Attitudes towards antimicrobial stewardship: results from a large private hospital in Australia
Menino O. Cotta A B D , Megan S. Robertson C , Mark Tacey B , Caroline Marshall A B , Karin A. Thursky A , Danny Liew B and Kirsty L. Buising AA Victorian Infectious Diseases Service, Melbourne Health, The Peter Doherty Institute, Parkville, Vic. 3010, Australia.
B Department of Medicine, Royal Melbourne Hospital Campus, University of Melbourne, Parkville, Vic. 3010, Australia.
C Clinical Trials and Research Centre, Epworth HealthCare, Richmond, Vic. 3121, Australia.
D Corresponding author. Email: menino.cotta@unimelb.edu.au
Healthcare Infection 19(3) 89-94 https://doi.org/10.1071/HI14008
Submitted: 4 March 2014 Accepted: 11 April 2014 Published: 28 May 2014
Journal Compilation © Australasian College for Infection Prevention and Control 2014
Abstract
Introduction: An effective hospital-wide antimicrobial stewardship (AMS) program requires engagement with all healthcare professionals involved in antimicrobial use. It is therefore useful to consider attitudes and perceptions among clinical stakeholders in Australian private hospitals before introducing AMS in these facilities. The aim of this study was to describe perceptions and attitudes towards antimicrobial resistance, antimicrobial use, AMS interventions, and willingness to participate.
Methods: A 26-item attitudinal survey was distributed to visiting specialists, nurses and pharmacists at a large (500 bed) private hospital in Australia. Survey questions utilised ‘Yes/No’ responses and a 7-point Likert scale ranging from ‘strongly agree’ to ‘strongly disagree’. Descriptive analyses were performed and Chi-squared tests conducted.
Results: There were a total of 331 respondents (80 physicians, 58 surgeons, 78 anaesthetists, 105 nurses and 10 pharmacists). The response rate was 42% among clinicians, 100% among pharmacists and 13% among nurses. Only half of the respondents were willing to participate in proposed AMS interventions. A larger proportion of respondents believed that antimicrobial resistance was more of a serious problem in other Australian hospitals compared with the surveyed hospital (62% v. 45%, P < 0.001). Fifty-eight percent agreed that improving prescribing at the hospital would reduce antimicrobial resistance. Twenty-nine percent of respondents had previous exposure to AMS, with pharmacists and physicians more likely to have heard of AMS compared with surgeons, anaesthetists and nurses (P = 0.016 and P < 0.001 respectively).
Conclusions: This study highlights the challenge of making antimicrobial resistance a relevant local issue in private hospitals and engaging key health professionals before implementing change.
References
[1] Ansari F, Erntell M, Goossens H, Davey P. The European surveillance of antimicrobial consumption (ESAC) point-prevalence survey of antibacterial use in 20 European hospitals in 2006. Clin Infect Dis 2009; 49 1496–504.| The European surveillance of antimicrobial consumption (ESAC) point-prevalence survey of antibacterial use in 20 European hospitals in 2006.Crossref | GoogleScholarGoogle Scholar | 19842976PubMed |
[2] Hughes JM. Preserving the lifesaving power of antimicrobial agents. JAMA 2011; 305 1027–8.
| Preserving the lifesaving power of antimicrobial agents.Crossref | GoogleScholarGoogle Scholar | 1:CAS:528:DC%2BC3MXjtFWlu7o%3D&md5=5686220307c8c1158408aa55d4ebc242CAS | 21343545PubMed |
[3] Fishman N. Antimicrobial stewardship. Am J Med 2006; 119 S53–61.
| Antimicrobial stewardship.Crossref | GoogleScholarGoogle Scholar | 16735152PubMed |
[4] Price J, Ekleberry A, Grover A, Melendy S, Baddam K, McMahon J, et al Evaluation of clinical practice guidelines on outcome of infection in patients in the surgical intensive care unit. Crit Care Med 1999; 27 2118–24.
