GCU-led antimicrobial stewardship research has global impact

Potentially policy changing research, led by GCU’s SHLS Associate Dean Research Professor Kay Currie, which looked into the barriers and enablers of effective antimicrobial stewardship (AMS) within hospitals, has been hailed as having global impact in the fight against antibiotic resistance.

The paper, entitled ‘Mechanisms affecting the implementation of a national antimicrobial stewardship programme; multi-professional perspectives explained using normalisation process theory’, has been published in Antimicrobial Resistance & Infection Control journal.

Lead study author Professor Currie and co-authors Dr Val Ness and Lucy Gozdzielewska, from GCU’s Safeguarding through Infection Prevention (SHIP) research team, were delighted with these rave reviewer comments on their research paper.

“The manuscript is well written, unique and of utmost importance in the field of infectious diseases as it describes in details some of the measures needed in order to curb antimicrobial resistance which is a global threat to public health.

“This is a significant piece of work and it will help in the development of strategies in various regions in the world as we are trying to update and develop the interim guidelines to try and maintain AMS during the COVID-19 pandemic.”

Antimicrobial resistance is a major global public health threat because no new antibiotics are being developed and the ones we have are becoming less effective due to overuse. There are international guidelines around how antibiotics should be prescribed and used.

In Scotland, there is a national co-ordinated programme of antimicrobial stewardship that promotes the appropriate use of antimicrobials, including antibiotics; improves patient outcomes; reduces microbial resistance; and decreases the spread of infections caused by multidrug-resistant organisms.

Professor Currie explains why the research is so important: “Our results are of international significance to healthcare policy makers and practitioners seeking to strengthen the sustainable implementation of hospital AMS programmes in comparable contexts.

“There have been a lot of studies and interventions on how GPs should use antibiotics but there has been very little on how effective prescribing can be supported in hospitals. This is the first piece of research that has been done on the sustainable implementation of AMS in hospitals.

“This research did not just look at what doctors do – it looked at what they do within a team of junior to senior doctors within a hospital setting and how those medical hierarchies influence prescribing behaviour. It also looked at as what nurses do or don’t or what clinical pharmacists do or are not able to do to support AMS.”

In collaboration with Scottish Antimicrobial Prescribing Group (SAPG) and funded by Health Protection Scotland (HPS), the research team set up interviews and focus groups through the health boards’ antimicrobial management teams, involving  junior doctors, ward-based nurses and clinical pharmacists in different health board areas across the Scottish NHS.

Professor Currie said: “We asked these frontline practitioners what they knew about the AMS guidelines, what helped them implement the guidelines and what prevents them using the guidelines effectively and we got really rich and interesting data.

“Results indicated that major barriers relate to organisational context and resource availability. AMS had coherence for implementation leads and prescribing doctors; less so for consultants and nurses who may not access training.

“Conflicting priorities made obtaining buy-in from some consultants difficult; limited role perceptions meant few nurses or clinical pharmacists engaged with AMS. Collective individual and team action to implement AMS could be constrained by lack of medical continuity and hierarchical relationships. Reflexive monitoring based on audit results was limited by the capacity of AMS Leads to provide direct feedback to practitioners.”

Dr Andrew Seaton, Consultant in Infectious Diseases and General Medicine, Antimicrobial Management Team Lead NHSGGC, said: “Reducing unnecessary antibiotic prescribing is key to controlling antibiotic resistance and reducing risk of drug resistant infections. This is well known amongst those working in hospitals, however, changing practice has been challenging. This study has identified important factors which might explain slowness/resistance to change (barriers) and some that may support change (enablers). It is crucial that these are now addressed with targeted behaviour change interventions to improve antibiotic prescribing in hospitals.”

The article can be viewed here.

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