xi'an, China.,Research Institute for Drug Safety and Monitoring, Institute of Pharmaceutical Science and Technology, Xi'an, China
| | - Li Shi
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi'an Jiaotong University, Xi'an, China.,Center for Drug Safety and Policy Research, Xi'an Jiaotong University, Xi'an, China.,Shaanxi Centre for Health Reform and Development Research, Xi'an, China.,Research Institute for Drug Safety and Monitoring, Institute of Pharmaceutical Science and Technology, Xi'an, China
| | - Aoyu Cheng
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi'an Jiaotong University, Xi'an, China.,Center for Drug Safety and Policy Research, Xi'an Jiaotong University, Xi'an, China.,Shaanxi Centre for Health Reform and Development Research, Xi'an, China.,Research Institute for Drug Safety and Monitoring, Institute of Pharmaceutical Science and Technology, Xi'an, China
| | - Yu Fang
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi'an Jiaotong University, Xi'an, China.,Center for Drug Safety and Policy Research, Xi'an Jiaotong University, Xi'an, China.,Shaanxi Centre for Health Reform and Development Research, Xi'an, China.,Research Institute for Drug Safety and Monitoring, Institute of Pharmaceutical Science and Technology, Xi'an, China
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Hayat K, Rosenthal M, Zhu S, Gillani AH, Chang J, Bogale AA, Kabba JA, Yang C, Jiang M, Zhao M, Fang Y. Attitude of clinicians towards hospital-based antimicrobial stewardship programs: a multicenter cross-sectional study from Punjab, Pakistan. Expert Rev Anti Infect Ther 2019; 17:661-669. [PMID: 31335228 DOI: 10.1080/14787210.2019.1647780] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Background: Antimicrobial resistance (AMR) is a major threat to global health and antimicrobial stewardship programs (ASPs) are useful to limit the momentum of AMR. This study was intended to determine the attitudes of clinicians about AMR, ASP strategies, and their readiness to participate in ASPs. Methods: A cross-sectional survey was carried out among clinicians working in teaching hospitals of Punjab between August and November 2018. A multistage sampling method was used. Descriptive statistics and Kruskal-Wallis tests were employed for data analysis. Results: A response rate of 77.9% (670 ⁄ 859) was achieved. Most of the physicians (n = 302, 71.7%) compared to surgeons (n = 134, 70.9%) and anesthetists (n = 25, 41.7%) considered AMR as a serious health problem in Pakistani hospitals (p < 0.001). Clinicians were agreed that hospital audit and feedback (n = 434, 64.8%), restriction of certain antibiotics (n = 424, 63.3%), readily accessible microbiological data (n = 453, 67.6%), and regular educational sessions (n = 496, 74.0%) are imperative approaches to implement ASPs. Median ASP and AMR scores were significantly associated with age, experience, and types of clinicians (p < 0.05). Conclusions: Despite poor previous knowledge of ASPs, all clinicians showed a positive attitude towards hospital ASPs. Several approaches suggested by clinicians will be helpful to implement hospital ASPs in Pakistan.
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Affiliation(s)
- Khezar Hayat
- a Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi'an Jiaotong University , Xi'an , China.,b Center for Drug Safety and Policy Research, Xi'an Jiaotong University , Xi'an , China.,c Shaanxi Centre for Health Reform and Development Research , Xi'an , China.,d Institute of Pharmaceutical Sciences, University of Veterinary and Animal Sciences , Lahore , Pakistan
| | - Meagen Rosenthal
- e Department of Pharmacy Administration, School of Pharmacy, University of Mississippi , Oxford , MS , USA
| | - Shan Zhu
- a Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi'an Jiaotong University , Xi'an , China.,b Center for Drug Safety and Policy Research, Xi'an Jiaotong University , Xi'an , China.,c Shaanxi Centre for Health Reform and Development Research , Xi'an , China
| | - Ali Hassan Gillani
- a Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi'an Jiaotong University , Xi'an , China.,b Center for Drug Safety and Policy Research, Xi'an Jiaotong University , Xi'an , China.,c Shaanxi Centre for Health Reform and Development Research , Xi'an , China
