Department of Infection Control and Epidemiology, Amrita Institute of Medical Sciences, Amrita Vishwa Vidyapeetham University, Kochi, Kerala, India.
Division of Infectious Diseases & HIV Medicine, Department of Medicine, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa.
Clin Microbiol Infect. 2021 Oct;27(10):1455-1464. doi: 10.1016/j.cmi.2020.12.013. Epub 2021 Jan 7.
To investigate the drivers for infection management and antimicrobial stewardship (AMS) across high-infection-risk surgical pathways.
A qualitative study-ethnographic observation of clinical practices, patient case studies, and face-to-face interviews with healthcare professionals (HCPs) and patients-was conducted across cardiovascular and thoracic and gastrointestinal surgical pathways in South Africa (SA) and India. Aided by Nvivo 11 software, data were coded and analysed until saturation was reached. The multiple modes of enquiry enabled cross-validation and triangulation of findings.
Between July 2018 and August 2019, data were gathered from 190 hours of non-participant observations (138 India, 72 SA), interviews with HCPs (44 India, 61 SA), patients (six India, eight SA), and case studies (four India, two SA). Across the surgical pathway, multiple barriers impede effective infection management and AMS. The existing implicit roles of HCPs (including nurses and senior surgeons) are overlooked as interventions target junior doctors, bypassing the opportunity for integrating infection-related care across the surgical team. Critically, the ownership of decisions remains with the operating surgeons, and entrenched hierarchies restrict the inclusion of other HCPs in decision-making. The structural foundations to enable staff to change their behaviours and participate in infection-related surgical care are lacking.
Identifying the implicit existing HCP roles in infection management is critical and will facilitate the development of effective and transparent processes across the surgical team for optimized care. Applying a framework approach that includes nurse leadership, empowering pharmacists and engaging surgical leads, is essential for integrated AMS and infection-related care.
调查高感染风险手术路径中感染管理和抗菌药物管理（AMS）的驱动因素。
在南非（SA）和印度进行了一项定性研究——对临床实践、患者病例研究以及与医疗保健专业人员（HCPs）和患者的面对面访谈进行了人种学观察。借助 Nvivo 11 软件，对数据进行编码和分析，直到达到饱和。多种查询方式使研究结果得到了交叉验证和三角验证。
在 2018 年 7 月至 2019 年 8 月期间，从 138 小时的非参与性观察（138 小时在印度，72 小时在南非）、HCPs（44 名在印度，61 名在南非）、患者（6 名在印度，8 名在南非）和病例研究（4 名在印度，2 名在南非）中收集了数据。在整个手术路径中，多种障碍阻碍了有效的感染管理和 AMS。HCPs（包括护士和高级外科医生）的现有隐性角色被忽视了，因为干预措施针对的是初级医生，从而错过了在整个外科团队中整合感染相关护理的机会。至关重要的是，决策的所有权仍然属于手术医生，而根深蒂固的等级制度限制了其他 HCP 参与决策。缺乏使员工能够改变行为并参与感染相关手术护理的结构基础。
确定感染管理中隐性 HCP 角色是至关重要的，这将有助于在整个外科团队中制定有效的、透明的流程，以优化护理。采用包括护士领导、授权药剂师和参与外科领导在内的框架方法，对于整合 AMS 和感染相关护理至关重要。
