Antimicrobial stewardship: attitudes, perceptions, and practices of healthcare workers in a pediatric tertiary hospital
Angelina C Bernardo | Jay Ron O Padua
Discipline: medicine by specialism
Abstract:
OBJECTIVES: This study aims to determine the healthcare workers’ (HCWs) attitudes,
perceptions, and practices regarding Antimicrobial Stewardship (AMS) at the Philippine Children's
Medical Center (PCMC).
MATERIALS AND METHODS: This cross-sectional study employed a validated online survey.
RESULTS: The study included 288 healthcare workers, predominantly female (77.35% ) and
aged 31-40 years (47.74%), with physicians being the largest professional group (57.14%). HCWs
had positive attitudes toward AMS. They perceived moderate to high antimicrobial resistance
(AMR) levels in different contexts but believed the hospital had lower AMR levels than the
country. HCWs agreed that AMR impacts antimicrobial choices, patient outcomes, and safety.
Contributors to AMR were prescribing inappropriate antimicrobials, unnecessary prescriptions,
poor patient adherence, and inadequate infection control measures. HCWs, except medical
technologists, were aware of the Antimicrobial Stewardship Program (ASP) and its interventions.
Only nurses and pharmacists were aware of the hospital policies against AMR. Barriers to AMS
implementation include inadequate training in antimicrobial use, lack of infectious disease/
microbiology services, lack of electronic medication management services, and personnel shortages.
HCWs had high self-reported AMS practices, but a practice gap in single-dose surgical antibiotic
prophylaxis was identified, with low physician adherence (50.6%).
CONCLUSION: This study revealed positive attitudes and high self-reported AMS practices
among HCWs. They also perceived moderate to high AMR in different contexts but believed that
the hospital has lower AMR levels than the country. Addressing the identified barriers to
implementation and practice gaps is crucial for achieving antimicrobial stewardship goals.
References:
- Antimicrobial Resistance Collaborators. Global burden of bacterial antimicrobial resistance in 2019: a systematic analysis. Lancet. 2022 Feb 12;399(10325):629-655. doi: 10.1016/S0140-6736(21)02724-0. Epub 2022 Jan 19. Erratum in: Lancet. 2022 Oct 1;400(10358):1102. doi: 10.1016/S0140-6736(21)02653-2. PMID: 35065702; PMCID: PMC8841637.
- Department of Health. Antimicrobial stewardship program in hospitals: Manual of procedures. 2016.
- World Health Organization [Internet]. Antimicrobial stewardship programmes in healthcare facilities in low- and middle-income countries: a WHO practical toolkit. Geneva: World Health Organization; 2019 [cited 2023 Nov 13]. Available from: https://apps.who.int/iris/handle/10665/329404. License: CC BY-NC-SA 3.0 IGO.
- Philippine Children’s Medical Center (PCMC). Antimicrobial stewardship (AMS) program: PCMC’s institutional manual of antimicrobial stewardship program. 2022.
- Abbas S, Lee K, Pakyz A, Markley D, Cooper K, Vanhoozer G, Doll M, Bearman G, Stevens MP. Knowledge, attitudes, and practices of bedside nursing staff regarding antibiotic stewardship: A cross-sectional study. Am J Infect Control. 2019 Mar;47(3):230-233. doi: 10.1016/j.ajic.2018.09.008. Epub 2018 Nov 22. PMID: 30471970.
- Ourghanlian C, Lapidus N, Antignac M, Fernandez C, Dumartin C, Hindlet P. Pharmacists’ role in antimicrobial stewardship and relationship with antibiotic consumption in hospitals: An observational multicentre study. J Glob Antimicrob Resist. 2020 Mar;20:131-134. doi: 10.1016/j.jgar.2019.07.009. Epub 2019 Jul 16. PMID: 31323427.
- Centers for Disease Control and Prevention [Internet]. Core elements of hospital antibiotic stewardship programs. Atlanta: The Centers for Disease Control and Prevention; [cited 2023 Nov 13]. Available from: https://www.cdc.gov/antibiotic-use/ healthcare/pdfs/core-elements.pdf.
- Trikha S, Dalpath SK, Sharma M, Shafiq N. 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. J Family Med Prim Care. 2020;9:3937-43.
- Wushouer H, Wang Z, Tian Y, Zhou Y, Zhu D, Vuillermin D, Shi L, Guan X. The impact of physicians’ knowledge on outpatient antibiotic use: Evidence from China’s county hospitals. Medicine (Baltimore). 2020 Jan;99(3):e18852. doi: 10.1097/MD.0000000000018852. PMID: 32011504; PMCID: PMC7220442.
