scholarly journals Exploring Perspectives on Antimicrobial Stewardship: A Qualitative Study of Health Managers in Kenya

2020 ◽  
Author(s):  
Samuel Mungai Mbugua ◽  
George Njoroge ◽  
Caroline Kijogi ◽  
Moses Kamita ◽  
Rachel Kimani ◽  
...  
Keyword(s):  
Antimicrobial Resistance ◽  
Antimicrobial Stewardship ◽  
Building Blocks ◽  
Health Concern ◽  
Surveillance Systems ◽  
Sensitivity Testing ◽  
Cross Sectional ◽  
Therapeutics Committee ◽  
Health Managers

Abstract Background: Antimicrobial resistance is a significant public health concern with the establishment of antimicrobial stewardship in hospitals being obligatory now more than ever. The perspectives and insights of health managers on antimicrobial stewardship, the complementary health services and building blocks are imperative towards implementation of robust antimicrobial stewardship programs.Methods: A cross-sectional, qualitative, multicenter study was conducted in three hospitals in Kenya. Key-informant, face-to-face interviews with hospital health managers were carried out on their perspectives on antimicrobial stewardship. Qualitative data was captured using audio tapes and field notes, transcribed and managed using QSR Nvivo 12 software. An iterative process was used to develop the thematic framework and updated in two rounds of iteration analysis. Analysis charts for each emergent theme were developed and categorized across all participants.Results: Perspectives on antimicrobial stewardship are described in five thematic categories; Importance of antimicrobial stewardship and the role of medicines and therapeutics committee, availability of an antimicrobial formulary and usage surveillance systems, Laboratory competency and recommendations for infection prevention and management, Educational resources and communications channels available, Building blocks and low-lying fruits for ASCs. The role of stewardship collaboration in diagnosis and antimicrobial prescription was alluded to with managers indicating a growing rise in occurrence of antimicrobial resistance. There was no contextualized, hospital specific antimicrobial formulary based on the local antibiograms in any of the hospitals. Lack of adequate laboratory competency was a major deficit with most hospitals lacking culture and sensitivity testing services. Staff training and communication channels were available in varying capacity across the three hospitals. Building blocks identified include medicines and therapeutics committee, education and training platforms (CMEs and CPDs) and hospital leadership commitment towards antimicrobial stewardship.Conclusions: The findings underpin the importance of understanding and incorporating the perspectives of health managers on the existing contextual mechanisms that can be leveraged on to establish robust AMS programs in the fight against AMR.

scholarly journals Exploring perspectives on antimicrobial stewardship: a qualitative study of health managers in Kenya

2020 ◽  
Author(s):  
Samuel MUNGAI Mbugua ◽  
George Njoroge ◽  
Caroline Kijogi ◽  
Moses Kamita ◽  
Rachel Kimani ◽  
...  
Keyword(s):  
Antimicrobial Resistance ◽  
Antimicrobial Stewardship ◽  
Building Blocks ◽  
Health Concern ◽  
Surveillance Systems ◽  
Sensitivity Testing ◽  
Cross Sectional ◽  
Therapeutics Committee ◽  
Health Managers