| | - Jie Chang
- a Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi'an Jiaotong University , Xi'an , China.,b Center for Drug Safety and Policy Research, Xi'an Jiaotong University , Xi'an , China.,c Shaanxi Centre for Health Reform and Development Research , Xi'an , China
| | - Alemtsehay Adam Bogale
- a Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi'an Jiaotong University , Xi'an , China.,b Center for Drug Safety and Policy Research, Xi'an Jiaotong University , Xi'an , China.,c Shaanxi Centre for Health Reform and Development Research , Xi'an , China
| | - John Alimamy Kabba
- a Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi'an Jiaotong University , Xi'an , China.,b Center for Drug Safety and Policy Research, Xi'an Jiaotong University , Xi'an , China.,c Shaanxi Centre for Health Reform and Development Research , Xi'an , China
| | - Caijun Yang
- a Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi'an Jiaotong University , Xi'an , China.,b Center for Drug Safety and Policy Research, Xi'an Jiaotong University , Xi'an , China.,c Shaanxi Centre for Health Reform and Development Research , Xi'an , China
| | - Minghuan Jiang
- a Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi'an Jiaotong University , Xi'an , China.,b Center for Drug Safety and Policy Research, Xi'an Jiaotong University , Xi'an , China.,c Shaanxi Centre for Health Reform and Development Research , Xi'an , China
| | - Mingyue Zhao
- a Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi'an Jiaotong University , Xi'an , China.,b Center for Drug Safety and Policy Research, Xi'an Jiaotong University , Xi'an , China.,c Shaanxi Centre for Health Reform and Development Research , Xi'an , China
| | - Yu Fang
- a Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi'an Jiaotong University , Xi'an , China.,b Center for Drug Safety and Policy Research, Xi'an Jiaotong University , Xi'an , China.,c Shaanxi Centre for Health Reform and Development Research , Xi'an , China
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Weier N, Tebano G, Thilly N, Demoré B, Pulcini C, Zaidi STR. Pharmacist participation in antimicrobial stewardship in Australian and French hospitals: a cross-sectional nationwide survey. J Antimicrob Chemother 2019; 73:804-813. [PMID: 29237051 DOI: 10.1093/jac/dkx435] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Accepted: 10/30/2017] [Indexed: 12/29/2022] Open
Abstract
Background Hospital pharmacists are an integral part of antimicrobial stewardship (AMS) programmes globally. Currently, little is known as to how hospital pharmacists see their role and involvement within the AMS framework. Objectives To assess the current level of involvement of Australian and French hospital pharmacists in AMS programmes and identify barriers limiting their involvement in AMS. Methods Hospital pharmacists throughout Australia and France were invited to participate in a nationwide online survey throughout March-May 2016. The survey was promoted through the national hospital pharmacists' association in Australia, while a stratified sampling method was used in France to invite pharmacists working in a variety of hospital settings. Results Invitations to participate in this survey were sent to 334 Australian pharmacists and 482 French pharmacists. Responses from 133 Australian and 126 French pharmacists were included for analysis. A total of 78.4% (203/259) of pharmacists reported the presence of an AMS programme. Pharmacists were most likely to be involved in AMS through assessing total antibiotic consumption and participating in AMS committee meetings. Barriers to participating in AMS included a lack of time and substantial non-clinical activities limiting involvement in AMS. Differences in responses were found between the two countries. Conclusions While the majority of pharmacists reported the presence of an AMS programme, multiple barriers to participation were identified by pharmacists in both countries. Further research should consider how to overcome the identified barriers to optimize the involvement of pharmacists in AMS.
