ABSTRACT
Antimicrobial resistance (AMR) currently results in 700,000 deaths annually, hence requiring urgent priority both at the national and international levels. Antimicrobial stewardship (AMS) and infection prevention and control (IPC) programmes are proposed to address antimicrobial resistance. The objective of this study was to evaluate these strategies across levels of healthcare.
Fourteen in-depth interviews were conducted among hospital administrators on AMS and IPC programmes. Another study was done among healthcare professionals (HCPs) on their perspective on AMS and IPC, using questionnaires. A retrospective study in three laboratories was conducted to collate microbial culture and susceptibility pattern over the previous 4 years. An educational intervention study was conducted among paediatric caregivers grouped in two of 30 participants. Ethical clearance was sought and obtained, and participants gave verbal consent. Data were analyzed using SPSS (version 22) and Graph pad Instat. p values<0.05 were considered significant.
Results showed that none of the healthcare institutions have a formal AMS programme. Majority of the administrators acknowledged barriers to AMS to include lack of management backing, interprofessional rivalry, and poor laboratories. Only the tertiary institution had a formal IPC programme. Some challenges to IPC across the healthcare institutions are inadequate waste disposal, lack of personal protective equipment and behavioural change among healthcare providers. The tertiary healthcare facility had better IPC and hand hygiene practice compared to the secondary facility with mean score of (30.72 ± 5.979 vs 29.08 ± 5.63 p = 0.1747) and (41.52 ± 5.96 vs 41.07 ± 8.46 p= 0.0009) respectively. Of the 370 participants for the IPC study, 195 (52.7%) had an average score on practice. Nurses had a higher mean score compared to medical doctors on IPC (31.19±4.801/25.60±7.937-p=<0.001) and hand hygiene practice (43.34 ± 4.170 / 39.83 ± 3.673- p =0.001) resectively. Of the 819 isolates from culture test, urine, semen and vagina swab were most represented (50.7%; 16.1%; 13.2%). Multidrug resistance (MDR) was found to be 61.4%. MDR for Ps aeruginosa, E coli, other coliforms and S. aureus were 95.5%, 25.6%, 67.3% and 82.8%, respectively. Total mean score of the sixty participants before and after education on knowledge of infection prevention measure and antimicrobials; and use of antimicrobials were 36.1 ± 6.467 / 46.7 ± 4.027 (p=<0.0001) and 29.82 ± 4.949 / 36.92 ± 3.997 (p=<0.0001), respectively. Total score mean on knowledge of infection prevention measures and antimicrobial use for one-to-one versus group education were 46.7 ± 4.027 / 43.3 ± 6.249 (p=0.022) and 37.9 ± 3.044 / 35.93 ± 4.608 (p=0.039) respectively. In conclusion, there was no AMS programme across all facilities studied, only the tertiary facility had a formal IPC programme. Government involvement and the leadership commitment of hospital executives were prominent barriers. Nurses adhered more to IPC practice than medical doctors. Low sensitivity to commonly used antimicrobials in both SHC and PHC was observed, and has been consistent for the previous 3 years. Many paediatric caregivers had poor knowledge of antimicrobials and their uses, which improved significantly after education. One-to-One education has more impact than group education.
