مجال
التميز
|
تميز دراسي و بحثي
|
|
|
البحوث المنشورة
|
|
البحث (1):
|
|
عنوان البحث:
|
Hospital
Adoption of Antimicrobial Stewardship Programmes in Gulf Cooperation Council
Countries: A Review of Existing Evidence
|
رابط إلى البحث:
|
Click
Here
|
تاريخ النشر:
|
30/07/2018
|
موجز عن البحث:
|
Antimicrobial
resistance is increasing at an alarming rate in The Gulf Cooperation Council
(GCC) due to the over and misuse of antimicrobials. The novel and rare
multi-drug resistant strains can spread globally since the region is a host
to the largest expat population in the world and a pilgrimage destination to
more than 4 million people annually. The adoption of antimicrobial
stewardship programmes could improve the use of antimicrobials and reduce
antimicrobial resistance in the region. However, despite the established
benefits of these interventions, little is known about the level of their
adoption in the region, and the impact of these programmes on antimicrobials
use and resistance. This study aims to review the existing evidence on the
level of adoption of antimicrobial stewardship programmes, the
facilitators/barriers to their adoption and the outcomes of their adoption in
GCC hospitals.
|
|
|
المؤتمرات العلمية:
|
|
المؤتمر (1):
|
|
عنوان المؤتمر:
|
28th European Congress
of Clinical Microbiology and Infectious Diseases
|
تاريخ الإنعقاد:
|
21/04/2018
|
مكان
الإنعقاد:
|
Madrid, Spain
|
طبيعة المشاركة:
|
Poster presentation
|
عنوان المشاركة:
|
Antimicrobial Stewardship Programmes
adoption in Saudi Hospitals: Results of a national survey
|
ملخص المشاركة:
|
Background: Saudi Arabia
hosts around 4 million pilgrims annually, and is home to a large population
of expatriate workers. This heavy international travel, coupled with the
over- and inappropriate use of antimicrobials in hospitals in the region is
causing high rates of antimicrobial resistance including novel and rare
multi-drug resistant strains. The adoption of antimicrobial stewardship
programmes (ASPs) in hospitals can improve the use of antimicrobials and
reduce the emergence of resistance. However, little is known about the level
of adoption of ASPs in the region and the barriers and facilitators affecting
their adoption. This study aims to investigate the level of adoption, and
factors influencing the adoption and implementation of ASPs in Saudi
hospitals at a national level.
Materials/methods: This is a
cross-sectional study by means of a self-administered questionnaire
investigating the level and barriers and facilitators of ASPs adoption in
Saudi hospitals. An online link was sent to all Saudi Ministry of Health
(MOH) hospitals (274 hospitals) through MOH correspondence and social media
platforms such as: official twitter accounts, emails and WhatsApp. Reminders
were sent to hospitals at two weekly intervals. Data analysis included
descriptive, multiple correlation and regression statistics.
Results: A
total of 147 hospitals responded to the survey (53.6% response rate).
Responses came from 214 healthcare workers including 33% from hospital
pharmacists, 26% from pharmacy directors, 8% from infectious diseases (ID)
specialists and 7% from chief executives. Only 26% of the hospitals reported
the adoption of ASPs within their hospitals. However, infection control
practitioners were available in 96% of the hospitals. 82% of respondents
identified the following barriers for implementing an ASP programme: lack of
knowledge/ awareness; lack of expertise and difficulty of the ASP adoption
process. Respondents from mental health hospitals were more reluctant to
adopt ASPs compared to other hospitals.
