确定并应对南非14家新生儿病房实施抗菌药物管理的背景驱动因素。
Defining and responding to the contextual drivers for implementation of antimicrobial stewardship in 14 neonatal units in South Africa.
作者信息
Van Den Bergh Dena, Charani Esmita, Dramowski Angela, Annor Ama Sakoa, Gijzelaar Michelle, Messina Angeliki, Van Jaarsveld Andriette, Goff Debra A, Prusakov Pavel, Balfour Liezl, Bekker Adrie, Cassim Azraa, Govender Nelesh P, Holgate Sandi L, Kolman Sonya, Tootla Hafsah, Schellack Natalie, Reddy Kessendri, Fisher Christine, Conradie Lucinda, Van Niekerk Anika, Laubscher Anje, Alexander Pearl, Naidoo Thanusha, Dippenaar Magdel, Bamford Colleen, Brits Sharnel, Chirwa Pinky, Erasmus Hannelie, Ekermans Pieter, Rungen Lerina, Kriel Teresa, Mawela Dini, Mjekula Simthembile, Nchabeleng Maphoshane, Nhari Ronald, Janse Van Rensburg Marli, Sánchez Pablo J, Brink Adrian
机构信息
Division of Infectious Diseases and HIV Medicine, Department of Medicine, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa.
Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.
出版信息
JAC Antimicrob Resist. 2025 Jan 27;7(1):dlae222. doi: 10.1093/jacamr/dlae222. eCollection 2025 Feb.
BACKGROUND
Research on the contextual drivers of antimicrobial stewardship (AMS) programme interventions in neonatal units is limited.
METHODS
As part of a prospective mixed-methods multidisciplinary neonatal AMS (NeoAMS) interventional study in 14 South African hospitals, we applied a three-phased process to assess implementation barriers and contextual drivers experienced by participating health professionals. The study included: (Phase one; P1) a survey of pre-intervention barriers and enablers; (P2) written feedback during the study intervention phase; and (P3) semi-structured exit interviews.
RESULTS
Respondents to the P1 survey ( = 100) identified 15 barriers, 9 in the domain of personnel resources, including staffing, time and workload constraints. Other barriers related to limited access to antimicrobial use and surveillance trends, complexity of neonatal care, absence of multidisciplinary team (MDT) AMS and change resistance. For P2, written feedback during implementation ( = 42) confirmed that the MDT approach facilitated systems changes, including policy adaptations, process improvements, strengthened infection control practices, and expansion of AMS MDT roles. MDT benefits were described as aligned team purpose, improved communication, and knowledge sharing. Reported challenges included time to meet and building trust. In P3 interviews ( = 42), improved interpersonal communication, trust, personal growth and confidence building were cited as highlights of working in multidisciplinary AMS teams. Extending the MDT approach to other hospitals, training more health professionals in AMS and increasing management involvement were identified as priorities going forward.
CONCLUSIONS
Understanding the organizational and interprofessional context for NeoAMS implementation enabled an MDT approach to develop and optimize neonatal AMS with potential for adoption in similar resource-constrained settings.
背景
关于新生儿病房抗菌药物管理（AMS）项目干预措施的背景驱动因素的研究有限。
方法
作为在南非14家医院开展的一项前瞻性多方法多学科新生儿AMS（NeoAMS）干预性研究的一部分，我们采用了一个三阶段流程来评估参与研究的卫生专业人员所经历的实施障碍和背景驱动因素。该研究包括：（第一阶段；P1）对干预前障碍和促进因素的调查；（P2）研究干预阶段的书面反馈；以及（P3）半结构化的退出访谈。
结果
P1调查的受访者（n = 100）确定了15个障碍，其中9个在人力资源领域，包括人员配备、时间和工作量限制。其他障碍与获取抗菌药物使用和监测趋势的机会有限、新生儿护理的复杂性、缺乏多学科团队（MDT）AMS以及变革阻力有关。对于P2，实施期间的书面反馈（n = 42）证实，MDT方法促进了系统变革，包括政策调整、流程改进、强化感染控制措施以及扩大AMS MDT的作用。MDT的好处被描述为团队目标一致、沟通改善和知识共享。报告的挑战包括开会时间和建立信任。在P3访谈（n = 42）中，人际沟通改善、信任、个人成长和信心建立被视为在多学科AMS团队中工作的亮点。将MDT方法推广到其他医院、对更多卫生专业人员进行AMS培训以及增加管理层的参与被确定为未来的优先事项。
结论
了解NeoAMS实施的组织和跨专业背景有助于采用MDT方法来开发和优化新生儿AMS，并有可能在类似资源受限的环境中采用。
Zotero 插件