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Antimicrobial Stewardship Program Implementation in a Saudi Medical City: An Exploratory Case Study.

ABSTRACT: Antimicrobial stewardship programs (ASPs) in hospitals have long been shown to improve antimicrobials' use and reduce the rates of antimicrobial resistance. However, their implementation in hospitals, especially in developing countries such as Saudi Arabia, remains low. One of the main barriers to implementation is the lack of knowledge of how to implement them. This study aims to explore how an antimicrobial stewardship programme was implemented in a Saudi hospital, the challenges faced and how they were overcome, and the program outcomes. A key stakeholder case study design was used, involving in-depth semi-structured interviews with the core members of the ASP team and analysis of 35 ASP hospital documents. ASP implementation followed a top-down approach and involved an initial preparatory phase and an implementation phase, requiring substantial infectious diseases and clinical pharmacy input throughout. Top management support was key to the successful implementation. ASP implementation reduced rates of multi-drug resistance and prescription of broad-spectrum antimicrobials. The implementation of ASPs in hospital is administrator rather than clinician driven. Outsourcing expertise and resources may help hospitals address the initial implementation challenges.

SUBMITTER: Alghamdi S

PROVIDER: S-EPMC8000012 | biostudies-literature | 2021 Mar

REPOSITORIES: biostudies-literature

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Antimicrobial Stewardship Program Implementation in a Saudi Medical City: An Exploratory Case Study.

Alghamdi Saleh S Berrou Ilhem I Bajnaid Eshtyag E Aslanpour Zoe Z Haseeb Abdul A Hammad Mohamed Anwar MA Shebl Nada N

Antibiotics (Basel, Switzerland) 20210309 3

Antimicrobial stewardship programs (ASPs) in hospitals have long been shown to improve antimicrobials' use and reduce the rates of antimicrobial resistance. However, their implementation in hospitals, especially in developing countries such as Saudi Arabia, remains low. One of the main barriers to implementation is the lack of knowledge of how to implement them. This study aims to explore how an antimicrobial stewardship programme was implemented in a Saudi hospital, the challenges faced and how ...[more]

PMID: 33803325

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Project description:IntroductionOne of the main causes of illness, mortality, and rising medical costs is antimicrobial resistance, which is a global healthcare concern.ObjectivesThis study explores the practice of physicians toward the effective implementation of Antibiotic Stewardship Programs (ASPs) in Najran city, Saudi Arabia.MethodologyThis cross-sectional study was conducted among physicians working at primary care setting in Najran city, Saudi Arabia, between May and August 2023. A self-administered questionnaire was distributed among the physicians composed of three parts: socio-demographic data, a questionnaire about physicians' practice in the efficacy of ASP, and a questionnaire about physicians' practice regarding prescribing antibiotics.ResultsOf the 128 physicians who participated in the study, 60.2% were males, and 43.8% were aged between 36 and 45 years. Among the practices in implementing the ASP effectively, controlling the source of infection domain received the highest score (mean score: 4.83). Every practice domain mean score was greater than 3, indicating that study participants possessed a moderate level of ASP practice and implementation skills. The overall mean practice score in the effective implementation of ASP was 154.9 ± 25.5 out of 185 points, with good, moderate, and poor practices constituting 67.2%, 28.1%, and 4.7%, respectively.ConclusionsThe physicians showed a moderate level of practice for the effective implementation of ASPs in Najran city. The factors significantly associated with increased practice score include older age, male gender, Saudi nationality, handling five or fewer infection cases daily, and infection-initiated antibiotic prescribing treatment managed per day. These findings suggest the need for targeted interventions and educational programs to enhance physicians' adherence to ASP guidelines and promote appropriate antibiotic prescribing practices, ultimately contributing to global efforts in combating antimicrobial resistance and improving patient outcomes.