Conclusions: This study highlights the low levels of ASPs
adoption in Saudi hospitals. Lack of expertise including ID specialists
continues to hinder ASPs adoption in hospitals. Investment in information
technology, educational programmes as well as a clear national antimicrobial
strategy and policy, guided by antibiotic resistance surveillance, is
essential to combat antimicrobial resistance.
|
|
|
المؤتمر (2):
|
|
عنوان المؤتمر:
|
International
Forum on Quality and Safety in Healthcare
|
تاريخ الإنعقاد:
|
27/04/2017
|
مكان
الإنعقاد:
|
London, UK
|
طبيعة المشاركة:
|
Poster presentation
|
عنوان المشاركة:
|
Prevalence,
barriers and facilitators of antimicrobial stewardship programmes in Saudi
hospitals
|
ملخص المشاركة:
|
Background
This
study is part of a PhD degree at the department of Pharmacy, Pharmacology and
Postgraduate medicine at the University of Hertfordshire. Data for the study
was collected from three hospitals within Saudi Arabia (A local hospital, a
regional hospital and a central hospital). Saudi Arabia is among the top
purchases of antibiotics in the world, and the increasing emergence of AR is
likely to put the country on a fast track to the post-antibiotic era. The
implementation of effective ASPs, especially in hospitals, can potentially
reduce the spread of resistance and promote the rational use of antibiotics.
The
aim of this pilot study was to explore characteristics of ASPs in Saudi
hospitals and identify the challenges and potential strategies for effective
implementation of ASPs.
Method
This
study interviewed healthcare workers in Saudi hospitals with the aim to
explore the prevalence, barriers and facilitators for ASP adoption in Saudi
hospitals. The interview schedule was developed following a review of the
literature and discussion among the researcher and supervisory team, as well
as consultation with experts in antimicrobial stewardship programmes. The
team conducting this study included the PhD student and two
supervisors/reviewers. Eighteen healthcare workers (1 Infectious diseases
consultant, 4 Clinical microbiologists, 4 Infection control practitioners, 4
hospital administrators and 5 pharmacists), were interviewed for this study.
Outcome
The
outcomes of this study may help highlight and understand the challenges for adopting
and implementing effective ASPs, which will aid in developing national
guidelines for antimicrobials use and resistance surveillance, and help
establish ASPs a regulatory requirement within Saudi hospitals. The results
of this study will also help feed into the larger national survey exploring
the prevalence and implementation of ASP across the Kingdom of Saudi Arabia.
Conclusion
Lack
of antimicrobial policies and guidelines, weak IT infrastructure and
knowledge and skills of healthcare workers were frequently reported as
barriers to successful implementation of ASPs in Saudi hospitals. The
outcomes of this study identified the reasons for the current lack of
antimicrobial stewardship programmes in Saudi hospitals and explored factors
that compromise their adoption and implementation. It is hoped that these
objectives will support the future appropriate use of antimicrobials and reduce
antimicrobial resistance, thereby maximising patient care and reducing
morbidity, mortality, length of hospital stay, and therefore the overall cost
of health care. Teamwork and cooperation is very important between healthcare
workers in healthcare settings, lack of this can affect the treatment process
and patients outcomes. Also cooperation from healthcare workers with
researchers is important to develop and improve health services and patients
outcomes.
|
|
|
المؤتمر (3):
|
|
عنوان المؤتمر:
|
78th FIP World
Congress of Pharmacy and Pharmaceutical Sciences
|
تاريخ الإنعقاد:
|
2- 6/09/2018
|
مكان
الإنعقاد:
|
Glasgow, Scotland
|
طبيعة المشاركة:
|
Poster presentation
|
عنوان المشاركة:
|
The
adoption of antimicrobial stewardship programmes in ministry of health hospitals
in Saudi Arabia
|
ملخص المشاركة:
|
Background: Antimicrobial
resistance (AR) is a global public health concern undermining efforts to
treat infectious diseases, resulting in increased morbidity and mortality,
and adding avoidable costs to already strained healthcare systems. The
irrational use of antimicrobials, and lack of antimicrobial stewardship
programmes (ASPs) are major contributing factors to AR. Saudi Arabia is among
the top consumers of antibiotics in the world, and the increasing emergence
of AR is likely to put the country on a fast track to the post-antibiotic
era. The implementation of effective ASPs, especially in hospitals, can
potentially reduce the spread of resistance and promote the rational use of
antibiotics.
