Online Course Improves Nurses’ Knowledge of Antimicrobial Stewardship

Abstract

Nurses who completed an online training course in antimicrobial stewardship showed increased knowledge about infections in long-term care residents and understanding of the nursing staff’s role in infection control, a small study has found. “Online education targeting nurses and their role in antimicrobial stewardship could be a useful and practical component of comprehensive antimicrobial stewardship programs in nursing homes,” according to study author Robin L.P. Jump, MD, PhD, an assistant professor of medicine in the division of infectious diseases and HIV medicine at Case Western Reserve University, and her coauthors [Am J Infect Control, Feb 8, 2017; doi:10.1016/j.ajic.2017.01.002]. For the study, a free online course covering the fundamentals of antimicrobial stewardship was completed by 103 nurses. The course takers were nearly all women, two-thirds of whom were registered nurses; the rest were largely licensed practicing nurses. Nearly two-thirds worked at community-based nursing home facilities, and well over half had been in the field for more than 10 years. The course comprised six modules, 30 minutes each, covering essential topics in antimicrobial stewardship in long-term care settings: igns and symptoms of infection in older adults; differentiating urinary tract infections from asymptomatic bacteriuria; recognition and evaluation of upper respiratory tract infections, bronchitis, and pneumonia; appropriate application of transmission-based precautions; proper collection of samples for microbiologic culture; and improving communication with providers using SBAR (Situation, Background, Assessment, and Recommendation). The surveys before and after the course of the participants’ attitudes, beliefs, and knowledge showed they gained confidence in various subjects, particularly how to differentiate urinary tract infections from asymptomatic bacteriuria, and upper respiratory tract infections, bronchitis, and pneumonia. In addition, the mean survey scores on the nurses’ understanding of how their attitudes and interactions with residents and residents’ families directly affected antimicrobial stewardship increased significantly after the course’s completion. Whether a nurse knew the baseline status of a resident and that resident’s antibiotic exposure rose in importance to the course takers, according to the surveys: from a Likert scale score of 3.8 out of 5 to 4.5 for both items. Most respondents supported the strategy of “watchful waiting” to avoid antibiotic prescribing; scores remained constant at 4.1 out of 5. Also unchanged across the pre-course and post-course surveys was the idea that “only vulnerable people acquire multidrug resistant pathogens,” which remained constant at 20 out of 5. The number of correctly answered knowledge-assessment survey questions increased from 75% (9.0 of 12 questions) to 86% (10.4 of 12 questions) across the course takers, especially around recognizing fever in older adults and in catheter-associated urinary tract infection prevention. A knowledge gap persisted, however, about how to properly collect samples for a microbiologic culture. Dr. Jump and her colleagues wrote that as regulatory pressures mount for improved antibiotic stewardship, “nurses will likely become integral members of multidisciplinary antimicrobial stewardship teams. Antimicrobial stewardship–focused education may increase nurses’ confidence, empower them to help effect changes necessary to reduce unnecessary antibiotic prescriptions, and improve the overall care and safety of nursing home residents.” Helen Jones is a NJ-based freelance writer.