Antimicrobial Stewardship Education Research Articles

Knowledge, Awareness and Attitude of Pharm.D. Students on Antimicrobial Stewardship: A Report

Antimicrobial Stewardship (AMS) is a strategy to optimize antimicrobials and prevent the emergence of antimicrobial resistance (AMR). Pharm.D. students are future Clinical pharmacists who play a key role in promoting rational use and implementing AMS programs. Only a few studies about their knowledge, awareness and attitude regarding AMS exist. A cross-sectional study was conducted in the middle of December 2023, among Pharm.D. students of different academic years from three Pharmacy colleges and Pharm.D. graduates in South India. The survey was conducted online using a validated questionnaire and Pharm.D. students audited the results under the guidance of an Infectious disease specialist. The survey comprised 17 questions covering demographic information, AMS knowledge, attitude and awareness questionnaires. This study included a total of 190 respondents. However, only 32.11% reported having participated in any AMS activity during their period of pharmacy education. Pharm.D. students have a positive attitude (72.48%) and optimal awareness (65.13%) but they lack sufficient knowledge (45.19%) towards AMS, specifically regarding surgical prophylaxis and antibiotic allergy testing. It serves as a valuable resource for educators, policymakers and stakeholders involved in shaping the curricula of Pharm.D. programs to enhance the training and preparedness of students in AMS practices. In the future, AMS education programs should target not only clinicians but also Pharm.D. students and interns.

Eliciting Clinician Perspectives on Asymptomatic Bacteriuria to Identify Targets for Antimicrobial Stewardship Education and Decision Support.

The aim of this study was to elicit clinicians' perspectives to help reduce antibiotic prescribing for asymptomatic bacteriuria and improve a patient-centered educational brochure for older adults with urinary tract infections or asymptomatic bacteriuria. Between October 2023 and April 2024, we conducted semi-structured qualitative interviews of clinicians who treat patients aged ≥65 years for urinary tract infections or bacteria in the urine, at infectious disease clinics, community senior living facilities, memory care clinics, and general practice. We developed an interview guide based on a behavior change framework and thematically analyzed written transcripts of audio-recorded interviews using inductive and deductive coding techniques. We identified several common themes surrounding management of asymptomatic bacteriuria from clinicians. These included an emphasis on ordering and interpreting urine tests, tension between guidelines and individual patient care for older adults, use of epidemiologic data to influence prescribing practices, pre-prepared communication talking points, and interest in educational materials for patients and clinical teams. Education about the need for symptoms to supplement urine testing, data about the impact of overuse of antibiotics, and oral and written communication strategies should be addressed to reduce antibiotic prescribing for asymptomatic bacteriuria.

Improving the antibiotic duration of therapy with the implementation of antimicrobial lanyard cards and education in a regional hospital

AbstractBackgroundThere is increasing evidence to support reducing antibiotic duration of therapy (DoT). The Therapeutic Guidelines: Antibiotic (version 16 [TG]) have been updated accordingly. However, these recommendations are not consistently followed.AimThe project aimed to reduce antibiotic DoT for common infections using antimicrobial lanyard cards and education.MethodA retrospective pre‐ and post‐implementation audit was undertaken to examine whether antimicrobial stewardship education and lanyard cards defined DoT per infection and severity in accordance with the TG improved antibiotic DoT for common respiratory, urinary, abdominal, and skin infections. Cards were distributed to doctors and pharmacists, with education delivered by an antimicrobial stewardship (AMS) pharmacist. This project was exempt due to the local policy requirements that constitute research by the Darling Downs Hospital and Health Service Human Research Ethics Committee (Reference no: EX/2022/QTDD/86644). The justification for this ethics exemption was as follows: the study conformed with the National Health and Medical Research Council (NHMRC) Ethical considerations in quality assurance and evaluation activities; education was incorporated as part of routine, scheduled sessions ran at Toowoomba hospital and staff were provided with information on the project as part of the education; consent was not required from staff to attend the education nor for using the lanyard cards; the research did not include any assessment of the education program, use of lanyard cards, or involvement of staff.ResultsFor all patients an improvement was found in the percentage of antibiotics prescribed per the TG (55–72%, p = 0.0095). This included statistically significant differences for respiratory (42–89%, p = 0.0002), but not for urinary (87–91%, p = 0.99), skin (58–77%, p = 0.3039), or abdominal infections (48–44%, p = 0.6990). The mean total excess treatment days decreased across all infections from 1.86 to 0.95 days (p = 0.0036, 95% confidence interval = −1.52 to −0.30).ConclusionThe introduction of antibiotic DoT cards, with AMS education, can improve antimicrobial prescribing in line with the TG in a regional hospital.