Abstract Background: Antimicrobial resistance is a significant public health concern with the establishment of antimicrobial stewardship in hospitals being obligatory now more than ever. The perspectives and insights of health managers on antimicrobial stewardship, the complementary health services and building blocks are imperative towards implementation of robust antimicrobial stewardship programs.Methods: A cross-sectional, qualitative, multicenter study was conducted in three hospitals in Kenya. Key-informant, face-to-face interviews with hospital health managers were carried out on their perspectives on antimicrobial stewardship. Qualitative data was captured using audio tapes and field notes, transcribed and managed using QSR Nvivo 12 software. An iterative process was used to develop the thematic framework and updated in two rounds of iteration analysis. Analysis charts for each emergent theme were developed and categorized across all participants.Results: Perspectives on antimicrobial stewardship are described in five thematic categories; Importance of antimicrobial stewardship and the role of medicines and therapeutics committee, availability of an antimicrobial formulary and usage surveillance systems, Laboratory competency and recommendations for infection prevention and management, Educational resources and communications channels available, Building blocks and low-lying fruits for ASCs. The role of stewardship collaboration in diagnosis and antimicrobial prescription was alluded to with managers indicating a growing rise in occurrence of antimicrobial resistance. There was no contextualized, hospital specific antimicrobial formulary based on the local antibiograms in any of the hospitals. Lack of adequate laboratory competency was a major deficit with most hospitals lacking culture and sensitivity testing services. Staff training and communication channels were available in varying capacity across the three hospitals. Building blocks identified include medicines and therapeutics committee, education and training platforms (CMEs and CPDs) and hospital leadership commitment towards antimicrobial stewardship.Conclusions: The findings underpin the importance of understanding and incorporating the perspectives of health managers on the existing contextual mechanisms that can be leveraged on to establish robust AMS programs in the fight against AMR.

scholarly journals Exploring perspectives on antimicrobial stewardship: a qualitative study of health managers in Kenya

2020 ◽  
Author(s):  
Samuel MUNGAI Mbugua ◽  
George Njoroge ◽  
Caroline Kijogi ◽  
Moses Kamita ◽  
Rachel Kimani ◽  
...  
Keyword(s):  
Antimicrobial Resistance ◽  
Health Services ◽  
Antimicrobial Stewardship ◽  
Building Blocks ◽  
Health Concern ◽  
Surveillance Systems ◽  
Sensitivity Testing ◽  
Therapeutics Committee ◽  
Health Managers

Abstract Background: Antimicrobial resistance is a significant public health concern with the establishment of antimicrobial stewardship in hospitals being obligatory now more than ever. The perspectives and insights of health managers on antimicrobial stewardship (AMS), the complementary health services and building blocks are imperative towards implementation of robust antimicrobial stewardship programs. This study aimed to understand the perspectives of hospital managers to AMS and identify areas of management engagement and addressing potential blockades to change.Methods: A cross-sectional, qualitative, multicenter study was conducted in three hospitals in Kenya. Key-informant, face-to-face interviews with hospital health managers were carried out on their perspectives on antimicrobial stewardship. Qualitative data was captured using audio tapes and field notes, transcribed and managed using NVivo 12 software. An iterative process was used to develop the thematic framework and updated in two rounds of iteration analysis. Analysis charts for each emergent theme were developed and categorized across all participants.Results: Perspectives on antimicrobial stewardship are described in five thematic categories; Importance of antimicrobial stewardship and the role of medicines and therapeutics committee, availability of an antimicrobial formulary and usage surveillance systems, laboratory competency and recommendations for infection prevention and management, educational resources and communications channels available, building blocks and low-lying fruits for Antimicrobial Stewardship Committees. The role of stewardship collaboration in diagnosis and antimicrobial prescription was alluded to with managers indicating a growing rise in occurrence of antimicrobial resistance. There was no contextualized, hospital specific antimicrobial formulary based on the local antibiograms in any of the hospitals. Lack of adequate laboratory competency was a major deficit with most hospitals lacking culture and sensitivity testing services. Staff training and communication channels were available in varying capacity across the three hospitals. Building blocks identified include medicines and therapeutics committee, education, and training platforms (Continuous Medical Education and Continuous Professional Development activities) and hospital leadership commitment towards antimicrobial stewardship.Conclusions: The practice of antimicrobial stewardship is not implemented and well developed in the sampled healthcare facilities as demonstrated by lack of core AMS complementary health services. However, the health managers are aware of the fundamental importance of antimicrobial stewardship programs and the vast benefits of implementation and institutionalization of AMS to the hospital and its clients alike. The findings underpin the importance of understanding and incorporating the perspectives of health managers on the existing contextual mechanisms that can be leveraged on to establish robust Antimicrobial Stewardship programs in the fight against antimicrobial resistance.