Project description:Background: Antimicrobial stewardship programs (ASPs) are collaborative efforts to optimize antimicrobial use in healthcare institutions through evidence-based quality improvement strategies. With regard to critically ill patients, appropriate antimicrobial usage is of significance, and any delay in therapy increases their risk of mortality. Therefore, the implementation of structured multidisciplinary ASPs in critical care settings is of the utmost importance to promote the judicious use of antimicrobials. Methods: This quasi-experimental study evaluating a multidisciplinary ASP in a 20-bed critical care setting was conducted from January 1, 2016 to July 31, 2017. Outcomes were compared nine months before and after ASP implementation. The national antimicrobial stewardship toolkit by Ministry of health was reviewed and the hospital antibiotic prescribing policy was accordingly modified. The antimicrobial stewardship algorithm (Start Smart and Then Focus) and an ASP toolkit were distributed to all intensive care unit staff. Prospective audit and feedback, in addition to prescribing forms for common infectious diseases and education, were the primary antimicrobial strategies. Results: We found that the mean total monthly antimicrobial consumption measured as defined daily dose per 100 bed days was reduced by 25% (742.86 vs. 555.33; p = 0.110) compared to 7% in the control condition (tracer medications) (35.35 vs. 38.10; p = 0.735). Interestingly, there was a negative impact on cost in the post-intervention phase. Interestingly, the use of intravenous ceftriaxone measured as defined daily dose per 100 bed days was decreased by 82% (94.32 vs. 16.68; p = 0.008), whereas oral levofloxacin use was increased by 84% (26.75 vs. 172.29; p = 0.008) in the intensive care unit. Conclusion: Overall, involvement of higher administration in multidisciplinary ASP committees, daily audit and feedback by clinical pharmacists and physicians with infectious disease training, continuous educational activities about antimicrobial use and resistance, use of local antimicrobial prescribing guidelines based on up-to-date antibiogram, and support from the intensive care team can optimize antibiotic use in Saudi healthcare institutions.

Project description:BackgroundExisting evidence underscores inappropriate antimicrobial prescribing and use in the community setting. Increased and inappropriate antimicrobial use are major factors contributing to the emergence and transmission of antimicrobial resistance (AMR). Antimicrobial stewardship (AMS) programmes are critical for mitigating AMR, enhancing patient outcomes, and reducing healthcare costs. Despite the existing Australian National Action Plan on AMR, optimisation of antimicrobial use in the community setting remains inadequately investigated. This study explored health professionals' perspectives on community AMS practices and systems, identifying challenges and areas for improvement.MethodsThis qualitative study utilised semi-structured interviews to explore the perspectives of 17 different health professionals from diverse community practice settings in South-East Queensland, Australia. Interviews were audio-recorded, anonymised, and transcribed verbatim. Data were thematically analysed, with NVivo 12 utilised for organisation and analysis. Data were then mapped and examined using the Elements of Medicines Stewardship (EMS), which aligns with United States Centers for Disease Control and Prevention- Core Elements of Antibiotic Stewardship. This was reported following the consolidated criteria for reporting qualitative research checklist.ResultsFour main themes described the health professionals' insights on community AMS practices and systems. Thematic analysis from these findings reveals a state of ambiguity and fragmentation in the community AMS practices and systems. In comparison to the hospital-based AMS system, the Australian community AMS system appears to be in its nascent stages of development. Applying the EMS is essential for developing and implementing community AMS strategies to enhance practices and systems.ConclusionThe study identified key health system factors that impact the implementation of community AMS programmes and highlighted the need for developing community-specific governance and frameworks that integrate multidisciplinary strategies to support effective implementation and enhance patient outcomes. This research will inform community AMS intervention strategies, influencing policy and practice to advance sustainable healthcare and address antimicrobial resistance.

Project description:Objectives To combat antimicrobial resistance, the World Health Organization (WHO) urged healthcare organizations in Low- and Middle-Income Countries (LMICs) to implement the core elements of the antimicrobial stewardship (AMS) programs. In response, Jordan took action and developed a national antimicrobial resistance action plan (NAP) in 2017 and commenced the AMS program in all healthcare facilities. It is paramount to evaluate the efforts to implement the AMS programs and understand the challenges of implementing a sustainable and effective program, in Low-Middle Income Country (LMIC) contexts. Therefore, the aim of this study was to appraise the compliance of public hospitals in Jordan to the WHO core elements of effective AMS programs after 4 years of commencement. Methods A cross-sectional study in public hospitals in Jordan, using the WHO AMS program core elements for LMICs was carried out. The questionnaire comprised 30 questions that covered the program’s six core elements: leadership commitment, accountability and responsibility, AMS actions, education and training, monitoring, and evaluation, and reporting and feedback. A five-point Likert scale was employed for each question. Results A total of 27 public hospitals participated, with a response rate of 84.4%. Adherence to core elements ranged from (53%) in the leadership commitment domain to (72%) for AMS procedure application (actions). Based on the mean score, there was no significant difference between hospitals according to location, size, and specialty. The most neglected core elements that emerged as top priority areas were the provision of financial support, collaboration, access, as well as monitoring and evaluation. Conclusion The current results revealed significant shortcomings in the AMS program in public hospitals despite 4 years of implementation and policy support. Most of the core elements of the AMS program were below average, which requires hospital leadership commitment, and multifaceted collaborative actions from the concerned stakeholders in Jordan.

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Antimicrobial Stewardship Program Implementation in a Saudi Medical City: An Exploratory Case Study.

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Antimicrobial Stewardship Program Implementation in a Saudi Medical City: An Exploratory Case Study.

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