The
aim of this research was to develop evidence-based recommendations to improve
successful adoption and implementation of ASPs in Saudi MOH hospitals in
order to improve antimicrobial practice and reduce AR.
Materials/methods: Firstly,
semi-structured interviews were conducted in three Saudi MOH hospitals to
explore barriers and facilitators for the adoption and implementation of ASPs
from the perspectives of hospital physicians, pharmacists, microbiologists,
infection control practitioners, hospital management, nurses and MOH leaders.
The findings of this qualitative study informed the development of a national
survey that established the status of ASPs in Saudi MOH hospitals and
identified barriers and facilitators to their successful adoption at national
level.
Secondly, this
research explored the case of one of
the few Saudi hospitals currently adopting ASPs and identified the key issues
at the stages of initiation, adoption decision and implementation of
the ASP in the hospital.
Finally, a
self-administered questionnaire was used to examine patients’ perspectives
regarding antimicrobial use and resistance to evaluate the institutional role
of patient education on antimicrobial use within Saudi hospitals.
Results: Lack of awareness
and knowledge; shortage of expert staff, lack of human and financial
recourses, difficulty in understanding the process of ASPs adoption, lack of
antimicrobial policies and guidelines and weak IT infrastructure were
reported as barriers to successful implementation of ASPs in Saudi hospitals.
Although 96% (141/147) of the hospitals have infection control practitioners
and 53% (78/147) of hospitals have microbiologists, there seems to be
shortage of infectious disease specialists/consultants (26%, 39/147) as well
as antimicrobial pharmacists (33%, 48/147).
ASP implementation
in the hospital was successful due to the availability of expertise
(Infectious diseases specialists, Clinical pharmacists), as well as the
availability of resources (IT system). Accountability, administrative
support, collaboration between staff and reinforcement management were
reported as facilitators for successful implementation of ASP at the
hospital.
Lack of patient
awarness regrading AR issue has been observed, with only 26% of participants (39/150) think that antibiotic
resistance is a problem in Saudi today.
Conclusions: Despite the established benefits of ASPs,
adoption and implementation in Saudi Arabia remains low. The availability of
staff and expertise, accountability, educational programmes, leadership and
administrative support can facilitate the adoption of ASPs in Saudi
hospitals. We argue that understanding the process of
hospital adoption of ASPs, and its facilitators has the potential to increase
their use in the region.
High
authorities should make an action in developing national guidelines for
antimicrobial use and resistance surveillance, and make ASPs a regulatory
requirement in Saudi hospitals and organise regular workshops and campaigns for healthcare personal,
patients and public through different media platforms to reach more audience.
|
|
|
المؤتمر (4):
|
|
عنوان المؤتمر:
|
36th Annual Meeting of the European Society for Paediatric
Infectious Diseases
|
تاريخ الإنعقاد:
|
27/05/2018
|
مكان
الإنعقاد:
|
Malmo, Sweden
|
طبيعة المشاركة:
|
Poster presentation
|
عنوان المشاركة:
|
Patients
Knowledge of and attitudes to antibiotics use in Saudi Hospitals: The
institutional role of patients’ education
|
ملخص المشاركة:
|
Background: Antimicrobial
Stewardship Programmes (ASPs) are well-established initiatives to curb the
inappropriate use of antimicrobials and reduce the
emergence of resistance in healthcare organisations. Although
prescriber-focused, the benefits of ASPs extend to patients through improving
their use of antimicrobials and raising their awareness of antimicrobials
resistance. In that, in addition to addressing prescribing behaviours,
hospitals adopting ASPs should also target patients’ use of antimicrobials.
However, this patients’ outcome is rarely measured in relation to ASPs
adoption. This study aims to assess patients’ knowledge of antimicrobials use
and resistance in an ASP-adopting and a non-adopting hospital to evaluate the
institutional role of patients’ education as part of ASP.