scholarly journals Exploring perspectives on antimicrobial stewardship: a qualitative study of health managers in Kenya

2020 ◽  
Vol 5 (1) ◽  
Author(s):  
Samuel Mungai Mbugua ◽  
George Njoroge ◽  
Caroline Kijogi ◽  
Moses Kamita ◽  
Rachel Kimani ◽  
...  
Keyword(s):  
Antimicrobial Resistance ◽  
Health Services ◽  
Antimicrobial Stewardship ◽  
Building Blocks ◽  
Health Concern ◽  
Surveillance Systems ◽  
Hospital Managers ◽  
Therapeutics Committee ◽  
Health Managers

Abstract Background Antimicrobial resistance is a significant public health concern with the establishment of antimicrobial stewardship in hospitals being increasingly obligatory. Perspectives and insights of health managers on antimicrobial stewardship (AMS), complementary health services and building blocks are imperative towards implementation of robust AMS programs. This study aimed to understand perspectives of hospital managers on AMS and identify areas of management engagement while addressing potential blockades to change. Methods A cross-sectional, qualitative, multicenter study was conducted in three hospitals in Kenya. Key-informant interviews on perspectives on AMS were administered to hospital managers. Qualitative data was captured using audio tapes and field notes, transcribed and managed using NVivo 12 software. An iterative process was used to develop the thematic framework and updated in two rounds of iteration analysis. Analysis charts for each emergent theme were developed and categorized across all participants. Results Perspectives on AMS are described in five thematic categories; Importance of antimicrobial stewardship and the role of medicines and therapeutics committee, availability of antimicrobial formulary and usage surveillance systems, laboratory competency and recommendations for infection prevention and management, educational resources and communications channels available, building blocks and low-lying fruits for Antimicrobial Stewardship Committees. The role of stewardship collaboration in diagnosis and antimicrobial prescription was alluded to with managers indicating a growing rise in occurrence of antimicrobial resistance. There lacked contextualized, hospital specific antimicrobial formulary and adequate laboratory competency. Staff training and communication channels were available in varying capacity across the three hospitals. Building blocks identified include medicines and therapeutics committee, education, and training platforms (Continuous Medical Education and Continuous Professional Development activities) and hospital leadership commitment. Conclusions The practice of antimicrobial stewardship is not implemented and well developed as demonstrated by lack of core AMS complementary health services. However, the health managers are aware of the fundamental importance of antimicrobial stewardship programs and the vast benefits of implementation and institutionalization of AMS to hospitals and their clients. The findings underpin the importance of understanding and incorporating perspectives of health managers on existing contextual mechanisms that can be leveraged on to establish robust AMS programs in the fight against antimicrobial resistance.

scholarly journals Exploring perspectives on antimicrobial stewardship: a qualitative study of health managers in Kenya

2020 ◽  
Author(s):  
Samuel Mungai Mbugua ◽  
George Njoroge ◽  
Caroline Kijogi ◽  
Moses Kamita ◽  
Rachel Kimani ◽  
...  
Keyword(s):  
Antimicrobial Resistance ◽  
Health Services ◽  
Antimicrobial Stewardship ◽  
Building Blocks ◽  
Health Concern ◽  
Surveillance Systems ◽  
Hospital Managers ◽  
Therapeutics Committee ◽  
Health Managers

