Roberti Javier, Alonso Juan Pedro, Ini Natalí, Loudet Cecilia, Cornistein Wanda, Suárez-Anzorena Inés, Guglielmino Marina, Rodríguez Ana Paula, García-Elorrio Ezequiel, Jorro-Barón Facundo, Rodríguez Viviana M
CIESP/CONICET, Buenos Aires, Argentina; Institute for Clinical Effectiveness and Public Health, Buenos Aires, Argentina.
Institute for Clinical Effectiveness and Public Health, Buenos Aires, Argentina; Gino Germani/CONICET, Buenos Aires, Argentina.
Infect Dis Health. 2025 Feb;30(1):28-37. doi: 10.1016/j.idh.2024.08.003. Epub 2024 Sep 20.
Healthcare-associated infections and antibiotic resistance worsen globally. Antibiotic stewardship programs (ASP) aim to optimise infection treatment and curb resistance, yet implementation hurdles persist. This study examined ASP challenges in ICUs.
This study employed a qualitative methodological design to evaluate the implementation process of an antibiotic stewardship program (ASP) in eight intensive care units (ICUs) across Argentina. Thirty-four semi-structured interviews with healthcare workers (HCWs) were conducted. Interviews were analysed guided by Normalisation Process Theory, examining coherence, cognitive participation, collective action, and reflexive monitoring constructs.
Key challenges included insufficient human resources, lack of institutional support, and resistance to change, particularly among staff not initially involved in the study. Despite these challenges, the program saw partial success in improving ICU practices, particularly in antibiotic use and communication across departments. The main strategy implemented in this quality improvement collaborative was the use of improvement cycles, which served as the central component for driving change. However, participation in improvement cycles was inconsistent, and sustainability post-intervention remains uncertain due to workload pressures and the need for continuous education. Concerns about workload and communication barriers persisted. Many participants did not perceive training as a separate component, which led to low engagement. Resistance to change became evident during modifications to clinical guidelines. The intervention had a positive impact on various processes, including communication and record keeping.
This study underscores the persistent challenges in implementing ASPs in healthcare, emphasising the need for enhanced collaboration, workforce capacity building, and evidence-based practices to overcome barriers and optimize antimicrobial use to improve patient outcomes.
医疗保健相关感染和抗生素耐药性在全球范围内日益严重。抗生素管理计划（ASP）旨在优化感染治疗并遏制耐药性，但实施障碍依然存在。本研究调查了重症监护病房（ICU）中抗生素管理计划面临的挑战。
本研究采用定性方法设计，以评估阿根廷八个重症监护病房（ICU）中抗生素管理计划（ASP）的实施过程。对医护人员（HCW）进行了34次半结构化访谈。访谈在规范化过程理论的指导下进行分析，考察连贯性、认知参与、集体行动和反思性监测等构念。
主要挑战包括人力资源不足、缺乏机构支持以及对变革的抵触，尤其是在最初未参与研究的工作人员中。尽管存在这些挑战，该计划在改善ICU实践方面取得了部分成功，特别是在抗生素使用和跨部门沟通方面。在这个质量改进协作中实施的主要策略是使用改进周期，这是推动变革的核心要素。然而，参与改进周期的情况并不一致，由于工作量压力和持续教育的需求，干预后的可持续性仍不确定。对工作量和沟通障碍的担忧依然存在。许多参与者没有将培训视为一个单独的组成部分，这导致参与度较低。在修改临床指南时，对变革产生了明显的抵触情绪。该干预对包括沟通和记录保存在内的各种流程产生了积极影响。
本研究强调了在医疗保健中实施抗生素管理计划时持续存在的挑战，强调需要加强协作、劳动力能力建设和循证实践，以克服障碍并优化抗菌药物使用，从而改善患者预后。