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Affiliation(s)
- Naomi Weier
- Division of Pharmacy, School of Medicine, University of Tasmania, Hobart, Tasmania, Australia
| | | | - Nathalie Thilly
- Université de Lorraine, EA 4360 APEMAC, Nancy, France.,Centre Hospitalier Régional Universitaire de Nancy, Plateforme d'Aide à la Recherche Clinique, Nancy, France
| | - Béatrice Demoré
- Centre Hospitalier Régional Universitaire de Nancy, Pharmacie Brabois, Nancy, France.,UMR 7565, SRSMC, CNRS-Lorraine University, Faculté de Pharmacie, Rue Albert Lebrun, Nancy, France
| | - Céline Pulcini
- Université de Lorraine, EA 4360 APEMAC, Nancy, France.,Centre Hospitalier Régional Universitaire de Nancy, Service de Maladies Infectieuses et Tropicales, Nancy, France
| | - Syed Tabish R Zaidi
- Division of Pharmacy, School of Medicine, University of Tasmania, Hobart, Tasmania, Australia
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Goulopoulos A, Rofe O, Kong D, Maclean A, O'Reilly M. Attitudes and beliefs of Australian emergency department clinicians on antimicrobial stewardship in the emergency department: A qualitative study. Emerg Med Australas 2019; 31:787-796. [PMID: 30920181 DOI: 10.1111/1742-6723.13251] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Revised: 12/31/2018] [Accepted: 01/20/2019] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To explore the attitudes and beliefs of Australian ED clinicians towards antimicrobial stewardship in the ED. METHODS Semi-structured one-to-one interviews were conducted with ED clinicians between March and October 2015. Participants were identified via purposive and snowball sampling. Questionnaires were developed using the literature. Interviews were audio-recorded, transcribed and analysed using thematic analysis via the framework approach. Two researchers coded independently, with one using QSR International's NVivo 10 software and the other manually. Emergent themes were identified and classified. RESULTS Twenty-two clinicians (eight doctors, eight nurses and six pharmacists) from seven institutions participated. Participants were aware and concerned about antimicrobial resistance. Clinicians were divided based on their opinion on whether antimicrobials are prescribed appropriately and judiciously in the ED, with many perceiving prescribing to be inappropriate. Prior knowledge of the term 'Antimicrobial Stewardship' was demonstrated by doctors and pharmacists, with a relative lack of awareness by nurses. Four main themes were identified as both barriers and facilitators to antimicrobial stewardship in the ED: individual healthcare provider, resource, organisational and cultural. Uncertainty of diagnosis, time and resource pressures, reliance on previous experience and lack of access to expert opinion were perceived barriers. To facilitate appropriate prescribing, clinicians emphasised the need for routine education and feedback, adequate staffing, robust guidelines, senior medical clinician advocacy and multidisciplinary support. CONCLUSIONS Australian ED clinicians were aware of antimicrobial resistance. Many perceive injudicious antimicrobial use as problematic. Consideration of ED clinicians' perceived barriers and facilitators might enhance implementation of antimicrobial stewardship programmes in EDs.
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Affiliation(s)
- Anne Goulopoulos
- Pharmacy Department, Eastern Health, Melbourne, Victoria, Australia
| | - Olivia Rofe
- Pharmacy Department, Eastern Health, Melbourne, Victoria, Australia
| | - David Kong
- Centre for Medicine Use and Safety, Monash University, Melbourne, Victoria, Australia.,Ballarat Health Services, Ballarat, Victoria, Australia.,The National Centre for Antimicrobial Stewardship, Peter Doherty Institute, Melbourne, Victoria, Australia
| | - Andrew Maclean
- Emergency Services, Box Hill Hospital, Eastern Health, Melbourne, Victoria, Australia
| | - Mary O'Reilly
- Monash University, Melbourne, Victoria, Australia.,Infectious Diseases Department, Eastern Health, Melbourne, Victoria, Australia
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Exploring community healthcare providers' perceptions on antimicrobial resistance. J Glob Antimicrob Resist 2019; 18:215-222. [PMID: 30797088 DOI: 10.1016/j.jgar.2019.02.010] [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] [Received: 05/31/2018] [Revised: 02/07/2019] [Accepted: 02/11/2019] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVES Antimicrobial resistance (AMR) is a threat to global health, making previously curable diseases disabling or incurable. Human misuse of antimicrobials exacerbates the issue. As stewards to the public and prescribers of antimicrobials, healthcare providers are vital to reducing AMR, thus their perceptions and experiences around the issue must be explored. This study aimed to understand the perceptions of community nurses and physicians regarding the causes of AMR as well as barriers and facilitators to addressing it. METHODS In-depth, semi-structured interviews were conducted to understand the perceptions of nurses and physicians on these issues. RESULTS Overall, participants expressed that both environmental and human causes at various levels contribute to AMR. Whilst most themes were discussed by both healthcare practitioner groups, nurses more frequently mentioned patient causes and patient education compared with physicians. Participants also reflected on facilitators to reduce AMR, including guidelines, patient and provider education, and top-down and bottom-up initiatives. Identified barriers included patient demands, physician pressures and fears, and systemic overworking of physicians. CONCLUSION This study demonstrated numerous factors underpinning AMR and many barriers to addressing it, hence a multifaceted approach is required. This work also offers insight on how different groups can be utilised or will react to interventions.
