Abstract
BackgroundUsing case-vignettes, we assessed the perception of European infection control (IC) specialists regarding the individual and collective risk associated with antimicrobial resistance (AMR) among inpatients.MethodsIn this study, sixteen case-vignettes were developed to simulate hospitalised patient scenarios in the field of AMR and IC. A total of 245 IC specialists working in different hospitals from 15 European countries were contacted, among which 149 agreed to participate in the study. Using an online database, each participant scored five randomly-assigned case-vignettes, regarding the perceived risk associated with six different multidrug resistant organisms (MDRO). The intra-class correlation coefficient (ICC), varying from 0 (poor) to 1 (perfect), was used to assess the agreement for the risk on a 7-point Likert scale. High risk and low/neutral risk scorers were compared regarding their national, organisational and individual characteristics.ResultsBetween January and May 2017, 149 participants scored 655 case-vignettes. The perceptions of the individual (clinical outcome) and collective (spread) risks were consistently lower than other MDRO for extended spectrum beta-lactamase producing Enterobacteriaceae cases and higher for carbapenemase producing Enterobacteriaceae (CPE) cases. Regarding CPE cases, answers were influenced more by the resistance pattern (93%) than for other MDRO. The risk associated with vancomycin resistant Enterococci cases was considered higher for the collective impact than for the individual outcome (63% vs 40%). The intra-country agreement regarding the individual risk was globally poor varying from 0.00 (ICC: 0–0.25) to 0.51 (0.18–0.85). The overall agreement across countries was poor at 0.20 (0.07–0.33). IC specialists working in hospitals preserved from MDROs perceived a higher individual (local, p = 0.01; national, p < 0.01) and collective risk (local and national p < 0.01) than those frequently exposed to bacteraemia. Conversely, IC specialists working in hospitals with a high MDRO clinical burden had a decreased risk perception.ConclusionsThe perception of the risk associated with AMR varied greatly across IC specialists and countries, relying on contextual factors including the epidemiology. IC specialists working in high prevalence areas may underestimate both the individual and collective risks, and might further negatively promote the MDRO spread. These finding highlight the need to shape local and national control strategies according to risk perceptions and contextual factors.
Highlights
The burden of antimicrobial resistance (AMR) is highly heterogeneous across European countries [1]
Strategies may rely on variable organisations from coercive systems to governance based, the latter relies on the willingness of healthcare professionals to comply with best practices [7]
Population and location of the study This study involved infection control (IC) specialists involved in the prevention of AMR in hospitals from 15 European countries (Austria, Finland, France, Greece, Germany, Hungary, Ireland, Israel, Netherland, Portugal, Serbia, Spain, Turkey, United Kingdom and Ukraine)
Summary
The burden of antimicrobial resistance (AMR) is highly heterogeneous across European countries [1] The control of this phenomenon requires global and coordinated actions to prevent the spread of multidrug-resistant organisms (MDRO) [2]. Despite this urgent need, strategies for dealing with a common issue seem to be highly variable across neighbouring countries, regions and hospitals [3, 4]. Strategies may rely on variable organisations from coercive systems to governance based, the latter relies on the willingness of healthcare professionals to comply with best practices [7] Personal determinants, such as knowledge, belief, attitude and behaviours are closely linked to the cultural, local and organisational contexts in which decisions are made [8, 9]. Using case-vignettes, we assessed the perception of European infection control (IC) specialists regarding the individual and collective risk associated with antimicrobial resistance (AMR) among inpatients
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