Materials/methods: This is a cross-sectional study by
means of a self-administered patient’s questionnaire in two Saudi hospitals;
a medical city (1500 beds), which is one of the few Saudi hospitals adopting
ASP, and a central hospital (380 beds) which is yet to adopt ASP. Patients’
responses were collected from May to August 2017. Data analysis included
descriptive and correlation statistics.
Results: 176 patients responded to the survey. 62%
of the responses were from the non-ASP adopting hospital. Patients were
mainly 31-40 years of age (46%). We identified a comparable lack of knowledge
of appropriate antimicrobials use in both hospitals such that 68% of
participants agreed to share their antibiotics with
family members, and only 31% of participants believe that antibiotic
resistance can result from not completing the full course of antibiotics.
Further, only 26% of patients think that antibiotic resistance is a problem
in Saudi today, and only 27% believe that their hospital stay improved
their awareness of antibiotic resistance.
Conclusions: Patients awareness of appropriate
antimicrobial use and resistance is low in Saudi hospitals. Successful
adoption of ASPs should ensure that patients are counselled on correct
antimicrobial use, and are aware of their potential contribution to
antimicrobial resistance. Pharmacists can be more involved in patients
counselling to ensure ASPs adoption outcomes are achieved.
|
|
|
المؤتمر (5):
|
|
عنوان المؤتمر:
|
36th Annual Meeting of
the European Society for Paediatric Infectious Diseases
|
تاريخ الإنعقاد:
|
27/05/2018
|
مكان
الإنعقاد:
|
Malmo, Sweden
|
طبيعة المشاركة:
|
Poster presentation
|
عنوان المشاركة:
|
Level,
process and determinants of Antimicrobial Stewardship Programmes adoption in
Ministry of Health Hospitals in Saudi Arabia.
|
ملخص المشاركة:
|
Background: Saudi Arabia is a destination to 4 million
pilgrims annually and a host to a large expatriate population. It is also
among the top consumers of antimicrobials globally, leading to soaring rates of
antimicrobial resistance including rare and novel multi-drug resistant
strains. Antimicrobial stewardship in healthcare facilities in the country
could improve antimicrobials use, and reduce the emergence of resistance
locally and globally. However, reports from the region highlight sporadic
practices of antimicrobial stewardship, and little is known about the factors
affecting ASP adoption in healthcare organisations there. This study aims to
investigate the level, process and impact of ASP adoption in Saudi hospitals,
and provide recommendations to hospitals and policy makers on how barriers to
ASP adoption could be successfully overcome.
Materials/methods: We conducted semi-structured
interviews with healthcare professionals in three Saudi hospitals to explore
their experience of ASP, and the barriers and facilitators to their adoption.
We then developed a questionnaire based on these findings to explore the
levels and factors affecting ASP adoption at a national level. We further
explored the process of ASP adoption in a medical city, which is one of the few Saudi hospitals currently adopting ASPs,
through in-depth interviews and a case study design.
Results: Only 26% of Saudi hospitals report ASP
adoption. Lack of expertise especially infectious diseases (ID) specialists
is a major barrier to adoption; especially since ID consultants drive the
formation of ASP teams and initiate and coordinate the adoption of ASP at
hospital level. ASP adoption significantly reduces inappropriate
antimicrobial use and the associated costs, and reduces resistance rates to
certain microorganism-agent combinations, with a paradoxical increase in
resistance rates to other combinations. In the absence of national
surveillance programmes, the impact of ASP adoption remains unclear.
Conclusions: Despite the established
benefits of ASPs, their adoption in Saudi hospitals remains low. Policy
makers are urged to consider making ASP adoption in hospitals a regulatory
requirement, supported by national guidelines and surveillance programmes.