| Evaluation of clinical practice guidelines on outcome of infection in patients in the surgical intensive care unit.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BD3c%2FhsVahug%3D%3D&md5=15c2651b33920e8cd1f6d63175386604CAS | 10548192PubMed |
[5] Marrie TJ, Lau CY, Wheeler SL, Wong CJ, Vandervoort MK, Feagan BG. A controlled trial of a critical pathway for treatment of community-acquired pneumonia. JAMA 2000; 283 749–55.
| A controlled trial of a critical pathway for treatment of community-acquired pneumonia.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BD3c7ksFamug%3D%3D&md5=07a340a410bf90b6d6f53d7d0ab53211CAS | 10683053PubMed |
[6] Solomon DH, Van Houten L, Glynn RJ, Baden L, Curtis K, Schrager H, et al Academic detailing to improve use of broad-spectrum antibiotics at an academic medical center. Arch Intern Med 2001; 161 1897–902.
| Academic detailing to improve use of broad-spectrum antibiotics at an academic medical center.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BD3MvotFKiug%3D%3D&md5=23f2aabecfecc7d83e508912420a3573CAS | 11493132PubMed |
[7] Jarvis WR. Preventing the emergence of multidrug-resistant microorganisms through antimicrobial use controls: the complexity of the problem. Infect Control Hosp Epidemiol 1996; 17 490–5.
| Preventing the emergence of multidrug-resistant microorganisms through antimicrobial use controls: the complexity of the problem.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DyaK2s%2FivFakuw%3D%3D&md5=047c6fa0d60f17f17673aa4a23370e76CAS | 8875291PubMed |
[8] Lambert BL, Salmon JW, Stubbings J, Gilomen-Study G, Valuck RJ, Kezlarian K. Factors associated with antibiotic prescribing in a managed care setting: an exploratory investigation. Soc Sci Med 1997; 45 1767–79.
| Factors associated with antibiotic prescribing in a managed care setting: an exploratory investigation.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DyaK1c7gvV2hug%3D%3D&md5=eeb1648255fffdde032ffd92d14e9e0cCAS | 9447627PubMed |
[9] Cabana MD, Rand CS, Powe NR, Wu AW, Wilson MH, Abboud PA, et al Why don’t physicians follow clinical practice guidelines? A framework for improvement. JAMA 1999; 282 1458–65.
| Why don’t physicians follow clinical practice guidelines? A framework for improvement.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BD3c%2FgsVSqtw%3D%3D&md5=8cd5731f9a7ed63ff902006d40170447CAS | 10535437PubMed |
[10] Cooke FJ, Franklin BD, Lawson W, Jacklin A, Holmes A. Multidisciplinary hospital antibiotic stewardship: a West London model. Clin Govern Int J 2004; 9 237–43.
| Multidisciplinary hospital antibiotic stewardship: a West London model.Crossref | GoogleScholarGoogle Scholar |
[11] Neu HC, Howrey SP. Testing the physician’s knowledge of antibiotic use: Self-assessment and learning via videotape. N Engl J Med 1975; 293 1291–5.
| Testing the physician’s knowledge of antibiotic use: Self-assessment and learning via videotape.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DyaE28%2FltFagtA%3D%3D&md5=8e8a29f09ce44c5cec67291d4fc25017CAS | 1186823PubMed |
[12] Paluck E, Katzenstein D, Frankish CJ, Herbert CP, Milner R, Speert D, et al Prescribing practices and attitudes toward giving children antibiotics. Can Fam Physician 2001; 47 521–7.
| 1:STN:280:DC%2BD3M3ivVagtQ%3D%3D&md5=176bbfbe03d34611bb098ff74ae7188dCAS | 11281085PubMed |
[13] Wester CW, Durairaj L, Evans AT, Schwartz DN, Husain S, Martinez E. Antibiotic resistance: a survey of physician perceptions. Arch Intern Med 2002; 162 2210–6.
| Antibiotic resistance: a survey of physician perceptions.Crossref | GoogleScholarGoogle Scholar | 12390064PubMed |
[14] Giblin TB, Sinkowitz-Cochran RL, Harris PL, Jacobs S, Liberatore K, Palfreyman MA, et al Clinicians’ perceptions of the problem of antimicrobial resistance in health care facilities. Arch Intern Med 2004; 164 1662–8.