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Saleh MS, Hong YH, Muda MR, Dali AF, Hassali MA, Khan TM, Neoh CF. Perception and practices of public hospital pharmacists towards the antimicrobial stewardship programme in the State of Selangor, Malaysia. Eur J Hosp Pharm 2018; 27:173-177. [PMID: 32419939 DOI: 10.1136/ejhpharm-2018-001679] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Revised: 10/18/2018] [Accepted: 10/23/2018] [Indexed: 11/04/2022] Open
Abstract
Objective The increase in antimicrobial resistance and the lack of new antimicrobial agents in drug discovery pipelines have called for global attention to mitigate the problem of antimicrobial misuse. While an antimicrobial stewardship (AMS) programme has been implemented in Malaysia, the perception and practices of public hospital pharmacists remain unknown. The aim of this study was to determine the perception and practices of Malaysian public hospital pharmacists towards the AMS programme in the state of Selangor, Malaysia. Methods A cross-sectional study, using a validated 23-item self-administered questionnaire, was conducted among pharmacists from 11 public hospitals in the State of Selangor, Malaysia, from December 2016 to January 2017. All public hospital pharmacists (n=432) were invited to participate in the survey. A 5-point Likert scale was employed in the questionnaire; the perception section was scored from 1 (strongly disagree) to 5 (strongly agree) while the practice section was scored from 1 (never) to 5 (always). Both descriptive and inferential statistical analyses were used to analyse data. Results Of the 432 pharmacists surveyed, 199 responded, giving a response rate of 46.0%. The majority of the respondents agreed (n=190, 95.5%) that the AMS programme improves patient care at their hospitals (median=5; IQR=1). Slightly less than half of the respondents indicated that a local antibiotic guideline was established in their hospitals (median=3, IQR=2.5), and had taken part in antimicrobial awareness campaigns to promote optimal use of antimicrobials in hospitals (median=3, IQR=1). Conclusions Overall, the perception and practices of the surveyed hospital pharmacists towards AMS programme were positive. National antibiotic guidelines, which take into consideration local antimicrobial resistance patterns, should be used fully to improve antimicrobial usage and to reduce practice variation. Collaboration among healthcare professionals should be strengthened to minimise the unfavourable consequences of unintended use of antimicrobial agents while optimising clinical outcomes.
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Affiliation(s)
- Muhammad Syafiq Saleh
- Faculty of Pharmacy, Universiti Teknologi MARA (UiTM), Selangor Branch, Puncak Alam Campus, Puncak Alam, Malaysia
| | - Yet Hoi Hong
- Department of Physiology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Mohd Rahimi Muda
- Faculty of Pharmacy, Universiti Teknologi MARA (UiTM), Selangor Branch, Puncak Alam Campus, Puncak Alam, Malaysia
| | - Ahmad Fauzi Dali
- Faculty of Pharmacy, Universiti Teknologi MARA (UiTM), Selangor Branch, Puncak Alam Campus, Puncak Alam, Malaysia
| | | | - Tahir Mehmood Khan
- Institute of Pharmaceutical Science, University of Veterinary and Animal Science, Lahore, Pakistan.,School of Pharmacy, Monash University, Sunway City, Malaysia
| | - Chin Fen Neoh
- Faculty of Pharmacy, Universiti Teknologi MARA (UiTM), Selangor Branch, Puncak Alam Campus, Puncak Alam, Malaysia.,Collaborative Drug Discovery Research (CDDR) Group, Pharmaceutical and Life Sciences Community of Research, UiTM, Shah Alam, Malaysia
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Abstract
Antimicrobial resistance is a significant public health issue and a major threat to global health. The solutions are multifactorial, and include: a reduction in the unnecessary use of antibiotics; public health campaigns; the use of systems approaches by healthcare organisations; and involving the knowledge and responsibilities of individual nurses. This article examines the challenge of antimicrobial resistance and explores the concept of antimicrobial stewardship in addressing this issue. It also discusses how nurses can contribute to a systems approach in primary and secondary care to support antimicrobial stewardship initiatives.
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Affiliation(s)
- David Ladenheim
- NHS East and North Hertfordshire Clinical Commissioning Group, Welwyn Garden City, England
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Abstract
Antimicrobial stewardship programs (ASPs) have predominately involved infectious diseases physicians and pharmacists with little attention to the nurses. To achieve optimal success of ASPs, engagement of nurses to actively participate in initiatives, strategies, and solutions to combat antibiotic resistance across the health care spectrum is required. In this context, the experiences of local ASP teams engaging nurses in appropriate antimicrobial use were explored to inform future strategies to enhance their involvement in ASPs.