64 Threshold concepts and implications for antimicrobial stewardship education

64 Threshold concepts and implications for antimicrobial stewardship education

773. The Role of Infectious Diseases Physicians in Postgraduate Antimicrobial Stewardship Education: A Nationwide Questionnaire Survey in Japan

Abstract Background To promote appropriate antimicrobial use, resident physicians’ understanding of antimicrobial stewardship (AS) is essential. While infectious disease (ID) physicians are expected to play a leading role in AS education, data are limited for the impact of ID physicians’ involvement. We aimed to evaluate the impact of direct interaction with ID physicians on resident physicians’ knowledge, perceptions, and attitudes regarding AS. Methods A cross sectional study involving the participants of the Japanese nationwide online examination for resident physicians in January 2023 was performed. The questionnaire with 29 items on their educational background as well as perceptions and attitudes regarding AS were distributed, collected, and analyzed in combination with the examination scores. Results Of 8,438 post-graduate year (PGY) 1 and 2 resident physicians participated in the examination, 4,051 (48.0%) from 577 institutions responded in the present study. A half (54.0%) worked at hospitals with an existing ID department (Table 1). A third (32.7%) did not receive any formal AS education during their residency program whereas 65.2% failed to understand the concept of AS, and 79.2% were less confident in choosing appropriate antimicrobials. Among respondents working at hospitals with an ID department, presence of bedside ID consultation service was associated with enhanced commitment to choosing narrow-spectrum antimicrobials, de-escalation, transition to oral therapy, and compliance of appropriate duration of therapy than ID consultation only based on chart review (49.6% vs. 42.6%, 51.4% vs. 41.6%, 76.3% vs. 66.3%, 66.7% vs. 55.7%, respectively [all of P < 0.05]) (Table 2). Although there was no statistically significant difference in total test scores, respondents who had an ID rotation were more likely to review past antimicrobial exposure and colonization of resistant pathogens and try to choose narrow-spectrum antimicrobials than those who received lectures only (59.3% vs 39.0%, P < 0.001) (Figure). Conclusion Resident physicians’ perceptions and attitudes regarding AS may improve through direct interaction with ID physicians. Our findings underscore the imperative role and value of ID physicians as key educators for future physicians. Disclosures All Authors: No reported disclosures

A qualitative interview study applying the COM-B model to explore how hospital-based trainers implement antimicrobial stewardship education and training in UK hospital-based care

BackgroundAntimicrobial resistance (AMR) is a major global health threat caused by the inappropriate use of antimicrobials in healthcare and other settings. Antimicrobial stewardship (AMS) is a broad multi-component health services intervention that promotes and monitors the judicious use of antimicrobials to preserve their future effectiveness. A main component of AMS is education and training (E&T). However, there are often discrepancies in how such interventions are implemented and delivered in hospital-based care. The aim of this study was to explore the factors influencing the implementation of AMS E&T in UK hospitals.MethodsSemi-structured interviews were carried out with AMS E&T trainers in UK hospitals. The interview schedule was developed using the Capability, Opportunity, Motivation = Behaviour (COM-B) model. Participants were identified via professional networks and social media. Interviews were analysed using inductive thematic analysis, followed by deductive analysis using the COM-B model as a framework.ResultsA total of 34 participants (26 antimicrobial pharmacists, 3 nurses, 1 advanced clinical practitioner, 2 infectious disease consultants, 1 microbiologist and 1 clinical scientist). responsible for designing, implementing and evaluating AMS E&T in UK hospitals (five from Northern Ireland, four from Wales, two from Scotland and 23 from England) took part in virtual interviews. Key themes were: (1) The organisational context, including system-level barriers to AMS included competing organisational targets (Reflective motivation and physical opportunity) and the impact of the COVID-19 pandemic on activity (Physical opportunity); (2) Healthcare professionals’ roles and the wider multi-disciplinary team, such that AMS roles were defined and addressed poorly in E&T (Social opportunity); and (3) The individual perception of the need for AMS E&T in hospital-based care, manifest in a perceived lack of conviction of the wider threat of AMR and the resulting need for AMS E&T (Reflective motivation).ConclusionThis study has identified factors influencing implementation of AMS E&T in UK hospitals and further identified where implemented, AMS E&T did not address real-world challenges. Current AMS E&T needs to be optimised to elicit practice change, with recommendations including training and engaging the wider work-force and drawing upon theoretically-informed intervention development frameworks to inform AMS E&T to better target AMS behaviour change.

