Evaluating hospital performance in antibiotic stewardship to guide action at national and local levels in a lower-middle income setting.
Evaluating hospital performance in antibiotic stewardship to guide action at national and local levels in a lower-middle income setting.
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DOI：
10.1080/16549716.2020.1761657
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发表时间：
2019-12-13
影响因子：
2.6
通讯作者：
Tosas-Auguet O
中科院分区：
文献类型：
--
作者：
McKnight J;Maina M;Zosi M;Kimemia G;Onyango T;Schultsz C;English M;Tosas-Auguet O
不适当地使用抗生素可能会导致产生抗药性的病原体。确保在所有医疗机构正确使用这些重要药物是至关重要的。然而，不幸的是，关于抗生素在LMIC临床环境中是如何使用的，以及抗生素管理计划在多大程度上到位和有效，人们知之甚少。我们的目标是记录肯尼亚16家医院的所有抗生素管理政策和结构。我们还想检查这些医院中与抗生素相关的实践的背景。我们提出了一系列问题，旨在评估肯尼亚对抗生素管理政策和做法的了解和应用情况。我们使用一组分为四类的17个指标，对全国16家公立医院进行了调查。此外，我们对前线医护人员和医院管理人员进行了31次半结构化访谈，以探索结果的背景和原因。只有一家医院实施了资源配置ABS政策。在所有其他医院，我们的调查小组通常确定以某种方式证明部分或完全控制抗生素使用的结构、资源和过程。定性访谈证实了这一点，这些访谈查明了共同的根本问题。最积极的是，我们发现证据表明，特定学科的临床指南已经被很好地接受，并限制和限制了抗生素的使用。只有一家医院有正式的ABS计划，但许多设施都有现有的结构和资源，可以用来改善抗生素的使用。因此，ABS战略应建立在现有做法的基础上，国家ABS政策应最大限度地利用现有结构来管理抗菌剂的供应和处方。我们的结论是，建立在既定责任、方法和实践基础上的ABS干预措施将比假定需要建立新的ABS机构的干预措施更有效。
Inappropriate use of antibiotics can lead to the development of resistant pathogens. Ensuring proper use of these important drugs in all healthcare facilities is essential. Unfortunately, however, very little is known about how antibiotics are used in LMIC clinical settings, nor to what degree antibiotic stewardship programmes are in place and effective. We aimed to record all Antibiotic Stewardship policies and structures in place in 16 Kenyan hospitals. We also wanted to examine the context of antibiotic-related practices in these hospitals. We generated a set of questions intended to assess the knowledge and application of antibiotic stewardship policies and practices in Kenya. Using a set of 17 indicators grouped into four categories, we surveyed 16 public hospitals across the country. Additionally, we conducted 31semi-structured interviews with frontline healthcare workers and hospital managers to explore the context of, and reasons for, the results. Only one hospital had a resourced ABS policy in place. In all other hospitals, our survey teams commonly identified structures, resources and processes that in some way demonstrated partial or full control of antibiotic usage. This was verified by the qualitative interviews that identified common underlying issues. Most positively, we find evidence discipline-specific clinical guidelines have been well accepted and have conditioned and restricted antibiotic use. Only one hospital had an official ABS programme, but many facilities had existing structures and resources that could be used to improve antibiotic use. Thus, ABS Strategies should be built upon existing practices with national ABS policies taking maximum advantage of existing structures to manage the supply and prescription of antimicrobials. We conclude that ABS interventions that build on established responsibilities, methods and practices would be more efficient than interventions that presume a need to establish new ABS apparatus.
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影响因子：
4
作者：
Chandler, Clare I. R.
通讯作者：
Chandler, Clare I. R.
DOI：
10.1186/s13012-016-0506-3
发表时间：
2016-10-19
期刊：
Implementation science : IS
影响因子：
--
作者：
May CR;Johnson M;Finch T
通讯作者：
Finch T
影响因子：
168.9
作者：
Laxminarayan, Ramanan;Matsoso, Precious;Davies, Sally
通讯作者：
Davies, Sally
影响因子：
4
作者：
English M;Ayieko P;Nyamai R;Were F;Githanga D;Irimu G
通讯作者：
Irimu G
影响因子：
168.9
作者：
Wilson, Michael L.;Fleming, Kenneth A.;Ru, Kun
通讯作者：
Ru, Kun