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Sutthiruk N, Considine J, Hutchinson A, Driscoll A, Malathum K, Botti M. Thai clinicians' attitudes toward antimicrobial stewardship programs. Am J Infect Control 2018; 46:425-430. [PMID: 29132695 DOI: 10.1016/j.ajic.2017.09.022] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2017] [Revised: 09/21/2017] [Accepted: 09/21/2017] [Indexed: 11/28/2022]
Abstract
BACKGROUND Effective hospital-wide antimicrobial stewardship (AMS) programs need multidisciplinary engagement; however, clinicians' attitudes have not been investigated in Thailand where AMS is in early development. The aim of this study was to explore Thai clinicians' (doctors, nurses, and pharmacists) perceptions and attitudes toward AMS. METHODS A paper-based survey was distributed in a 1,000-bed university hospital in Bangkok, Thailand, between November 9, 2015, and December 21, 2015. A total of 1,087 clinicians participated: 392 doctors, 613 nurses, and 82 pharmacists. RESULTS Most participants agreed that improving antimicrobial prescribing would decrease antimicrobial resistance (AMR) and should be a priority of hospital policy. Doctors were less likely to agree with policies that limit antimicrobial prescribing (P < .001) than nurses or pharmacists, and were less likely to be interested in participating in AMS education than other clinicians (P < .001). Pharmacists indicated higher agreement with the statement, recommending that a specialist team provide individualized antimicrobial prescribing advice (P < .01) and that feedback improves antimicrobial selection (P < .001). Nurses were less likely to agree that community antibiotic use (P < .001) or patient pressure for antibiotics contribute to AMR (P < .001). CONCLUSIONS AMS programs are vital to improving antimicrobial use by clinicians. Understanding clinicians' attitudes and perceptions related to AMS is important to ensure that AMS programs developed address areas relevant to local clinical needs.
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Affiliation(s)
- Nantanit Sutthiruk
- School of Nursing and Midwifery, Deakin University, Geelong, VIC, Australia.
| | - Julie Considine
- School of Nursing and Midwifery, Deakin University, Geelong, VIC, Australia; Centre for Quality and Patient Safety Research - Eastern Health Partnership, Box Hill, VIC, Australia
| | - Ana Hutchinson
- School of Nursing and Midwifery, Deakin University, Geelong, VIC, Australia; Centre for Quality and Patient Safety Research - Epworth HealthCare Partnership, Richmond, VIC, Australia
| | - Andrea Driscoll
- School of Nursing and Midwifery, Deakin University, Geelong, VIC, Australia; Austin Health, Heidelberg, VIC, Australia
| | - Kumthorn Malathum
- Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Mari Botti
- School of Nursing and Midwifery, Deakin University, Geelong, VIC, Australia; Centre for Quality and Patient Safety Research - Epworth HealthCare Partnership, Richmond, VIC, Australia
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Monsees E, Goldman J, Popejoy L. Staff nurses as antimicrobial stewards: An integrative literature review. Am J Infect Control 2017; 45:917-922. [PMID: 28768593 DOI: 10.1016/j.ajic.2017.03.009] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2017] [Revised: 03/08/2017] [Accepted: 03/08/2017] [Indexed: 11/24/2022]
Abstract
BACKGROUND Guidelines on antimicrobial stewardship emphasize the importance of an interdisciplinary team, but current practice focuses primarily on defining the role of infectious disease physicians and pharmacists; the role of inpatient staff nurses as antimicrobial stewards is largely unexplored. METHODS An updated integrative review method guided a systematic appraisal of 13 articles spanning January 2007-June 2016. Quantitative and qualitative peer-reviewed publications including staff nurses and antimicrobial knowledge or stewardship were incorporated into the analysis. RESULTS Two predominant themes emerged from this review: (1) nursing knowledge, education, and information needs; and (2) patient safety and organizational factors influencing antibiotic management. DISCUSSION Focused consideration to empower and educate staff nurses in antimicrobial management is needed to strengthen collaboration and build an interprofessional stewardship workforce. CONCLUSIONS Further exploration on the integration and measurement of nursing participation is needed to accelerate this important patient safety initiative.
