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

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.

Health care systems administrators perspectives on antimicrobial stewardship and infection prevention and control programs across three healthcare levels: a qualitative study

“…There’s is no formal antimicrobial stewardship in all facilities sampled, the presence of DTC was perceived as a facilitator to starting AMS program. Such finding was reported in Kenya among healthcare professions [ 8 ]. In many low-resource settings, adaptations have been made where it is difficult to have a stand-alone AMS team, similar committee as the IPC or in this case DTC and AMS committees may be merged into one.…”

“…It is imperative that individual healthcare facility takes measures to implement AMS/IPC programs until the expected national input reinforces their effort. Understanding the perspectives of hospital and health managers to AMS is vital towards the establishment of robust and sustainable antimicrobial stewardship programs and the engagement of management in addressing potential blockades to change [ 8 ]. This study sought to describe the perspectives, barriers and facilitators to AMS and IPC programs among health managers and the current state of these programs in the three levels of healthcare facilities in Benin City, Nigeria.…”

The role of medicines and therapeutics committees structure in supporting optimal antibacterial use in hospitals in Uganda: A mixed method study

“…In Nigeria and South Africa, the subcommittees of antimicrobial stewardship committees were found to be the most active, primarily due to concerns surrounding the misuse and abuse of antibacterial agents and the consequent increase in the burden of antibacterial resistance (AMR) within hospital settings [4,9]. Although MTCs facilitate the implementation of antimicrobial stewardship, several studies have questioned their effectiveness in optimising antibacterial use in terms of generating better patient outcomes, improving patient safety and reducing cost and antibacterial resistance, citing the resource-limited settings in which they are often deployed [9,10]. The effectiveness of MTCs was hindered by a multitude of factors, including but not limited to overburdened committee personnel, insufficient financial resources leading to the lack of established standards for medicine selection, conflicting personal and professional interests, inadequate communication and performance evaluation, and unpredictable national directives [11].…”

Exploring Prescription Practices: Insights from an Antimicrobial Stewardship Program at a Tertiary Healthcare Facility, Rwanda

“…However, two initiatives are being initiated at the University Teaching Hospitals of Kigali (CHUK) and another one at the University Teaching Hospitals of Butare (CHUB). A core strategy in successful AMS programs involves engaging prescribers at the point of prescribing antibiotics to promote informed decision making [ 11 , 12 , 13 , 14 ]. Recognizing the growing threat of AMR, King Faisal Hospital (KFH), a prominent healthcare institution in Rwanda, has taken a commendable step by initiating its own AMS program.…”