Abstract
ObjectivesTo investigate the drivers for infection management and antimicrobial stewardship (AMS) across high-infection-risk surgical pathways. MethodsA qualitative study—ethnographic observation of clinical practices, patient case studies, and face-to-face interviews with healthcare professionals (HCPs) and patients—was conducted across cardiovascular and thoracic and gastrointestinal surgical pathways in South Africa (SA) and India. Aided by Nvivo 11 software, data were coded and analysed until saturation was reached. The multiple modes of enquiry enabled cross-validation and triangulation of findings. ResultsBetween July 2018 and August 2019, data were gathered from 190 hours of non-participant observations (138 India, 72 SA), interviews with HCPs (44 India, 61 SA), patients (six India, eight SA), and case studies (four India, two SA). Across the surgical pathway, multiple barriers impede effective infection management and AMS. The existing implicit roles of HCPs (including nurses and senior surgeons) are overlooked as interventions target junior doctors, bypassing the opportunity for integrating infection-related care across the surgical team. Critically, the ownership of decisions remains with the operating surgeons, and entrenched hierarchies restrict the inclusion of other HCPs in decision-making. The structural foundations to enable staff to change their behaviours and participate in infection-related surgical care are lacking. ConclusionsIdentifying the implicit existing HCP roles in infection management is critical and will facilitate the development of effective and transparent processes across the surgical team for optimized care. Applying a framework approach that includes nurse leadership, empowering pharmacists and engaging surgical leads, is essential for integrated AMS and infection-related care.
Highlights
Quantitative data demonstrate more broad-spectrum antibiotic use and longer course durations in surgical patients with no evidence of infection [14]. Most of this evidence is from high-income settings; less is known about the processes, behaviours, and drivers for antimicrobial stewardship (AMS) and infection prevention and control (IPC) in surgical specialties in LMICs [15], whereddue to lack of adequate healthcare infrastructure and cost implicationsdpatients may not always have access to healthcare, including surgery [16]
The case studies illustrate the complexity in infection management in the surgical pathway, highlighting the number of healthcare professionals involved in the infection-related decision-making
These case studies demonstrate that infections and antibiotic use remain a risk throughout the patient pathway and are not limited to the surgery itself
Summary
The surgical teams attribute value to different outcomes and risks in relation to patient care: for example, attributing greater priority to infection prevention than to following antimicrobial stewardship (AMS) principles in order to prevent the emergence and spread of AMR in their patient populations [12,13]. Quantitative data demonstrate more broad-spectrum antibiotic use and longer course durations in surgical patients with no evidence of infection [14]. Most of this evidence is from high-income settings; less is known about the processes, behaviours, and drivers for AMS and infection prevention and control (IPC) in surgical specialties in LMICs [15], whereddue to lack of adequate healthcare infrastructure and cost implicationsdpatients may not always have access to healthcare, including surgery [16].
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