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Nurses are underutilised in antimicrobial stewardship – Results of a multisite survey in paediatric and adult hospitals. Infect Dis Health 2017. [DOI: 10.1016/j.idh.2017.04.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Antimicrobial Stewardship: A Cross-Sectional Survey Assessing the Perceptions and Practices of Community Pharmacists in Ethiopia. Interdiscip Perspect Infect Dis 2016; 2016:5686752. [PMID: 27994621 PMCID: PMC5138470 DOI: 10.1155/2016/5686752] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2016] [Revised: 09/28/2016] [Accepted: 10/10/2016] [Indexed: 12/04/2022] Open
Abstract
Background. Community pharmacists are key healthcare professionals for antimicrobial stewardship programs owing to their role in dispensing of antimicrobials. The aim of the present study was to assess the perception and practices of community pharmacists towards antimicrobial stewardship (AMS) in Ethiopia. Methods. A cross-sectional survey was conducted by selecting pharmacy sites through stratified simple random sampling technique. Descriptive and inferential statistics were used to analyze the data. Results. Majority of respondents strongly agreed or agreed that AMS program is vital for the improvement of patient care. Almost all of respondents agreed that pharmacists can play a prominent role in AMS and infection prevention (93.2%, median = 5; IQR = 2–5). However, only 26.5% of respondents strongly agreed or agreed that AMS should be practiced at community pharmacy level (median = 4, IQR = 1–3) and more than half of community pharmacists (59.9%) often/always dispense antimicrobial without a prescription. Conclusion. The present study revealed positive perceptions and practices of community pharmacists towards antimicrobial stewardship. Yet, some weak areas like integration of AMS program in community pharmacies, the significance of interprofessional involvement, and dispensing of antimicrobials without a valid prescription still need improvement.
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Jones M, Butler J, Graber CJ, Glassman P, Samore MH, Pollack LA, Weir C, Goetz MB. Think twice: A cognitive perspective of an antibiotic timeout intervention to improve antibiotic use. J Biomed Inform 2016; 71S:S22-S31. [PMID: 27327529 DOI: 10.1016/j.jbi.2016.06.005] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Revised: 06/01/2016] [Accepted: 06/16/2016] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To understand clinicians' impressions of and decision-making processes regarding an informatics-supported antibiotic timeout program to re-evaluate the appropriateness of continuing vancomycin and piperacillin/tazobactam. METHODS We implemented a multi-pronged informatics intervention, based on Dual Process Theory, to prompt discontinuation of unwarranted vancomycin and piperacillin/tazobactam on or after day three in a large Veterans Affairs Medical Center. Two workflow changes were introduced to facilitate cognitive deliberation about continuing antibiotics at day three: (1) teams completed an electronic template note, and (2) a paper summary of clinical and antibiotic-related information was provided to clinical teams. Shortly after starting the intervention, six focus groups were conducted with users or potential users. Interviews were recorded and transcribed. Iterative thematic analysis identified recurrent themes from feedback. RESULTS Themes that emerged are represented by the following quotations: (1) captures and controls attention ("it reminds us to think about it"), (2) enhances informed and deliberative reasoning ("it makes you think twice"), (3) redirects decision direction ("…because [there was no indication] I just [discontinued] it without even trying"), (4) fosters autonomy and improves team empowerment ("the template… forces the team to really discuss it"), and (5) limits use of emotion-based heuristics ("my clinical concern is high enough I think they need more aggressive therapy…"). CONCLUSIONS Requiring template completion to continue antibiotics nudged clinicians to re-assess the appropriateness of specified antibiotics. Antibiotic timeouts can encourage deliberation on overprescribed antibiotics without substantially curtailing autonomy. An effective nudge should take into account clinician's time, workflow, and thought processes.
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Affiliation(s)
- Makoto Jones
- VA Salt Lake City Health Care System, George E Whalen VA Medical Center, Salt Lake City, UT, USA; University of Utah, Salt Lake City, UT, USA.