| Clinicians’ perceptions of the problem of antimicrobial resistance in health care facilities.Crossref | GoogleScholarGoogle Scholar | 15302636PubMed |
[15] Srinivasan A, Song X, Richards A, Sinkowitz-Cochran R, Cardo D, Rand C. A survey of knowledge, attitudes, and beliefs of house staff physicians from various specialties concerning antimicrobial use and resistance. Arch Intern Med 2004; 164 1451–6.
| A survey of knowledge, attitudes, and beliefs of house staff physicians from various specialties concerning antimicrobial use and resistance.Crossref | GoogleScholarGoogle Scholar | 15249355PubMed |
[16] Brinsley KJ, Sinkowitz-Cochran RL, Cardo DM. Assessing motivation for physicians to prevent antimicrobial resistance in hospitalized children using the Health Belief Model as a framework. Am J Infect Control 2005; 33 175–81.
| Assessing motivation for physicians to prevent antimicrobial resistance in hospitalized children using the Health Belief Model as a framework.Crossref | GoogleScholarGoogle Scholar | 15798673PubMed |
[17] Guerra CM, Pereira CA, Neves Neto AR, Cardo DM, Correa L. Physicians’ perceptions, beliefs, attitudes, and knowledge concerning antimicrobial resistance in a Brazilian teaching hospital. Infect Control Hosp Epidemiol 2007; 28 1411–4.
| Physicians’ perceptions, beliefs, attitudes, and knowledge concerning antimicrobial resistance in a Brazilian teaching hospital.Crossref | GoogleScholarGoogle Scholar | 17994525PubMed |
[18] Bannan A, Buono E, McLaws ML, Gottlieb T. A survey of medical staff attitudes to an antibiotic approval and stewardship programme. Intern Med J 2009; 39 662–8.
| A survey of medical staff attitudes to an antibiotic approval and stewardship programme.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BD1Mjgsl2htA%3D%3D&md5=e494f27d770e67b6324cfdc2704f745dCAS | 19383062PubMed |
[19] Pulcini C, Williams F, Molinari N, Davey P, Nathwani D. Junior doctors’ knowledge and perceptions of antibiotic resistance and prescribing: a survey in France and Scotland. Clin Microbiol Infect 2011; 17 80–7.
| Junior doctors’ knowledge and perceptions of antibiotic resistance and prescribing: a survey in France and Scotland.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BC3M%2FislahtQ%3D%3D&md5=d27965e2240bec9b798f28ab9a2e0d29CAS | 20132254PubMed |
[20] Australian Commission on Safety and Quality in Health Care (ACSQHC). National Safety and Quality Health Service Standards. Sydney: ACSQHC, 2011. Available from: http://www.safetyandquality.gov.au/wp-content/uploads/2011/01/NSQHS-Standards-Sept2011.pdf [verified 20 July 2013].
[21] Gee C. The contribution of the Australian Private Hospitals Sector. The Asia Pacific Journal of Health Management 2007; 2 41–6.
[22] James RS, McIntosh KA, Luu SB, Cotta MO, Marshall C, Thursky KA, et al Antimicrobial stewardship in Victorian hospitals: a statewide survey to identify current gaps. Med J Aust 2013; 199 692–5.
| Antimicrobial stewardship in Victorian hospitals: a statewide survey to identify current gaps.Crossref | GoogleScholarGoogle Scholar | 24237101PubMed |
[23] Antibiotic Expert Group. Therapeutic guidelines: antibiotic. Version 14. Melbourne: Therapeutic Guidelines Limited; 2010.
[24] Gillespie E, Rodrigues A, Wright L, Williams N, Stuart RL. Improving antibiotic stewardship by involving nurses. Am J Infect Control 2013; 41 365–7.
| Improving antibiotic stewardship by involving nurses.Crossref | GoogleScholarGoogle Scholar | 23069737PubMed |
