Department of Accreditation, Healthcare Accreditation Council, Amman, Jordan.
Department of Chemical and Pharmaceutical Sciences, School of Life Sciences, Pharmacy and Chemistry, Kingston University London, Kingston upon Thames, United Kingdom.
Front Public Health. 2023 May 30;11:1078596. doi: 10.3389/fpubh.2023.1078596. eCollection 2023.
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.
为了应对抗菌药物耐药性问题，世界卫生组织（WHO）敦促中低收入国家（LMICs）的医疗机构实施抗菌药物管理（AMS）计划的核心要素。作为回应，约旦采取了行动，于 2017 年制定了国家抗菌药物耐药行动计划（NAP），并在所有医疗机构启动了 AMS 计划。评估实施 AMS 计划的努力，并了解在中低收入国家（LMICs）背景下实施可持续和有效的计划所面临的挑战至关重要。因此，本研究旨在评估约旦公立医院在启动该计划 4 年后对 WHO 有效 AMS 计划核心要素的遵守情况。
在约旦公立医院进行了一项横断面研究，使用了 WHO 针对 LMICs 的 AMS 计划核心要素。问卷包括 30 个问题，涵盖了该计划的六个核心要素：领导层承诺、问责制和责任、AMS 措施、教育和培训、监测和评估以及报告和反馈。每个问题都采用了 5 点李克特量表。
共有 27 家公立医院参与，响应率为 84.4%。对核心要素的遵守程度从领导层承诺领域的（53%）到 AMS 程序应用（措施）的（72%）不等。根据平均得分，医院的地理位置、规模和专业没有显著差异。作为优先领域出现的最被忽视的核心要素是提供财务支持、协作、获取以及监测和评估。
尽管实施了 4 年并得到政策支持，但当前的结果显示公立医院的 AMS 计划仍存在显著缺陷。AMS 计划的大多数核心要素都低于平均水平，这需要医院领导层的承诺以及约旦相关利益相关者的多方面合作行动。