| | - Jorie Butler
- VA Salt Lake City Health Care System, George E Whalen VA Medical Center, Salt Lake City, UT, USA; University of Utah, Salt Lake City, UT, USA; IDEAS 2.0 Center, George E. Whalen VA Medical Center, Salt Lake City, UT, USA; Geriatric Research Education and Clinical Center, George E. Whalen VA Medical Center, Salt Lake City, UT, USA
| | - Christopher J Graber
- VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA; David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Peter Glassman
- VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA; David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Matthew H Samore
- VA Salt Lake City Health Care System, George E Whalen VA Medical Center, Salt Lake City, UT, USA; Division of Epidemiology, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Lori A Pollack
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Charlene Weir
- VA Salt Lake City Health Care System, George E Whalen VA Medical Center, Salt Lake City, UT, USA; University of Utah, Salt Lake City, UT, USA
| | - Matthew Bidwell Goetz
- VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA; David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
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Burger M, Fourie J, Loots D, Mnisi T, Schellack N, Bezuidenhout S, Meyer JC. Knowledge and perceptions of antimicrobial stewardship concepts among final year pharmacy students in pharmacy schools across South Africa. S Afr J Infect Dis 2016. [DOI: 10.1080/23120053.2016.1192808] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Khan MU, Hassali MAA, Ahmad A, Elkalmi RM, Zaidi STR, Dhingra S. Perceptions and Practices of Community Pharmacists towards Antimicrobial Stewardship in the State of Selangor, Malaysia. PLoS One 2016; 11:e0149623. [PMID: 26901404 PMCID: PMC4764324 DOI: 10.1371/journal.pone.0149623] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2015] [Accepted: 02/03/2016] [Indexed: 11/18/2022] Open
Abstract
Background Increasing antimicrobial resistance is one of the pressing concerns globally. Injudicious use of antibiotics is one of the modifiable factors responsible for antimicrobial resistance. Given the widespread use of antimicrobials in community settings, pharmacists have an important role in ensuring appropriate use of antibiotics. The objective of this study was to assess the perception and self-reported practices of community pharmacists towards antimicrobial stewardship. Methods A cross-sectional study was conducted among community pharmacists between March–April, 2015, using a self-administered, pre-tested questionnaire in the State of Selangor, Malaysia. A simple random sampling approach was used to select pharmacy sites. Descriptive and inferential statistical methods were used to analyse the data. Results A total of 188 pharmacists responded to the survey, giving a response rate of 83.5%. The majority of participants (n = 182, 96.8%) believed that antimicrobial stewardship program helps healthcare professionals to improve the quality of patient care. However, more than half of pharmacists were neutral in their opinion about the incorporation of antimicrobial stewardship programs in community pharmacies (n = 102, 54.2%). Though collaboration was often done by pharmacists with other health professionals over the use of antibiotics (n = 104, 55.3%), a significant proportion of participants (n = 102, 54.2%) rarely/occasionally participate in antimicrobial awareness campaigns. Pharmacists having postgraduate qualification were more likely to held positive perceptions of, and were engaged in, antimicrobial stewardship than their non-postgraduate counterpart (p<0.05). Similarly, more experienced pharmacists (> 10 years) held positive perceptions towards antimicrobial stewardship (p<0.05). Conclusion The study highlighted some gaps in the perception and practices of community pharmacist towards antimicrobial stewardship. Development of customized interventions would be critical to bridging these gaps and improve their perception and practices towards antimicrobial stewardship.
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Affiliation(s)
- Muhammad Umair Khan
- Department of Clinical Pharmacy, Faculty of Pharmaceutical Sciences, UCSI University, Kuala Lumpur, Malaysia
| | - Mohamed Azmi Ahmad Hassali
- Student Affairs & Networking, Discipline of Social and Administrative Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang, Malaysia
| | - Akram Ahmad
- Department of Clinical Pharmacy, Faculty of Pharmaceutical Sciences, UCSI University, Kuala Lumpur, Malaysia
| | - Ramadan Mohamed Elkalmi
- Department of Pharmacy Practice, Kulliyyah of Pharmacy, International Islamic University Malaysia, Kuantan Campus, Pahang, Malaysia
| | - Syed Tabish Razi Zaidi
- Pharmacy, School of Medicine, Faculty of Health, University of Tasmania, Hobart, Tasmania, Australia
| | - Sameer Dhingra
- School of Pharmacy, Faculty of Medical Sciences, The University of the West Indies, St. Augustine, Eric Williams Medical Sciences Complex, Uriah Butler Highway, Champ Fleurs, Trinidad and Tobago
- * E-mail:
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Cotta MO, Robertson MS, Marshall C, Thursky KA, Liew D, Buising KL. Implementing antimicrobial stewardship in the Australian private hospital system: a qualitative study. AUST HEALTH REV 2016; 39:315-322. [PMID: 25556967 DOI: 10.1071/ah14111] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2014] [Accepted: 11/03/2014] [Indexed: 01/07/2023]
Abstract
OBJECTIVE To explore organisational factors and barriers contributing to limited uptake of antimicrobial stewardship (AMS) in Australian private hospitals and to determine solutions for AMS implementation. METHODS A qualitative study using a series of focus group discussions was conducted in a large private hospital making use of a semistructured interview guide to facilitate discussion among clinical and non-clinical stakeholders. A thematic analysis using five sequential components that mapped and interpreted emergent themes surrounding AMS implementation was undertaken by a multidisciplinary team of researchers. RESULTS Analysis revealed that autonomy of consultant specialists was perceived as being of greater significance in private hospitals compared with public hospitals. Use of an expert team providing antimicrobial prescribing advice and education without intruding on existing patient-specialist relationships was proposed by participants as an acceptable method of introducing AMS in private hospitals. There was more opportunity for nursing and pharmacist involvement, as well as empowering patients. Opportunities were identified for the hospital executive to market an AMS service as a feature that promoted excellence in patient care. CONCLUSIONS Provision of advice from experts, championing by clinical leaders, marketing by hospital executives and involving nurses, pharmacists and patients should be considered during implementation of AMS in private hospitals.