Implementation of the national antimicrobial stewardship competencies for UK undergraduate healthcare professional education within undergraduate pharmacy programmes: a survey of UK schools of pharmacy.

Pharmacists play a key role in antimicrobial stewardship (AMS). Consensus-based national AMS competencies for undergraduate healthcare professionals in the UK reflect the increasing emphasis on competency-based healthcare professional education. However, the extent to which these are included within undergraduate pharmacy education programmes in the UK is unknown. To explore which of the AMS competencies are delivered, including when and at which level, within UK undergraduate MPharm programmes. A cross-sectional online questionnaire captured the level of study of the MPharm programme in which each competency was taught, the method of delivery and assessment of AMS education, and examples of student feedback. Ten institutions completed the survey (33% response rate). No institution reported covering all 54 AMS competencies and 5 of these were taught at half or fewer of the institutions. Key gaps were identified around taking samples, communication, outpatient parenteral antimicrobial therapy and surgical prophylaxis. The minimum time dedicated to AMS teaching differed between institutions (range 9-119 h), teaching was generally through didactic methods, and assessment was generally through knowledge recall and objective structured clinical examinations. Feedback from students suggests they find AMS and antimicrobial resistance (AMR) to be complex yet important topics. UK schools of pharmacy should utilize the competency framework to identify gaps in their AMS, AMR and infection teaching. To prepare newly qualified pharmacists to be effective at delivering AMS and prescribing antimicrobials, schools of pharmacy should utilize more simulated environments and clinical placements for education and assessment of AMS.

Skills, Not Just Knowledge: Infectious Diseases Fellows' Recommendations Regarding Antimicrobial Stewardship Training.

Antimicrobial stewardship (AS) is an important topic in infectious diseases (ID) training, yet many ID fellowships lack formal training, and little is known about fellows' learning preferences. We conducted 24 in-depth interviews with ID fellows across the United States during 2018 and 2019 to explore their experiences with and preferences for AS education during fellowship. Interviews were transcribed, deidentified, and analyzed to identify themes. Fellows had variable exposure to AS before and during fellowship, which impacted their knowledge about and attitude toward stewardship as a career; however, all fellows expressed the importance of learning general stewardship principles during fellowship. Some fellows' training included mandatory stewardship lectures and/or rotations, but most fellows felt their primary stewardship learning occurred through informal experiences in the clinical setting, such as holding the antimicrobial approval pager. Fellows expressed a preference for a standardized, structured curriculum that included in-person practical, interactive discussions with multidisciplinary faculty along with the opportunity to practice and apply their skills; however, they emphasized that time needed to be set aside for those educational activities. Although they wanted to learn the evidence and rationale for stewardship recommendations, they especially wanted training in and feedback on how to communicate stewardship recommendations to other health professionals, particularly in the setting of conflict. ID fellows believe that standardized AS curricula should be included in their fellowship training, and they prefer structured, practical, and interactive learning experiences.

Four years after the implementation of antimicrobial stewardship program in Jordan: evaluation of program's core elements.

To combat antimicrobial resistance, the World Health Organization (WHO) urged healthcare organizations in Low- and Middle-Income Countries (LMICs) to implement the core elements of the antimicrobial stewardship (AMS) programs. In response, Jordan took action and developed a national antimicrobial resistance action plan (NAP) in 2017 and commenced the AMS program in all healthcare facilities. It is paramount to evaluate the efforts to implement the AMS programs and understand the challenges of implementing a sustainable and effective program, in Low-Middle Income Country (LMIC) contexts. Therefore, the aim of this study was to appraise the compliance of public hospitals in Jordan to the WHO core elements of effective AMS programs after 4 years of commencement. A cross-sectional study in public hospitals in Jordan, using the WHO AMS program core elements for LMICs was carried out. The questionnaire comprised 30 questions that covered the program's six core elements: leadership commitment, accountability and responsibility, AMS actions, education and training, monitoring, and evaluation, and reporting and feedback. A five-point Likert scale was employed for each question. A total of 27 public hospitals participated, with a response rate of 84.4%. Adherence to core elements ranged from (53%) in the leadership commitment domain to (72%) for AMS procedure application (actions). Based on the mean score, there was no significant difference between hospitals according to location, size, and specialty. The most neglected core elements that emerged as top priority areas were the provision of financial support, collaboration, access, as well as monitoring and evaluation. The current results revealed significant shortcomings in the AMS program in public hospitals despite 4 years of implementation and policy support. Most of the core elements of the AMS program were below average, which requires hospital leadership commitment, and multifaceted collaborative actions from the concerned stakeholders in Jordan.

