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 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 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.

Antimicrobial Stewardship

2019 ◽  
Author(s):  
Sarfaraz Ameen ◽  
Caoimhe NicFhogartaigh
Keyword(s):  
Antimicrobial Resistance ◽  
Clinical Outcomes ◽  
Antimicrobial Stewardship ◽  
Length Of Hospital Stay ◽  
Health Concern ◽  
Resistant Bacteria ◽  
Global Public Health ◽  
National Guidelines ◽  
Minor Operations ◽  
The Right

Antimicrobial stewardship (AMS) is a healthcare- system- wide approach to promoting and monitoring the judicious use of antimicrobials (including antibiotics) to preserve their future effectiveness and optimize outcomes for patients. Put simply, it is using the right antibiotic, at the right dose, via the right route, at the right time, for the right duration (Centres for Disease Control, 2010). Antimicrobial resistance (AMR) is a serious and growing global public health concern. Antibiotics are a unique class of drug as their use in individual patients may have an impact on others through the spread of resistant organisms. Antibiotics are essential for saving lives in conditions such as sepsis, and without effective antibiotics even minor operations could be life-threatening due to the risk of resistant infections. Across Europe approximately 25,000 people die each year as a result of hospital infections caused by resistant bacteria, and others have more prolonged and complicated illness. By 2050, AMR is predicted to be one of the major causes of death worldwide. Protecting the use of currently available antibiotics is crucial as discovery of new antimicrobials has stalled. Studies consistently demonstrate that 30–50% of antimicrobial prescriptions are unnecessary or inappropriate. Figure 18.1 shows some of the reasons behind this. As well as driving increasing resistance, unnecessary prescribing leads to unwanted adverse effects, including avoidable drug reactions and interactions, Clostridium difficile-associated diarrhoea, and healthcare-associated infections with resistant micro-organisms, all of which are associated with adverse clinical outcomes, including increased length of hospital stay and mortality, with increased cost to healthcare systems. Prudent use of antibiotics improves patient care and clinical outcomes, reduces the spread of antimicrobial resistance, and saves money. There are a number of global and national guidelines outlining what a robust AMS programme should consist of (see Further reading and useful resources), including: ● Infectious Diseases Society of America (IDSA): Guidelines for Developing an Institutional Programme to Enhance Antimicrobial Stewardship. ● National Institute for Health and Care Excellence (NICE): Antimicrobial Stewardship: Systems and Processes for Effective Antimicrobial Medicine Use [NG15]. ● Department of Health (DoH): Start Smart Then Focus, updated 2015. ● DoH: UK 5- Year Antimicrobial Resistance Strategy 2013 to 2018.

scholarly journals An overview of antimicrobial resistance surveillance among healthcare-associated pathogens in South Africa

2018 ◽  
Vol 7 (2) ◽  
Author(s):  
Ashika Singh-Moodley ◽  
Husna Ismail ◽  
Olga Perovic
Keyword(s):  
Antimicrobial Resistance ◽  
Treatment Guidelines ◽  
Resistance Mechanisms ◽  
Health Concern ◽  
Infection Prevention And Control ◽  
Surveillance Systems ◽  
African Countries ◽  
Lack Of Information ◽  
Healthcare Associated ◽  
And Control

Healthcare-associated infections are a serious public health concern resulting in morbidity and mortality particularly in developing countries. The lack of information from Africa, the increasing rates of antimicrobial resistance and the emergence of new resistance mechanisms intensifies this concern warranting the need for vigorous standardised surveillance platforms that produce reliable and accurate data which can be used for addressing these concerns. The implementation of national treatment guidelines, policies, antimicrobial stewardship programmes and infection prevention and control practices within healthcare institutions require a platform from which it can draw information and direct its approach. In this review, the importance of standardised surveillance systems, the challenges faced in the application of a surveillance system and the condition (existence and nonexistence) of such systems in African countries is discussed. This review also reports on some South African data.

scholarly journals The role of veterinarians in the One Health approach to antimicrobial resistance perspectives in Jordan (Preprint)

2022 ◽  
Author(s):  
Randa Bazzi
Keyword(s):  
Antimicrobial Resistance ◽  
Animal Husbandry ◽  
Study Data ◽  
Surveillance Systems ◽  
Attitudes And Practices ◽  
Significant Difference ◽  
The One ◽  
Definition Of ◽  
Knowledge Attitudes And Practices

UNSTRUCTURED This study aims to evaluate the role of Jordanian veterinarians in terms of their knowledge, attitudes and common practices in combating antimicrobial resistance (AMR) and summarize the registered veterinary drugs between 2017 2020. Descriptive study data were collected using a standardized questionnaire that focused on the knowledge, attitudes, and practices of Jordanian veterinarians. The findings were analyzed descriptively; 84% of the participants agreed with the statement on the definition of AMR. The majority (95.65%) of participants agreed that AMR is a challenge for the veterinary sector in Jordan and that it should be prioritized over other zoonotic diseases. Approximately 69% of the participants believed that the misuse and overuse of antimicrobials by unqualified, fraudulent, or unauthorized practitioners is the primary reason for the rise of cases associated with AMR and the challenges that accompany these. The most common practice among the respondents in this study was to recommend clients (e.g., farmers and owners) to practice good animal husbandry (80.00%). The study also revealed that there was a significant difference (p = 0.015) between attendance at AMR training sessions and the professional sector (private, public, and academic) of the veterinarians. This study underscores the importance of implementing a continuous education program on AMR so as to enhance the all-round knowledge of veterinarians and improve their advisory skills. In addition, laws should be enacted to ensure that veterinarians prescribe the correct antimicrobials and to improve surveillance systems for monitoring the use of antimicrobials in veterinary medicine. INTERNATIONAL REGISTERED REPORT RR2-https://doi.org/10.1186/s44149-021-00033-5

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