Abstract Background: Antimicrobial resistance is a significant public health concern with the establishment of antimicrobial stewardship in hospitals being increasingly obligatory. Perspectives and insights of health managers on antimicrobial stewardship (AMS), complementary health services and building blocks are imperative towards implementation of robust AMS programs. This study aimed to understand perspectives of hospital managers on AMS and identify areas of management engagement while addressing potential blockades to change.Methods: A cross-sectional, qualitative, multicenter study was conducted in three hospitals in Kenya. Key-informant interviews on perspectives on AMS were administered to hospital managers. Qualitative data was captured using audio tapes and field notes, transcribed and managed using NVivo 12 software. An iterative process was used to develop the thematic framework and updated in two rounds of iteration analysis. Analysis charts for each emergent theme were developed and categorized across all participants.Results: Perspectives on AMS are described in five thematic categories; Importance of antimicrobial stewardship and the role of medicines and therapeutics committee, availability of antimicrobial formulary and usage surveillance systems, laboratory competency and recommendations for infection prevention and management, educational resources and communications channels available, building blocks and low-lying fruits for Antimicrobial Stewardship Committees. The role of stewardship collaboration in diagnosis and antimicrobial prescription was alluded to with managers indicating a growing rise in occurrence of antimicrobial resistance. There lacked contextualized, hospital specific antimicrobial formulary and adequate laboratory competency. Staff training and communication channels were available in varying capacity across the three hospitals. Building blocks identified include medicines and therapeutics committee, education, and training platforms (Continuous Medical Education and Continuous Professional Development activities) and hospital leadership commitment.Conclusions: The practice of antimicrobial stewardship is not implemented and well developed as demonstrated by lack of core AMS complementary health services. However, the health managers are aware of the fundamental importance of antimicrobial stewardship programs and the vast benefits of implementation and institutionalization of AMS to hospitals and their clients. The findings underpin the importance of understanding and incorporating perspectives of health managers on existing contextual mechanisms that can be leveraged on to establish robust AMS programs in the fight against antimicrobial resistance.

scholarly journals Assessing Knowledge and Perception Regarding Antimicrobial Stewardship and Antimicrobial Resistance in University Students of Pakistan: Findings and Implications

Antibiotics ◽  
2021 ◽  
Vol 10 (7) ◽  
pp. 866
Author(s):  
Iltaf Hussain ◽  
Nisa Yousaf ◽  
Sana Haider ◽  
Pervisha Jalil ◽  
Muhammad Usman Saleem ◽  
...  
Keyword(s):  
Antimicrobial Resistance ◽  
University Students ◽  
Antimicrobial Stewardship ◽  
Antibiotic Use ◽  
Cross Sectional Study ◽  
Dosing Regimen ◽  
Student Knowledge ◽  
Chi Square ◽  
Cross Sectional ◽  
Self Administered Questionnaire

The irrational use of antimicrobials has enormously contributed to antimicrobial resistance (AMR) globally and especially in the developing world. To assess the knowledge and perception regarding AMR and antimicrobial stewardship (AMS), a descriptive cross-sectional study was carried out in university students enrolled in pharmacy, veterinary, and biology programs by using an online self-administered questionnaire. The Chi-square and Fisher exact tests (where applicable) were performed to assess the association of the demographics with the students’ knowledge and perception regarding AMR and AMS. A total of 496 students completed the questionnaire, among which, 85.7% of the participants were familiar with the term AMR and 79.4% of the participants correctly identified a poorly designed dosing regimen as a contributing factor towards AMR. The majority of participants (57.9%) were familiar with the term AMS and 86.5% were aware of the aim of AMS. The participants showed good knowledge regarding AMR and AMS, but to further improve student knowledge and perception of AMS and AMR, it is suggested that dedicated modules on antibiotic use and AMS should be incorporated into the curricula of these undergraduate and postgraduate programs.

scholarly journals Spatial-time Visualization of Cutaneous Leishmaniasis in an Urban Area: Informing Health Policy and Practice

2020 ◽  
Author(s):  
Neda Firouraghi ◽  
Sayyed Mostafa Mostafavi ◽  
Amene Raouf-Rahmati ◽  
Alireza Mohammadi ◽  
Reza Saemi ◽  
...  
Keyword(s):  
High Risk ◽  
Incidence Rate ◽  
Urban Area ◽  
Incidence Rates ◽  
Low Risk ◽  
Health Concern ◽  
Surveillance Systems ◽  
Cross Sectional ◽  
Targeted Interventions ◽  
Risk Areas