Is Education Alone Enough to Sustain Improvements of Antimicrobial Stewardship in General Practice in Australia? Results of an Intervention Follow-Up Study.

Sustained behaviour change and practice improvements for the optimal use of antimicrobials remains challenging in primary care. In 2018, a simple antimicrobial stewardship education programme involving guideline recommendations for common infections, antimicrobial audit reports, and local antibiograms resulted in significant improvements in guideline compliance and more appropriate antimicrobial prescribing by GPs. This observational follow-up study aims to examine the sustainability of the positive intervention effect after two years of implementation of the intervention. Practice-based data on all oral antimicrobial prescriptions issued by GPs were collected retrospectively to compare with intervention data and to measure the sustainability of the intervention effect. The data were analysed using a two-sample test of proportions. The primary outcomes included changes in the rate of prescription compliance with the Australian "Therapeutic Guidelines: Antibiotic" and the appropriateness of antimicrobial choice and duration of therapy. Overall, there was a significant decline in guideline compliance, from 58.5 to 36.5% (risk ratio (RR) (95% CI): 0.62 (0.52-0.74)), in the appropriateness of antimicrobial choice, from 92.8 to 72.8% (0.78 (0.73, 0.84)), and in the prescribed duration, from 87.7 to 53.3% (0.61 (0.54, 0.68)) in the intervention follow-up period. In respiratory infections and ear, nose, and throat infections, the rates of guideline compliance and appropriate choice and duration of antimicrobial prescription decreased significantly at p < 0.001. Appropriateness in the duration of antimicrobial therapy also significantly decreased for most antimicrobials. The evidence suggests that a simple and single-occasion antimicrobial stewardship education programme is probably not enough to sustain improvements in the optimal use of antimicrobials by GPs. Future research is needed to validate the results in multiple GP clinics and to examine the effect of sustained education programmes involving infection-specific and antimicrobial-targeted audits and feedback.

1302. Interactive Case-based Antimicrobial Stewardship Education Program to Pharmacists at a Large Community Health System

Abstract Background Education on antimicrobial stewardship (AMS) is one of the several elements outlined by the Center for Disease Control for hospital antibiotic stewardship programs. However, the Infectious Diseases Society of America guideline on implementing antimicrobial stewardship notes that passive education should not be a sole method for training as the effects are often short lived. AMS education strategies beyond didactic lectures and written material distribution are needed. We sought to describe the implementation of an interactive, case-based AMS educational program targeting pharmacists across a multi-hospital community health system licensed for over 1,500 beds. Methods Each month, a custom patient case was drafted by an infectious diseases trained pharmacist to highlight a common AMS principle encountered in practice. These topics were broadly categorized into appropriate empiric antibiotic selection, treatment plan modification, and identification of non-infectious clinical syndromes. A specific question with multiple choice answers was drafted. The case was disseminated to all hospital pharmacists via email using Microsoft Outlook. Pharmacists were prompted to use the voting buttons to select the correct answer (Figure 1). After a week, results of the survey was shared with the entire pharmacist staff along with information on the primary teaching point and detailed explanations for why each answer was correct or incorrect. Example Voting Buttons for Case-Based Education Results A total of eleven AMS cases were disseminated to 88 hospital pharmacists involved with direct patient care. Average number of responses per case was 27 (31%), range 17-41 (19%-47%). Average number of correct responses for each case was 74%, range 26%-100%. The highest rates of correct responses came from cases focusing on empiric antibiotic selection (87%), followed by identification of non-infectious clinical syndromes (73%). The lowest rate of correct responses were found with treatment plan modification cases (65%). Conclusion This case-based AMS education program leveraged existing technology to provide engagement across a large and geographically diverse pharmacist staff, provide opportunity to apply stewardship concepts, and assess staff pharmacist knowledge on general AMS principles. Disclosures Matthew Song, PharmD, BCIDP, Merck: Stocks/Bonds|ObsEva: Stocks/Bonds.

