Antimicrobial stewardship in residential aged care facilities: need and readiness assessment

BMC Infectious Diseases

David CM Kong³  Caroline Marshall⁶  Anton Y Peleg⁴  Allen C Cheng⁴  Noleen Bennett⁷  N Deborah Friedman⁵  Kirsty L Buising¹  Rhonda L Stuart²  Megan Kwong⁸  Ching Jou Lim³ 

[1] Department of Infectious Diseases, St Vincent’s Hospital, Fitzroy, VIC, Australia;Department of Medicine, Monash University, Clayton, VIC, Australia;Centre for Medicine Use and Safety, Monash University, 381 Royal Parade, Parkville, VIC 3052, Australia;Department of Infectious Diseases, Alfred Health, Melbourne, VIC, Australia;Department of Infectious Diseases, Barwon Health, Geelong, VIC, Australia;Victorian Infectious Diseases Service, Royal Melbourne Hospital, Parkville, VIC, Australia;Victorian Healthcare Associated Infection Surveillance System Co-ordinating Centre, North Melbourne, VIC, Australia;Department of Medicine, University of Melbourne, Royal Melbourne Hospital, 4th Floor, Clinical Sciences Building, Royal Parade, Parkville, VIC 3050, Australia

关键词: Qualitative research;    Residential care;    Antimicrobial stewardship;    Antibiotic resistance;    Antibiotic prescribing;   

Others  :  1127288
DOI  :  10.1186/1471-2334-14-410

 received in 2014-05-06, accepted in 2014-07-15,  发布年份 2014

【 摘 要 】

Background

Information about the feasibility, barriers and facilitators of antimicrobial stewardship (AMS) in residential aged care facilities (RACFs) has been scant. Exploring the prevailing perceptions and attitudes of key healthcare providers towards antibiotic prescribing behaviour, antibiotic resistance and AMS in the RACF setting is imperative to guide AMS interventions.

Methods

Semi-structured interviews and focus groups were conducted with key RACF healthcare providers until saturation of themes occurred. Participants were recruited using purposive and snowball sampling. The framework approach was applied for data analysis.

Results

A total of 40 nurses, 15 general practitioners (GPs) and 6 pharmacists from 12 RACFs were recruited. Five major themes emerged; perceptions of current antibiotic prescribing behaviour, perceptions of antibiotic resistance, attitude towards and understanding of AMS, perceived barriers to and facilitators of AMS implementation, and feasible AMS interventions. A higher proportion of GPs and pharmacists compared with nurses felt there was over-prescribing of antibiotics in the RACF setting. Antibiotic resistance was generally perceived as an issue for infection control rather than impacting clinical decisions. All key stakeholders were supportive of AMS implementation in RACFs; however, they recognized barriers related to workload and logistical issues. A range of practical AMS interventions were identified, with nursing-based education, aged-care specific antibiotic guidelines and regular antibiotic surveillance deemed most useful and feasible.

Conclusions

Areas of antibiotic over-prescribing have been identified from different healthcare providers’ perspectives. However, concern about the clinical impact of antibiotic resistance was generally lacking. Importantly, information gathered about feasibility, barriers and facilitators of various AMS interventions will provide important insights to guide development of AMS programs in the RACF setting.

【 授权许可】

   
2014 Lim et al.; licensee BioMed Central Ltd.

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