- Pagcatipunan MR, Halili S Jr, Arciaga RS, Makalinaw SR, Gonzales ML, Garcia RD, Aguirre C, Ong-Lim AL, Luna I, Gallardo E, Lim J, Aguilar D, Pererras N. Antimicrobial stewardship (AMS) program in private hospitals in the Philippines: Its acceptability, barriers, and enablers. Pediatric Infectious Disease Society of the Philippines Journal. 2020 Jul-Dec;21(2):24-38.
- Diño PET, Aquino SS, Depante DDM, Peña IG. Determination of the enablers and challenges in the implementation of pharmacy-based antimicrobial stewardship (AMS) program in a level 3 hospital in Manila. Acta Med Philipp. [Online ahead of print] Published online July 25, 2023. Available from: https://actamedicaphilippina.upm.edu.ph/index.php/acta/article/view/6658
- Kimbowa IM, Eriksen J, Nakafeero M, Obua C, Lundborg CS, Kalyango J, Ocan M. Antimicrobial stewardship: Attitudes and practices of healthcare providers in selected health facilities in Uganda. PLoS One. 2022 Feb 3;17(2):e0262993. doi: 10.1371/journal.pone.0262993. PMID: 35113932; PMCID: PMC8812957.
- Scheepers LN, Niesing CM, Bester P. Facilitators and barriers to implementing antimicrobial stewardship programs in public South African hospitals. Antimicrob Steward Healthc Epidemiol. 2023 Feb 23;3(1):e34. doi: 10.1017/ash.2022.355. PMID: 36865702; PMCID: PMC9972532.
- Ashraf S, Ashraf S, Ashraf M, Imran MA, Choudhary ZA, Hafsa HT, Awais AB, Kalsoom L, Farooq I, Habib Z, Ashraf S, Iqbal QUA, Ghufran M, Sherazi SSH, Akram MK, Akmal R, Rafique S, Nawaz K, Safdar Z, Siddique UN, Hassan M, Arshad S, Virk AR, Ashraf M, Saboor QA, Humayun A, Izhar M. Knowledge, attitude, and practice of clinicians about antimicrobial stewardship and resistance among hospitals of Pakistan: a multicenter cross-sectional study. Environ Sci Pollut Res Int. 2022 Feb;29(6):8382-8392. doi: 10.1007/s11356-021-16178-2. Epub 2021 Sep 6. PMID: 34490566; PMCID: PMC8421064.
- Kjærsgaard M, Leth RA, Udupi A, Ank N. Antibiotic stewardship based on education: minor impact on knowledge, perception and attitude. Infect Dis (Lond). 2019 Oct;51(10):753-763. doi: 10.1080/23744235.2019.1648856. Epub 2019 Aug 7. PMID: 31389732.
- Tahoon MA, Khalil MM, Hammad E, Morad WS, Awad SM, Ezzat S. The effect of educational intervention on healthcare providers’ knowledge, attitude, and practice towards antimicrobial stewardship program at National Liver Institute, Egypt. Egypt Liver J. 2020;10(5):[page range if available]. doi:10.1186/s43066-019-0016-5
- Charani E, Castro-Sanchez E, Sevdalis N, Kyratsis Y, Drumright L, Shah N, Holmes A. Understanding the determinants of antimicrobial prescribing within hospitals: The role of “prescribing etiquette”. Clin Infect Dis. 2013 Jul 15;57(2):188–196. doi:10.1093/cid/cit212
- Setiawan E, Cotta MO, Abdul-Aziz MH, Sosilya H, Widjanarko D, Wardhani DK, Roberts JA. Indonesian healthcare providers’ perceptions and attitude on antimicrobial resistance, prescription and stewardship programs. Future Microbiol. 2022 Mar;17:363-375. doi: 10.2217/fmb-2021-0193. Epub 2022 Feb 25. PMID: 35212232.
- García C, Llamocca LP, García K, Jiménez A, Samalvides F, Gotuzzo E, Jacobs J. Knowledge, attitudes and practice survey about antimicrobial resistance and prescribing among physicians in a hospital setting in Lima, Peru. BMC Clin Pharmacol. 2011 Nov 15;11:18. doi: 10.1186/1472-6904-11-18. PMID: 22085536; PMCID: PMC3231801.
- Zhao W, Xu Y, Liu R, Zhao T, Ning Y, Feng Y, Kang H, Li S, Han X, Shang L. Knowledge, attitudes, and practices of bedside nurses regarding antimicrobial stewardship in China: An explanatory sequential mixed methods study. J Nurs Manag. 2023. doi:10.1155/2023/9059920.