1796. Evaluation of Asymptomatic Bacteriuria in Critical Access Hospitals

Abstract Background The University of Washington Tele-Antimicrobial Stewardship Program (UW-TASP) provides antimicrobial stewardship education and training to rural and critical access hospitals (CAHs) in the United States through collaborative tele-mentoring. In 2021, UW-TASP implemented a pilot stewardship cohort to reduce antibiotic treatment of asymptomatic bacteriuria (ASB). We sought to quantify the overall prevalence of ASB and proportion treated in participating hospitals. Methods Patients undergoing urine testing were identified through local electronic medical records and microbiology data. CAHs adjudicated their own cases and reported demographics, symptoms of urinary tract infection, systemic inflammatory response symptoms (SIRS), location at the time of culture, laboratory results, and antibiotic treatment through a RedCap collection tool. The data form was created and analyzed by UW-TASP faculty. This study was waived by the University of Washington institutional review board. Results Nineteen CAHs in 5 states participated in this pilot. Eight submitted urine analysis and culture data for 417 patients. Seventy-seven percent of patients were female and the median age was 70. The emergency department was the most common culture collection location (274/417, 66%), followed by ambulatory care clinics (111/417, 27%), and nursing facilities (13/417, 3%). SIRS criteria and/or organ dysfunction were present in 149/417 patients (36%). Two hundred sixty patients (62%) had a positive culture with Escherichia coli being the most common implicated organism (167/260, 64%). ASB was identified in 69/260 patients (27%), and antibiotics were prescribed for 53/69 (77%) of those with ASB. Oral antibiotics were prescribed for 311 (75%) patients. Of those, 22% were prescribed a fluoroquinolone. Median treatment duration was 7 days (range, 1-14). Conclusion Although the prevalence of ASB was only 27% among 417 patients, treatment of ASB was high at 77%. High numbers of culture collections from the emergency department and ambulatory care settings identify these locations as future foci for stewardship interventions in CAHs. Low hanging fruit for intervention include reducing unnecessary fluoroquinolone use and reducing duration of antibiotic therapy. Disclosures Chloe Bryson-Cahn, MD, Alaska Airlines: Advisor/Consultant.

1289. A Practical Approach to Antimicrobial Stewardship Education: Engaging Infectious Diseases Trainees in Targeted Outpatient Provider Feedback Program

Abstract Background A 2016 needs assessment survey of infectious diseases (ID) training program directors revealed gaps in ID fellows’ education including the application of antimicrobial stewardship into clinical practice. Direct involvement of ID trainees in inpatient antimicrobial stewardship (AS) activities has previously been described with favorable outcomes and achievement of program goals. Engagement of ID fellows in outpatient (OP) AS activities including targeted provider feedback has not been well described and may provide opportunity for more hands-on OP AS experience for trainees. Methods Our OP AS program developed a 4-week virtual rotation experience for ID fellows to meet organizational needs for AS education during the COVID-19 pandemic. Acute respiratory tract infection (ARI) was chosen as a disease state priority. The expected progression of the ID fellow was as follows: Week 1: Review Core Elements of outpatient AS, regulatory requirements, and disease state priorities; review available stewardship tracking data sources; Week 2: Review facility-level antibiotic use data for a single outpatient clinic, and identify top 3 antibiotic prescribers in the clinic; Week 3: Deliver a virtual outpatient AS presentation to all providers at a single clinic, and create antibiotic report cards (See Figure 1) for top antibiotic prescribers; Week 4: Conduct 15-min targeted provider feedback sessions using antibiotic report cards for top 3 providers. Example Antibiotic Report Card Results Between September 2021-April 2022, three ID fellows completed the OP AS rotation experience. All fellows completed each week of the rotation successfully. Solicitation of feedback from providers receiving targeted feedback sessions (See Figure 2) is ongoing, and a standardized feedback form will be sent to all ID fellows completing the rotation at the end of the academic year to evaluate the program’s success in meeting pre-specified learning objectives. The rate of antibiotic prescribing for uncomplicated acute respiratory tract infection will be re-evaluated post-intervention for providers receiving targeted education. Targeted Provider Feedback Survey Conclusion Direct involvement of ID fellows in OP AS activities may be mutually beneficial for trainees and OP AS programs. A virtual format for AS education and intervention was practical and feasible. Disclosures All Authors: No reported disclosures.

