Perceptions and attitudes of health professionals on the establishment of an antimicrobial stewardship programme at a tertiary hospital in Gauteng Province
ackground Antibiotic resistance is a global health threat that arises primarily from the inappropriate use of antibiotics. The establishment of antimicrobial stewardship programmes in health care facilities is recommended to curb the misuse of antibiotics. It is important to understand the existing antibiotic prescribing practices and to identify potential barriers and facilitators to the establishment of antimicrobial stewardship programmes at the level of the health care facility in order to implement tailored solutions. Therefore, this study aimed to get an in-depth understanding of the perceptions and attitudes of health professionals on the establishment of an antimicrobial stewardship programme (ASP) in a tertiary hospital in Gauteng province. The study also describes perceived barriers and facilitators regarding the implementation of an ASP at the hospital Methodology An exploratory qualitative study design was used. The study was conducted in a public sector tertiary care academic hospital in Gauteng province. Sixteen face-to-face in-depth interviews were conducted with professional nurses,medical interns, registrars, consultants and pharmacists using a semi-structured interview guide. Thematic analysis was conducted and codes were identified and grouped into major themes and subthemes. Results Both appropriate and inappropriate antibiotic prescribing practices were described in this hospital. Prolonged antibiotic use, inappropriate combinations of antibiotics and antibiotics prescribed for non-infectious conditions such as cardiac failure were some of the inappropriate prescribing practices described. Appropriate practices described were the prescription of antibiotics based on microbiological culture results and clinical criteria. Inappropriateness in the administration of antibiotics by nursing staff was also described and included workaround behaviours such as the administration of antibiotics in a way that differs from what was prescribed such as through an incorrect route and for an incorrect duration. Drivers of antibiotic prescribing included health care worker knowledge, the fear of poor patient outcomes, laboratory delays, staff shortages, availability of antibiotics and the antibiotic prescribing culture. Patient demand was not cited as a driver of antibiotic prescribing in this study. There was a widespread perception that the composition of an antimicrobial stewardship committee should consist of a multidisciplinary team which is in keeping with local and international recommendations. The categories of health care workers that were nominated include specialist physicians, infectious diseases specialists, infection prevention and control practitioners, registrars, interns, professional nurses, pharmacists and hospital management. The interventions proposed for the ASP include prospective audit with intervention and feedback, education on antibiotic prescribing through bedside teaching, formal lectures and guidelines. Perceived barriers to ASP implementation include lack of resources, namely human resources, drugs and information technology systems, poor communication and resistance to change. Perceived facilitators were the existence of experts in AMS, managerial support of the ASP, a willingness to learn and the availability of diagnostic facilities such as imaging and microbiology laboratories. Conclusion The establishment of an ASP is welcomed by the health professionals in this hospital. This study has explored their perceptions and attitudes with regards to the establishment of an ASP and identified barriers and facilitators that can inform the implementation of the ASP in this hospital.
A research report submitted in partial fulfillment of the requirements for the degree of Master of Public Health (MPH) in the School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, 2020