Abstract Background:Cutaneous leishmaniasis (CL) is an important public health concern worldwide. Iran is among the most CL-affected countries, being listed as one of the first six endemic countries in the world. In order to develop targeted interventions, we performed a spatial-time visualization of CL cases in an urban area to identify high-risk and low-risk areas during 2016-2019.Methods:This cross-sectional study was conducted in the city of Mashhad. Patient data were gathered from Mashhad health centers. All cases (n=2425) were diagnosed in two stages; the initial diagnosis was based on clinical findings. Subsequently, clinical manifestation was confirmed by parasitological tests. The data were aggregated at the neighborhood and district levels and smoothed CL incidence rates per 100,000 individuals were calculated using the spatial empirical Bayesian approach. Furthermore, we used the Anselin Local Moran’s I statistic to identify clusters and outliers of CL distribution during 2016-2019 in Mashhad. Results:The overall incidence rates decreased from 34.6 per 100,000 in 2016 to 19.9 per 100,000 individuals in 2019. Both cluster analyses by crude incidence rate and smoothed incidence rate identified high-risk areas in southwestern Mashhad over the study period. Furthermore, the analyses revealed low-risk areas in northeastern Mashhad over the same 3-year period.Conclusions:The southwestern area of Mashhad had the highest CL incidence rates. This piece of information might be of value to design tailored interventions such as running effective resource allocation models, informed control plans and implementation of efficient surveillance systems. Furthermore, this study generates new hypotheses to test potential relationships between socio-economic and environmental risk factors and incidence of CL in areas with higher associated risks.

scholarly journals Knowledge, Attitudes and Practices of Veterinarians Towards Antimicrobial Resistance and Stewardship in Nigeria

Antibiotics ◽  
2020 ◽  
Vol 9 (8) ◽  
pp. 453
Author(s):  
Usman O. Adekanye ◽  
Abel B. Ekiri ◽  
Erika Galipó ◽  
Abubakar Bala Muhammad ◽  
Ana Mateus ◽  
...  
Keyword(s):  
Antimicrobial Resistance ◽  
Antimicrobial Stewardship ◽  
Online Survey ◽  
Action Plan ◽  
Prophylactic Antibiotic ◽  
Antibiotic Use ◽  
Health Concern ◽  
Attitudes And Practices ◽  
Laboratory Services ◽  
Knowledge Attitudes And Practices

Antimicrobial resistance (AMR) is a global health concern and the inappropriate use of antibiotics in animals and humans is considered a contributing factor. A cross-sectional survey to assess the knowledge, attitudes and practices of veterinarians regarding AMR and antimicrobial stewardship was conducted in Nigeria. A total of 241 respondents completed an online survey. Only 21% of respondents correctly defined the term antimicrobial stewardship and 59.8% were unaware of the guidelines provided by the Nigeria AMR National Action Plan. Over half (51%) of the respondents indicated that prophylactic antibiotic use was appropriate when farm biosecurity was poor. Only 20% of the respondents conducted antimicrobial susceptibility testing (AST) frequently, and the unavailability of veterinary laboratory services (82%) and the owner’s inability to pay (72%) were reported as key barriers to conducting AST. The study findings suggest strategies focusing on the following areas may be useful in improving appropriate antibiotic use and antimicrobial stewardship among veterinarians in Nigeria: increased awareness of responsible antimicrobial use among practicing and newly graduated veterinarians, increased dissemination of regularly updated antibiotic use guidelines, increased understanding of the role of good biosecurity and vaccination practices in disease prevention, and increased provision of laboratory services and AST at affordable costs.