Nursing experiences in antimicrobial optimisation in the intensive care unit: A convergent analysis of a national survey

BackgroundRecent evidence highlights the need for an interdisciplinary approach to antimicrobial stewardship (AMS). Nursing involvement in optimising antimicrobials in the intensive care unit (ICU) remains understudied. ObjectiveThe objective of this study was to explore nurses' perceptions and experiences of antimicrobial optimisation or stewardship in ICUs in Australia. MethodsAn anonymous web-based survey was deployed nationally in early 2021 through two ICU nursing networks. Associations between survey responses were analysed descriptively and by using nonparametric tests (with statistical significance established at p ≤ 0.05). Free-text survey responses underwent qualitative thematic analysis. Interpretation and reporting of quantitative and qualitative data were integrated. ResultsA total of 226 ICU nurses completed the survey. The majority (197/226; 87%) responded that lack of education limits engagement in AMS. Only 13% (30/226) reported the presence of AMS education and training for nurses in their ICUs. Only about half (108/226; 48%) of the nurses were confident to question prescribers when they considered that the antimicrobial prescribed was unnecessary, with nurses in senior roles more likely to do so than nurses providing bedside care (p < 0.05). Gaps in education (including unfamiliarity with AMS roles), noninclusive antimicrobial discussions, moral distress, and potential workload burden were seen as potential barriers/challenges to engagement. ConclusionThe multifactorial barriers identified that inhibit nurses from performing AMS tasks could be addressed by strengthening interprofessional education at all levels and by applying practical AMS interventions that are inclusive for nursing participation. A purposeful culture change that fosters psychological safety and collaborative practice is paramount to supporting nurses in these roles.

A Novel GPPAS Model: Guiding the Implementation of Antimicrobial Stewardship in Primary Care Utilising Collaboration between General Practitioners and Community Pharmacists.

Interprofessional collaboration between general practitioners (GPs) and community pharmacists (CPs) is central to implement antimicrobial stewardship (AMS) programmes in primary care. This study aimed to design a GP/pharmacist antimicrobial stewardship (GPPAS) model for primary care in Australia. An exploratory study design was followed that included seven studies conducted from 2017 to 2021 for the development of the GPPAS model. We generated secondary and primary evidence through a systematic review, a scoping review, a rapid review, nationwide surveys of Australian GPs and CPs including qualitative components, and a pilot study of a GPPAS submodel. All study evidence was synthesised, reviewed, merged, and triangulated to design the prototype GPPAS model using a Systems Engineering Initiative for Patient Safety theoretical framework. The secondary evidence provided effective GPPAS interventions, and the primary evidence identified GP/CP interprofessional issues, challenges, and future needs for implementing GPPAS interventions. The framework of the GPPAS model informed five GPPAS implementation submodels to foster implementation of AMS education program, antimicrobial audits, diagnostic stewardship, delayed prescribing, and routine review of antimicrobial prescriptions, through improved GP–CP collaboration. The GPPAS model could be used globally as a guide for GPs and CPs to collaboratively optimise antimicrobial use in primary care. Implementation studies on the GPPAS model and submodels are required to integrate the GPPAS model into GP/pharmacist interprofessional care models in Australia for improving AMS in routine primary care.

Influences on nurses' engagement in antimicrobial stewardship behaviours: a multi-country survey using the Theoretical Domains Framework

Antimicrobial resistance (AMR) is affected significantly by inappropriate antibiotic use, and is one of the greatest threats to human health. Antimicrobial stewardship (AMS) is a programme of actions promoting responsible use of antimicrobials, and is essential for limiting AMR. Nurses have an important role to play in this context. To investigate the determinants of nurse AMS behaviours and the impact of past training. A cross-sectional multi-country survey design with mixed methods was employed. Participants were 262 nurses {223 female; mean age 44.45 [standard deviation (SD) 10.77] years} of 10 nationalities, with individual survey links sent via professional networks in five countries, alongside Twitter. Nine AMS behaviours and 14 behavioural determinants were assessed quantitatively using the Theoretical Domains Framework (TDF), and mapped to the Capability, Opportunity, Motivation - Behaviour (COM-B) model. Analysis identified differences between nurses with and without AMS training. The influence of coronavirus disease 2019 (COVID-19) on AMS behaviour was investigated qualitatively using free-text data. Nurses performed all nine AMS behaviours, which were significantly higher [t (238) -4.14, P<0.001] among those who had received AMS training [mean 53.15 (SD 7.40)] compared with those who had not received AMS training [mean 48.30 (SD 10.75)]. Nurses who had received AMS training scored significantly higher in all of the TDF domains. The TDF was able to explain 27% of the variance in behaviour, with 'Skills' and 'Behavioural regulation' (e.g. ability to self-monitor and plan) shown to be the most predictive of AMS actions. Both of these domains are situated in the 'Capability' construct of the COM-B model, which can be enhanced with the intervention strategies of education and training. An increase in AMS behaviours was reported since the COVID-19 pandemic, regardless of previous training. Six core themes were linked to AMS: (1) infection prevention and control; (2) antimicrobials and antimicrobial resistance; (3) diagnosis of infection and use of antibiotics; (4) antimicrobial prescribing practice; (5) person-centred care; and (6) interprofessional collaborative practice. Nurse training has a significant beneficial effect on AMS behaviour and its determinants. Nurses who had received AMS training scored higher in all TDF determinants of behaviour compared with those who had not received AMS training, resulting in higher capability, opportunity and motivation to perform AMS behaviour. AMS education and training should be offered to nurses to enhance these factors. Future research should consider the optimal level of training to optimize AMS behaviour, with a focus on developing skills and behavioural regulation.

