Barriers to implementing antimicrobial stewardship programmes in three Saudi hospitals: Evidence from a qualitative study

Alghamdi, Saleh; Atef-Shebl, Nada; Aslanpour, Zoe; Berrou, Ilhem

doi:10.1016/j.jgar.2019.01.031

Cited by 28 publications

(56 citation statements)

References 33 publications

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“…However, the universal adaptation of these guidelines remains deficient due tobarriers viz. ; personnel shortages, trained staff, financial cutbacks, and resistance from administration; leadership and a culture that embraces change[ 24 25 ] and lack of state-specific guidelines. [ 25 ]…”

Section: Discussionmentioning

confidence: 99%

Antibiotic prescribing patterns and knowledge of antibiotic resistance amongst the doctors working at public health facilities of a state in northern India: A cross sectional study

Trikha

Dalpath

Sharma

et al. 2020

J Family Med Prim Care

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Objectives: The aim of the study is to understand antibiotic prescribing patterns and to understand knowledge of antibiotic resistance amongst the doctors working at public health facilities of a northern Indian state. Methodology: A cross-sectional study among doctors of the civil hospitals of Haryana state of India was conducted 2019. Data were collected by self-administered questionnaire from a total of 215 doctors posted at the 22 district hospitals. Results: The response rate was 98%. Doctors (66%) perceived antibiotic resistance as a very important global problem, a very important problem in India (68%) and as an important problem in their hospital (31%). Experience in years was significantly associated with considering hand hygiene (OR, 5.78; 95% CI, 1.6420.3; P = 0.005) and treatment of bacteria as per susceptibility report of the organism (OR, 0.54; 95% CI, 0.310.93; P = 0.03). Surgeons reported piperacillin-tazobactam (17%), cloxacillin (17%), and cephazolin (12.05%) and others (54.2%) as the first choice of antibiotics for infection after surgery. Doctors (52.3%) reported that they started antibiotics 12 hours before surgery; 15 (17%) prescribed antibiotics 6 hours before surgery; and 23 (27%) 1 day before the surgery. Time for stopping antibiotics after surgery, as reported by participants, was 1 day (15%), 23 days (35%), 57 days (44%), respectively. A total of 71 (83%) doctors thought that surgical incision could lead to post-surgical site infection. Conclusion: Findings of study can be utilized to enhance education on antimicrobial prescribing, antimicrobial surveillance, and prescribing patterns among doctors in our settings.

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Section: Discussionmentioning

confidence: 99%

Antibiotic prescribing patterns and knowledge of antibiotic resistance amongst the doctors working at public health facilities of a state in northern India: A cross sectional study

Trikha

Dalpath

Sharma

et al. 2020

J Family Med Prim Care

View full text Add to dashboard Cite

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“…( Baraka et al, 2019 ). In another qualitative study by Alghamdi et al conducted in three hospitals in Saudi Arabia reported lack of enforcement of antimicrobial prescribing policies and guidelines, physicians fear and concerns influence their acceptance of ASP interventions ( Alghamdi et al, 2019 ).…”

Section: Introductionmentioning

confidence: 99%

Evaluation of Antimicrobial Stewardship Programs (ASPs) and their perceived level of success at Makkah region hospitals, Kingdom of Saudi Arabia

Haseeb

Faidah

Algethamy³

et al. 2020

Saudi Pharmaceutical Journal

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Antimicrobial stewardship programs (ASPs) are collaborative efforts to optimize antimicrobial use in healthcare institutions through evidence-based quality improvement strategies. The general administration of pharmaceutical care in the Saudi ministry of health (MOH) is putting outstanding efforts in implementing antimicrobial stewardship in Saudi health care settings. Several surveys have been conducted globally and reported many types of antimicrobial stewardship strategies in health institutions and their effectiveness. This study aims to identify ASPs in Makkah region hospitals and their perceived level of success. We administered a regional survey to explore current progress and issues related to the implementation of ASPs in Makkah region hospitals at the pharmacy level (n = 25). Among responding hospitals, 19 (76%) hospitals, the most commonly reported ASP were as following: formulary restrictions (90%) for broad-spectrum antimicrobials and use of prospective feedback on antimicrobial prescribing (68%), use of clinical guidelines and pathways (100%), and use of automatic stop orders (68%) to limit inappropriate antimicrobial therapy. The study outcomes will also be of pivotal importance to devise policies and strategies for antimicrobial stewardship implementation in other non-MOH settings in the Makkah region. Based on our results, all reported institutions have at least one antimicrobial stewardship program in a process with a high success rate. A multidisciplinary ASP approach, active involvement of drug & therapeutic committee, formulary restrictions, and availability of education & training of pharmacists and physicians on ASP are the primary elements for perceived successful antimicrobial stewardship programs in the Makkah region hospitals.

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“…Optimization of antimicrobial use in hospitals through stewardship is an increasingly fundamental priority within the context of proliferating antimicrobial resistance [ 7 ]. Indeed, emphasis on enforcement of AMS guidelines should be more explicit than ever [ 10 ]. Understanding the perspectives of hospital managers to AMS is vital towards the establishment of robust and sustainable antimicrobial stewardship programs and the engagement of management and addressing potential blockades to change.…”

Section: Introductionmentioning

confidence: 99%

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

Mbugua

Njoroge

Kijogi

et al. 2020

glob health res policy

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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.

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Barriers to implementing antimicrobial stewardship programmes in three Saudi hospitals: Evidence from a qualitative study

Cited by 28 publications

References 33 publications

Antibiotic prescribing patterns and knowledge of antibiotic resistance amongst the doctors working at public health facilities of a state in northern India: A cross sectional study

Antibiotic prescribing patterns and knowledge of antibiotic resistance amongst the doctors working at public health facilities of a state in northern India: A cross sectional study

Evaluation of Antimicrobial Stewardship Programs (ASPs) and their perceived level of success at Makkah region hospitals, Kingdom of Saudi Arabia

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

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