Antimicrobial Stewardship in the Emergency Department

2016 ◽  
Vol 29 (6) ◽  
pp. 556-563 ◽  
Author(s):  
Bryan M. Bishop
Keyword(s):  
Emergency Department ◽  
Antimicrobial Resistance ◽  
Antimicrobial Stewardship ◽  
Health Concern ◽  
Antimicrobial Use ◽  
Upper Respiratory Infection ◽  
Diagnostic Uncertainty ◽  
National Public Health ◽  
Inpatient Settings ◽  
Tract Infections

Antimicrobial resistance is a national public health concern. Misuse of antimicrobials for conditions such as upper respiratory infection, urinary tract infections, and cellulitis has led to increased resistance to antimicrobials commonly utilized to treat those infections, such as sulfamethoxazole/trimethoprim and flouroquinolones. The emergency department (ED) is a site where these infections are commonly encountered both in ambulatory patients and in patients requiring admission to a hospital. The ED is uniquely positioned to affect the antimicrobial use and resistance patterns in both ambulatory settings and inpatient settings. However, implementing antimicrobial stewardship programs in the ED is fraught with challenges including diagnostic uncertainty, distractions secondary to patient or clinician turnover, and concerns with patient satisfaction to name just a few. However, this review article highlights successful interventions that have stemmed inappropriate antimicrobial use in the ED setting and warrant further study. This article also proposes other, yet to be validated proposals. Finally, this article serves as a call to action for pharmacists working in antimicrobial stewardship programs and in emergency medicine settings. There needs to be further research on the implementation of these and other interventions to reduce inappropriate antimicrobial use to prevent patient harm and curb the development of antimicrobial resistance.

scholarly journals RATIONALE OF ANTIBIOTIC PRESCRIPTION IN PATIENTS VISITING A TERTIARY CARE SOUTH INDIAN HOSPITAL

2021 ◽  
pp. 27-30
Author(s):  
MOHAMED AHMED ◽  
PAWAN KUMAR ◽  
KISHORE DV ◽  
PRABHAT KUMAR ◽  
RUBEENA KAUSER ◽  
...  
Keyword(s):  
Antimicrobial Resistance ◽  
Tertiary Care ◽  
General Medicine ◽  
Critical Issue ◽  
Care Hospital ◽  
Sensitivity Testing ◽  
Prescribing Pattern ◽  
Cross Sectional ◽  
Specific Patient ◽  
South Indian

Objective: Antimicrobials are the class of drugs that are used irrationally in most cases leading to rise in instances of antimicrobial resistance altering the effect of such agents. Antimicrobial resistance has become a critical issue universally nerving the need to monitor the utilization pattern and rationality in prescribing of antibiotics. This helps in selection of most appropriate antibiotic for the specific patient and achieving the goals of the therapy. Methods: A prospective cross-sectional study with a sample size of 600 participants was conducted in department of general medicine of a tertiary care hospital. Inpatients prescribed with antibiotics were included in the study and their case sheets were reviewed to analyzing the prescribing pattern. The medication usage pattern was then assessed for rationality in prescribing was evaluated. The results obtained were statistically analyzed using SPSS Software. Results: It is noted that a more number of males participated and the greatest number of the patients were from the age group of 31-45. The diagnosis found in the majority of the patients was respiratory tract infection followed by others. On scrutinizing the prescriptions, it was noted that cephalosporins and penicillins were most often prescribed, and on an average single, antibiotic was frequently used with the preferred route of administration in most of the prescriptions being injection route. Though many of the antibiotics were prescribed empirically, it was observed that 59% of them were most appropriately dosed and maximum patients that are around 57% were cured from their illnesses. Conclusion: This study provided important baseline information on antimicrobial use within a large tertiary care teaching hospital and identified potential targets for future antimicrobial stewardship programs. The culture and sensitivity testing suggested that the drug resistance was more for most commonly prescribed antibiotics in the hospital. Increased targeted prescribing based on sensitivity tests will bring down the high use of empiric broad-spectrum antibiotic use.

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