Development of an Optimal Short Course for Pharmacy Students in Sri Lanka to Enhance the Knowledge of Antimicrobial Resistance

Antimicrobial resistance (AMR) has been identified as one of the greatest threats to human health. Healthcare professionals play a pivotal role in patient care activities, and an understanding of antimicrobial agents and AMR is a critical component of high-quality care. Pharmacists are experts in medicines, and their education and training can directly impact the quality of services they provide to patients. Antimicrobial stewardship (AMS) competencies for pharmacy students have been developed and implemented in the developed world. However, in developing countries like Sri Lanka, there is a gap in the training of pharmacy students in AMS competencies, thereby hindering their ability to be effective in stewardship activities upon graduation.This study presents a protocol that includes learning outcomes and content to explore a national consensus on AMS competencies that will improve knowledge about antibiotics and AMR in pharmacy students in Sri Lanka. The first draft of the proposed curriculum was developed through a literature review, informed by extensive investigations of pharmacy students’ current knowledge and understanding and ensuring suitability in the Sri Lankan context. A process of liaising with academics and stakeholders in Sri Lanka and discussions with academics from developed countries (such as Australia) was used to prepare the final draft. Future consultation and implementation will also seek further input from current and recently graduated pharmacy students in Sri Lanka. The competencies developed will apply to pharmacy undergraduate programs in Sri Lankan universities and for practicing Sri Lankan pharmacists in a continuous professional development program. Once implemented, this protocol will help strengthen AMS education amongst pharmacists in Sri Lanka and ultimately benefit Sri Lankan consumers and assist other health care professionals addressing AMR.

Private practice dentists improve antibiotic use after dental antibiotic stewardship from infectious diseases experts

Background: Dentists prescribe ~25.7 million antibiotic prescriptions annually. Private practice dentists (PPDs) represent 80% of US dentists who need to implement dental antimicrobial stewardship. We conducted a prospective cohort study of PPDs comparing appropriateness of antibiotic use before and after dental AS education. Methods: PPDs were invited to participate in this study. In phase 1 (pre-education), we collected 3 months (June–August 2019) of retrospective antibiotic use data (indication, dose, duration, penicillin allergy history) and number of dental procedures. We also conducted a preliminary survey to assess baseline antimicrobial stewardship knowledge. In phase 2 (education), PPDs attended 4 televideo education sessions (March–May 2021) taught by an infectious disease– antimicrobial stewardship (ID-AS) pharmacist and physician. In phase 3 (posteducation), we prospectively collected 3 months (June–August 2021) of antibiotic use data (as in phase 1), using an online database with ongoing feedback. In phase 4, we conducted antibiotic use audit and feedback to PPDs after the survey, and we solicited recommendations to reach more PPDs. The Student t test was used for statistical analyses. Results: Study participants comprised 15 PPDs: 2 oral maxillofacial surgeons, 6 periodontists, 4 endodontists, and 3 general dentists. Among them, 10 had been in practice &gt;20 years. The presurvey revealed that 14 were unfamiliar with dental antimicrobial stewardship. All prescribed clindamycin (25% for nonpenicillin allergy), and standard antibiotic duration ranged from 5 to 14 days based on dental school training. In phase 3, despite more procedures, overall antibiotic use and duration decreased, and the use of clindamycin, quinolones, and prophylaxis for joint implant patients, also decreased. Appropriate use improved from 22% to 95%. Postsurvey responses on perceived value of antimicrobial stewardship education were 100% positive, with recommendations to make antimicrobial stewardship a required annual continuing education, similar to opioid continuing education. Study participants invited the ID-AS experts to teach an additional 150 PPDs to date via established PPD study clubs to expand dental antimicrobial stewardship across the United States. Conclusions: After learning dental antimicrobial stewardship guidance from ID-AS experts, PPDs rapidly optimized antibiotic prescribing behavior. PPDs identified their established study clubs as a forum to quickly expand dental antimicrobial stewardship training by ID-AS experts throughout the United States.Funding: MERCKDisclosures: None