- van Gulik N, Hutchinson A, Considine J, Driscoll A, Malathum K, Botti M. Perceived roles and barriers to nurses’ engagement in antimicrobial stewardship: A Thai qualitative case study. Infect Dis Health. 2021 Aug;26(3):218-227. doi: 10.1016/j.idh.2021.04.003. Epub 2021 May 11. PMID: 33994163.
- Friedman ND, Temkin E, Carmeli Y. The negative impact of antibiotic resistance. Clin Microbiol Infect. 2016 May;22(5):416-22. doi: 10.1016/j.cmi.2015.12.002. Epub 2015 Dec 17. PMID: 26706614.
- Balliram R, Sibanda W, Essack SY. The knowledge, attitudes and practices of doctors, pharmacists and nurses on antimicrobials, antimicrobial resistance and antimicrobial stewardship in South Africa. S Afr J Infect Dis. 2021 Apr 21;36(1):262. doi: 10.4102/sajid.v36i1.262. PMID: 34485504; PMCID: PMC8378097.
- Burger M, Fourie J, Loots D, Mnisi T, Schellack N, Bezuidenhout S, Meyer JC. Knowledge and perceptions of antimicrobial stewardship concepts among final year pharmacy students in pharmacy schools across South Africa. S Afr J Infect Dis. 2016;31(3):84–90. doi:10.1080/23120053.2016.1192808
- Abera B, Kibret M, Mulu W. Knowledge and beliefs on antimicrobial resistance among physicians and nurses in hospitals in Amhara Region, Ethiopia. BMC Pharmacol Toxicol. 2014;15:26. doi:10.1186/2050-6511-15-26
- Baraka MA, Alsultan H, Alsalman T, Alaithan H, Islam MA, Alasseri AA. Health care providers’ perceptions regarding antimicrobial stewardship programs (AMS) implementation-facilitators and challenges: a cross-sectional study in the Eastern province of Saudi Arabia. Ann Clin Microbiol Antimicrob. 2019 Sep 24;18(1):26. doi: 10.1186/s12941-019-0325-x. PMID: 31551088; PMCID: PMC6760054.
- Khanal S, Acharya U, Trotter A, Tripathi P, Koirala S, Pahari B, Acharya S. Challenges and opportunities in the implementation of an antimicrobial stewardship program in Nepal. Antimicrob Steward Healthc Epidemiol. 2023;3(1):E58. doi:10.1017/ash.2022.359.
- Hawn MT, Knowlton LM. Balancing the Risks and Benefits of Surgical Prophylaxis: Timing and Duration Do Matter. JAMA Surg. 2019 Jul 1;154(7):598-599. doi: 10.1001/jamasurg.2019.0570. PMID: 31017641.
- Fowotade A, Fasuyi T, Aigbovo O, Versporten A, Adekanmbi O, Akinyemi O, Goossens H, Kehinde A, Oduyebo O. Point Prevalence Survey of Antimicrobial Prescribing in a Nigerian Hospital: Findings and Implications on Antimicrobial Resistance. West Afr J Med. 2020 Jul-Aug;37(3):216-220. PMID: 32476113.
- Global point prevalence survey for antimicrobial consumption and resistance report 2022-P3 for Philippine Children’s Medical Center. [Unpublished report].
- de Guzman Betito G, Pauwels I, Versporten A, Goossens H, De Los Reyes MR, Gler MT. Implementation of a multidisciplinary antimicrobial stewardship programme in a Philippine tertiary care hospital: an evaluation by repeated point prevalence surveys. J Glob Antimicrob Resist. 2021 Sep;26:157-165. doi: 10.1016/j.jgar.2021.05.009. Epub 2021 Jun 10. PMID: 34118483.
- Boyles TH, Whitelaw A, Bamford C, Moodley M, Bonorchis K, Morris V, Rawoot N, Naicker V, Lusakiewicz I, Black J, Stead D, Lesosky M, Raubenheimer P, Dlamini S, Mendelson M. Antibiotic stewardship ward rounds and a dedicated prescription chart reduce antibiotic consumption and pharmacy costs without affecting inpatient mortality or re-admission rates. PLoS One. 2013 Dec 9;8(12):e79747. doi: 10.1371/journal.pone.0079747. PMID: 24348995; PMCID: PMC3857167.
ISSN 2704-3665 (Online)
ISSN 0117-3774 (Print)