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Affiliation(s)
- Menino O Cotta
- Victorian Infectious Diseases Service at the Doherty Institute, 792 Elizabeth Street Melbourne, Victoria 3000, Australia.
| | - Megan S Robertson
- Clinical Trials and Research Centre, Epworth HealthCare, 89 Bridge Road, Richmond, Vic. 3121, Australia. Email
| | - Caroline Marshall
- Victorian Infectious Diseases Service at the Doherty Institute, 792 Elizabeth Street Melbourne, Victoria 3000, Australia.
| | - Karin A Thursky
- Victorian Infectious Diseases Service at the Doherty Institute, 792 Elizabeth Street Melbourne, Victoria 3000, Australia.
| | - Danny Liew
- Department of Medicine, Royal Melbourne Hospital Campus, University of Melbourne, Parkville, Vic. 3010, Australia. Email
| | - Kirsty L Buising
- Victorian Infectious Diseases Service at the Doherty Institute, 792 Elizabeth Street Melbourne, Victoria 3000, Australia.
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Cairns KA, Roberts JA, Cotta MO, Cheng AC. Antimicrobial Stewardship in Australian Hospitals and Other Settings. Infect Dis Ther 2015; 4:27-38. [PMID: 26362294 PMCID: PMC4569646 DOI: 10.1007/s40121-015-0083-9] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2015] [Indexed: 11/25/2022] Open
Abstract
Australia’s model of antimicrobial stewardship (AMS) has evolved significantly over recent years, from a long-standing national approach of antimicrobial prescribing guidelines and antimicrobial prescribing restrictions to recent advances including the first National Antimicrobial Resistance Strategy and incorporating mandatory AMS as part of hospital accreditation standards. AMS programs are most commonly found in the hospital setting. Various models are used throughout the country based on the local context and resources available. Programs implemented at Alfred Health and the Royal Brisbane and Women’s Hospital represent two successful models in tertiary referral settings that accommodate a general ward setting as well as specialized areas with a high infection burden. Measurement of outcomes related to AMS activities remains poorly standardized, with process indicators such as antimicrobial utilization forming a large proportion of outcome measurement. Presently there is no requirement for any AMS outcome measurements to be reported externally. Point prevalence surveys of appropriateness of prescribing and compliance with prescribing guidelines are widely used at a national level. Despite this, there is still a paucity of published Australian data to support the effect of AMS on patient clinical outcomes. Private hospitals, the community, veterinary medicine and aged care sectors represent an important area for future AMS expansion within Australia. The AMS focus has traditionally been on prescribing restrictions (through the Commonwealth funding agencies); however, recent work has described other areas for improvement and development in both settings. AMS in Australia continues to evolve. The recent development of an Australian strategic plan to link antimicrobial utilization and resistance surveillance with policy represents an important step forward for the future of AMS in Australia.
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Affiliation(s)
- Kelly A Cairns
- Pharmacy Department, Alfred Health, Melbourne, VIC, Australia.
| | - Jason A Roberts
- Department of Intensive Care Medicine and Pharmacy Department, Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia.,Burns Trauma and Critical Care Research Centre, The University of Queensland, Brisbane, QLD, Australia.,School of Pharmacy, The University of Queensland, Brisbane, QLD, Australia
| | - Menino O Cotta
- Department of Intensive Care Medicine and Pharmacy Department, Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia.,Burns Trauma and Critical Care Research Centre, The University of Queensland, Brisbane, QLD, Australia.,School of Pharmacy, The University of Queensland, Brisbane, QLD, Australia.,Department of Medicine, Royal Melbourne Hospital, University of Melbourne, Melbourne, VIC, Australia
| | - Allen C Cheng
- Infection Prevention and Healthcare Epidemiology Unit, Alfred Health, Melbourne, VIC, Australia.,Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia
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Loh JA, Darby JD, Daffy JR, Moore CL, Battye MJ, Poy Lorenzo YS, Stanley PA. Implementation of an antimicrobial stewardship program in an Australian metropolitan private hospital: lessons learned. ACTA ACUST UNITED AC 2015. [DOI: 10.1071/hi15015] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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