Healthcare organisations are urged to invest in making available expertise
and training and development programmes if antimicrobial resistance is to be
tackled in the region.
|
|
|
المؤتمر (6):
|
|
عنوان المؤتمر:
|
Federation
of Infection Societies (FIS) Conference (organised by British Society for
Antimicrobial Chemotherapy)
|
تاريخ الإنعقاد:
|
01/12/2017
|
مكان
الإنعقاد:
|
Birmingham, UK
|
طبيعة المشاركة:
|
Poster
presentation
|
عنوان المشاركة:
|
Antimicrobial
Stewardship Programme adoption and implementation process in a Saudi MOH
hospital: a case study
|
ملخص المشاركة:
|
Introduction & Aims
Antimicrobial
stewardship programme (ASP) refers to a multidimensional initiative to curb
the inappropriate prescribing of antimicrobials and reduce antimicrobial
resistance. Despite the widely recognised benefits of (ASPs) in reducing
antimicrobial use, resistance, length of hospital stay, healthcare associated
infections and mortality; issues of their adoption and implementation
persist, particularly in countries where human and material resources are
scarce or absent, and ASP teams are not functioning or non-existent. Saudi
Arabia and other Arab Gulf countries harbour rare and novel resistant strains
and mechanisms including resistance to last-line antibiotic colistin. This
has major implications especially since the region hosts the Hajj, a mass
gathering and a potential source of outbreaks, resistance emergence and
transfer. Adoption and implementation of ASPs and strategies in the region
could reduce the emergence and spread of resistance.
Aim: This
study aims to explore the process and outcomes of adoption and implementation
of ASP in a large Saudi hospital, and identify how adoption barriers were
successfully overcome.
Methodology
We undertook a qualitative case study-based analysis of
KAMC adoption and implementation of ASP in 2016. Data included the following: 5 in-depth interviews with
core members of the ASP at the medical city, including: an infectious disease consultant, a clinical
pharmacist, a clinical microbiologist, an infection control consultant and a
chief executive officer; 16
hours on-site observation; and content analysis of 35 documents of various
types. Analysis was both inductive and deductive, the latter being informed
by the “ the innovation within the healthcare
organizations model (Fleuren, Wiefferink, & Paulussen, 2004)” theoretical framework.
Results & Discussion
The antimicrobials
subcommittee, part of the pharmacy and therapeutic committee sought to establish
ASP in the hospital due to the widespread of antimicrobial misuse and abuse,
and the unprecedented rise of multi-drug resistant strains which resulted in
failure of various surgical procedures and increase in patient deaths. ASP
was developed from 06- to-12/2015, starting with recruitment of ASP team
members, followed by outlining roles and responsibilities, drafting policies,
and piloting ASP strategies such as restriction (pre-authorisation forms) and
audit and feedback interventions. The programme was first trialled in
specific wards where infectious diseases physicians were available/
accessible. Following recruitment of infectious diseases assistants, the
programme was rolled out at a hospital level. KAMC achieved the hoped-for
results of the ASP intervention including reduction of resistance rates
through the increase of Enterobacter spp. isolates
susceptibility to cefepime from 39% to 66%, A.baumanni to
colistin from 69% to 97% and E.coli
to piperacillin/tazobactam from 47% to 77%.
Lack of expert personnel, human, financial
and IT resources as well as hospital management and support are often
reported as barriers to ASP adoption (Cotta et al.,
2015; Pakyz et al., 2014; Trivedi & Rosenberg, 2013). Our findings suggest that ASP
implementation in KAMC was successful due to the availability of expertise
(Infectious diseases specialists, Clinical pharmacists), as well as the
availability of resources (IT system). Accountability, administrative
support, collaboration between staff and reinforcement management were
reported as facilitators for successful implementation of ASP at the
hospital.
Conclusions
Despite the established benefits of
ASPs, adoption and implementation in Saudi Arabia remains low. The
availability of staff and expertise, accountability, educational programmes,
leadership and administrative support can facilitate the adoption of ASPs in
Saudi hospitals. We argue that
understanding the process of hospital adoption of ASPs, and its facilitators
has the potential to increase their use in the region.
|