Coaching ward pharmacists in antimicrobial stewardship: A pilot study

BackgroundWard pharmacists are well-positioned to enhance the activities of hospital antimicrobial stewardship (AMS) programs by reviewing the appropriateness of antimicrobials and making recommendations to prescribers. However, recent studies have identified gaps in ward pharmacists' AMS practice, knowledge, skills, and confidence which suggests education and training programs are needed. Objective(s)To describe, for the first time, an interactive educational activity – coaching in AMS – targeted at ward pharmacists and explore their perceptions of coaching as a mode of delivering education to improve AMS knowledge, skills, confidence, and practice. A secondary objective was to describe the type, frequency, and acceptance of AMS recommendations made by coached pharmacists. MethodsThis was a descriptive pilot study with a qualitative evaluation of pharmacists' perceptions and experiences of coaching. AMS coaching was delivered over 2 months in 2019 to pharmacists providing clinical pharmacy services to general medical and surgical wards. A focus group was conducted one month after the coaching period to elicit pharmacists' perceptions of coaching as a mode of delivering AMS education and how it impacted their AMS knowledge, skills, confidence, and practice. AMS recommendations made by coached pharmacists were prospectively recorded, and the prescriber acceptance rate was determined. ResultsWard pharmacists reported positive experiences with AMS coaching and believed it helped them identify a range of recommendations to improve antimicrobial prescribing and increased their confidence to communicate recommendations to prescribers. Workload issues were identified as the main barrier to implementation. Suggestions were provided to improve coaching implementation feasibility. During coaching, 162 AMS recommendations were identified for a range of antimicrobials, and 69% (113/162) were accepted and implemented. ConclusionsWard pharmacists believed coaching improved their AMS knowledge, skills, confidence, and practice, including their confidence to discuss recommendations with prescribers. These results can assist with the design and evaluation of future hospital-based AMS educational initiatives.

P03 A qualitative exploration of antimicrobial stewardship and resistance education in undergraduate healthcare professional programmes

BackgroundEducation of undergraduate healthcare professionals (HCPs) on antimicrobial stewardship (AMS) and antimicrobial resistance (AMR) is recommended as an important strategy to prepare future HCPs for their roles in these areas.1 There is limited qualitative research investigating the views of clinical and academic staff involved in the teaching of undergraduate HCP students on current AMS/AMR education practices and curricula.ObjectivesTo explore the views and experiences of clinical and academic staff involved in HCP and public health programmes on AMS and AMR education.MethodsA qualitative study using semi-structured interviews was conducted in October to December 2020. The interview participants were purposively sampled to recruit clinical or academic staff involved in education of students on undergraduate HCP programmes (dentistry, medicine, nursing and midwifery, pharmacy) and public health programmes in an Irish university. Participants were asked to outline their views on current teaching and assessment methods, use of AMS competency frameworks and potential areas for improvement. Interview recordings were conducted online, the recordings were transcribed verbatim, and transcripts analysed by thematic analysis. Ethical approval was obtained, and all participants provided written informed consent.ResultsInterviews were conducted with 15 participants (10 female). A range of disciplines were represented as outlined in the methods. The main interview themes included the challenge of balancing curriculum priorities and capacity in HCP programmes, the importance of ensuring student understanding of AMS/AMR principles, and patient centred application of knowledge. Current teaching and assessment methods were found to vary between the HCP programmes with a mix of didactic lectures and workshops, and assessment ranging from written exams and multiple choice questions to observed structured clinical exams. Very few participants reported educating different HCP students together. Participants were asked to review an antimicrobial education competency framework,2 with most participants believing that this would improve the structure of AMS education, ensuring that key learning outcomes would be addressed in the curriculum. The importance of preparing students for interprofessional practice in AMS in the future was identified as a key theme, with participants highlighting the importance of interprofessional education opportunities to foster communication and teamwork skills in AMS at an early stage.ConclusionsThe importance of AMS and AMR education in HCP programmes was reported in this study, however the main challenge is limited curricular space in busy HCP programmes. Education may be improved by aligning AMS education with an appropriate competency framework. Enhancement of undergraduate interprofessional education opportunities, to prepare students for interprofessional AMS in future practice, is recommended.