Paediatric nurses’, children's and parents’ adherence to infection prevention and control and knowledge of antimicrobial stewardship: A systematic review

Abstract

Introduction: Infection prevention and control precautions help to decrease microbial transmission, and through the appropriate use of antibiotics, Antimicrobial Stewardship programs aim to decrease the prevalence and emergence of Antimicrobial Resistance. Methods: A systematic review was undertaken to critically appraise and synthesise evidence for nurses', children's and parents' knowledge and understanding of antimicrobial stewardship, and of infection prevention and control in acute paediatric care settings. The Preferred Reporting Items for Systematic reviews and Meta-Analyses guided the review. Studies were included if they examined the factors that contributed to nurses' adherence to, or consumers' practice in relation to, antimicrobial stewardship and infection prevention and control. Results: Of the 16,957 papers identified, 50 studies conducted in acute paediatric settings met the eligibility criteria, and were included. Most studies were of low methodological quality. Fourteen studies evaluated nurses' knowledge and self-reported adherence to Infection Prevention and Control principles and identified consistent practice gaps by nurses. Six studies evaluating the effectiveness of education programs reported modest improvements in nurses' knowledge and adherence to infection prevention and control. There were 15 studies, that investigated consumers' involvement in infection prevention and control that identified the following themes: Consumer knowledge and attitudes to infection prevention and control and transmissionbased precautions, and parents' willingness to take an active role in infection prevention. Six studies focused on paediatric nurses' role in antimicrobial stewardship, exploring the following themes: (1) nurses' understanding and beliefs of antimicrobial stewardship roles, and (2) barriers to nurses taking a greater role in antimicrobial stewardship. Nine studies explored the role of consumers in antimicrobial stewardship and identified consumers' misconceptions about the benefits and downplayed concerns regarding antibiotic use. Discussion: Although consumers articulated a willingness to be actively involved in infection prevention, observed practice remained lower than that required to consistently prevent infection transmission. Conclusion: These findings highlight a critically important gap in current practice. In relation to optimal use of antimicrobials, although paediatric nurses were involved in supporting antimicrobial stewardship processes and educating consumers, they identified limited antimicrobial stewardship knowledge. Consumers appeared to lack understanding about the benefits of antibiotics and negated concerns regarding antibiotic use.

Nurses' knowledge and implementation of antimicrobial stewardship and infection prevention strategies in acute paediatric settings

“…Nurses in this study had a limited view of what their role was in AMS, they were aware of the traffic light system for managing antibiotics, and some were aware of the hospital AMS team. Despite extensive research indicating that nurses have a key role in multiple AMS activities, several nurses stated that did not have or want a role in reviewing antimicrobial prescribing preferring to focus solely on safe antimicrobial administration [ 4 , 5 ]. The education of parents and patients was however a key priority for nurses.…”

“…Antimicrobial Stewardship (AMS) is a comprehensive, multidisciplinary approach to ensuring that patients receive appropriate and safe antimicrobial treatment [ 2 ]. During the COVID-19 pandemic, nurses were instrumental in managing patients with COVID-19 infection [ 3 ], and the key role nurses perform in infection prevention and management is now well recognised [ 4 ]. In contrast, nurses' contribution to AMS has been under recognised and organisational barriers may inhibit their involvement [ 5 , 6 , 7 , 8 ].…”

Assessing Safety Status of Pediatric Intensive Care Units of Tehran, Iran according to the World Health Organization’s Safety Standards

“… 52 , 53 Legal gaps, management, inadequate equipment were mentioned as other causes of hospital infections in ICUs 54 and lack of understanding of infection prevention. 55 …”

Antimicrobial stewardship program in pediatric medicine

“…Here interventions can include CDSS and direct education through didactics and interviews. In addition, education of patients/families through direct communication, posters, or public resources can also improve their antimicrobial stewardship knowledge, adherence to infection prevention and control, as well as antimicrobial overprescribing by providers 43,44 . In academic settings, regular education of trainees through stewardship‐focused curricula combined with feedback can promote adherence to institutional guidelines with subsequent improvement of antimicrobial use 45 …”