Abstract
BackgroundAntimicrobial resistance is a significant public health concern with the establishment of antimicrobial stewardship in hospitals being increasingly obligatory. Perspectives and insights of health managers on antimicrobial stewardship (AMS), complementary health services and building blocks are imperative towards implementation of robust AMS programs. This study aimed to understand perspectives of hospital managers on AMS and identify areas of management engagement while addressing potential blockades to change.MethodsA cross-sectional, qualitative, multicenter study was conducted in three hospitals in Kenya. Key-informant interviews on perspectives on AMS were administered to hospital managers. Qualitative data was captured using audio tapes and field notes, transcribed and managed using NVivo 12 software. An iterative process was used to develop the thematic framework and updated in two rounds of iteration analysis. Analysis charts for each emergent theme were developed and categorized across all participants.ResultsPerspectives on AMS are described in five thematic categories; Importance of antimicrobial stewardship and the role of medicines and therapeutics committee, availability of antimicrobial formulary and usage surveillance systems, laboratory competency and recommendations for infection prevention and management, educational resources and communications channels available, building blocks and low-lying fruits for Antimicrobial Stewardship Committees. The role of stewardship collaboration in diagnosis and antimicrobial prescription was alluded to with managers indicating a growing rise in occurrence of antimicrobial resistance. There lacked contextualized, hospital specific antimicrobial formulary and adequate laboratory competency. Staff training and communication channels were available in varying capacity across the three hospitals. Building blocks identified include medicines and therapeutics committee, education, and training platforms (Continuous Medical Education and Continuous Professional Development activities) and hospital leadership commitment.ConclusionsThe practice of antimicrobial stewardship is not implemented and well developed as demonstrated by lack of core AMS complementary health services. However, the health managers are aware of the fundamental importance of antimicrobial stewardship programs and the vast benefits of implementation and institutionalization of AMS to hospitals and their clients. The findings underpin the importance of understanding and incorporating perspectives of health managers on existing contextual mechanisms that can be leveraged on to establish robust AMS programs in the fight against antimicrobial resistance.
Highlights
Antimicrobial resistance is a significant public health concern with the establishment of antimicrobial stewardship in hospitals being increasingly obligatory
In Kenya, antimicrobial stewardship (AMS) programs remain underdeveloped coupled with high antibiotic use in hospitals, lack of system-wide monitoring of infection prevention and control measures, and lack of awareness among healthcare workers [4]
This is important because studies have shown that AMS models focusing exclusively on delivering advice on antimicrobial usage rather than incorporating management of existing interpersonal relationships and mechanisms may limit their capacity in optimizing antimicrobial use [7]
Summary
Antimicrobial resistance is a significant public health concern with the establishment of antimicrobial stewardship in hospitals being increasingly obligatory. AMS processes are established in hospitals with introduction of a knowledge base and social structures that sometimes conflict with traditional hierarchies of decision making and consultation [6] This qualitative study, in part, examines the current existing mechanisms of surveillance and monitoring of the use of antimicrobials in these contextual settings and how they can be used as building blocks in the establishment of AMS. This is important because studies have shown that AMS models focusing exclusively on delivering advice on antimicrobial usage rather than incorporating management of existing interpersonal relationships and mechanisms may limit their capacity in optimizing antimicrobial use [7]. Effective implementation of AMS programs will depend on structural, organizational, and cultural contexts identified prior to implementation [9]
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