Tackling antimicrobial resistance: developing and implementing antimicrobial stewardship interventions in four African commonwealth countries through a health partnership model.

In recent years, health partnerships have shared infection prevention and control innovations between United Kingdom hospitals and Low-Middle-Income Countries. However, none had focused on antimicrobial stewardship (AMS), a core component of tackling antimicrobial resistance (AMR). This paper documents an effective approach to developing a program to increase AMS capacity in four African countries: Ghana, Tanzania, Uganda, and Zambia as part of the Commonwealth Partnerships for Antimicrobial Stewardship (CwPAMS) program. A systematic approach was applied to assess gaps in AMS interventions and inform the development of the CwPAMS program through deskbased assessments, including National Action Plans on AMR, online focus group meetings, and expert advisory group reviews. Twelve partnerships were selected for the CwPAMS program. AMS support tools were developed based on recommendations from the scoping, including an AMS checklist tool, a healthcare worker knowledge and attitudes questionnaire, and an antimicrobial prescribing app to support clinical decision-making. Training workshops on AMS were developed and delivered to volunteers in Africa and the UK using a train-the-trainer model. The tools and workshops facilitated capacity building for AMS through the generation and strengthening of knowledge, skills, commitment, structures, systems, and leadership among stakeholders in the UK and Africa. The overall average rating assigned to the program following independent evaluation using the Organisation for Economic Cooperation and Development Assistance Committee Evaluation Criteria was very good. The evaluation also highlighted that the majority of the HPs (75%) focused on AMS and/or improved prescribing practice; all HPs have developed and implemented AMS strategies, guidelines, and tools within their hospitals; and NHS staff were able to translate the knowledge and skills they had received early on in the program into clinical practice in response to COVID-19 challenges.

Development and Implementation of an Antimicrobial Stewardship Checklist in Sub-Saharan Africa: A Co-Creation Consensus Approach.

Antimicrobial stewardship (AMS) initiatives promote the responsible use of antimicrobials in healthcare settings as a key measure to curb the global threat of antimicrobial resistance (AMR). Defining the core elements of AMS is essential for developing and evaluating comprehensive AMS programmes. This project used co-creation and Delphi consensus procedures to adapt and extend the existing published international AMS checklist. The overall objective was to arrive at a contextualised checklist of core AMS elements and key behaviours for use within healthcare settings in Sub-Saharan Africa, as well as to implement the checklist in health institutions in four African countries. The AMS checklist tool was developed using a modified Delphi approach to achieve local expert consensus on the items to be included on the checklist. Fourteen healthcare/public health professionals from Tanzania, Zambia, Uganda, Ghana and the UK were invited to review, score and comment on items from a published global AMS checklist. Following their feedback, 8 items were rephrased, and 25 new items were added to the checklist. The final AMS checklist tool was deployed across 19 healthcare sites and used to assess AMS programmes before and after an AMS intervention in 14 of the 19 sites. The final tool comprised 54 items. Across the 14 sites, the completed checklists consistently showed improvements for all the AMS components following the intervention. The greatest improvements observed were the presence of formal multidisciplinary AMS structures (79%) and the execution of a point-prevalence survey (72%). The elements with the least improvement were access to laboratory/imaging services (7%) and the presence of adequate financial support for AMS (14%). In addition to capturing the quantitative and qualitative changes associated with the AMS intervention, project evaluation suggested that administering the AMS checklist made unique contributions to ongoing AMS activities. Furthermore, 29 additional AMS activities were reported as a direct result of the prompting checklist questions. Contextualised, co-created AMS tools are necessary for managing antimicrobial use across healthcare settings and increasing local AMS ownership and commitment. This study led to the development of a new AMS checklist, which proved successful in capturing AMS improvements in Tanzania, Zambia, Uganda, and Ghana. The tool also made unique contributions to furthering local AMS efforts. This study extends the existing AMS materials for low- and middle-income countries and provides empirical evidence for successful use in practice.

A global study on job and career satisfaction of early-career pharmacists and pharmaceutical scientists.

Background: Job and career satisfaction of early-career pharmacists and pharmaceutical scientists is imperative to ensure a motivated and effective workforce, and a secure future for pharmacy practice. In turn, this enables planning, deployment and long term implementation of global imperatives, through universal pharmacy coverage. Objectives: This study used data from a global survey to determine the level of job and career satisfaction and identify factors that are most significant in determining satisfaction in early-career professionals. Methods: A cross-sectional survey was distributed to members of the International Pharmaceutical Federation (FIP) Young Pharmacists Group (YPG) via email and social media platforms from November 2019 to May 2020. A previously validated questionnaire using 5-point Likert scales was used. Data were analysed by exploratory factor analysis, using principal component analysis, oblique rotation, and reliability testing of identified components, followed by a comparative statistical analysis. Results: A total of 1014 respondents from 92 countries participated in this study. Regions of domicile significantly affected job satisfaction (p = 0.004) and career satisfaction (p < 0.0001) scores. Pharmacists working in community pharmacies perceived lower job satisfaction measures compared to those who work in academic institutions (p < 0.0001) and industry sector (p = 0.012). There is a negative association between career expectations and job satisfaction and career satisfaction scores. The workplace climate is related to education and training opportunities, lower reported workloads, greater autonomy, and more remuneration. Conclusion: This was an international study of early-career pharmacists and pharmaceutical scientists. Enhancing factors associated with job and career satisfaction is essential to support early-career pharmacists and pharmaceutical scientists in obtaining fulfilment and esteem in their chosen careers. Developing and implementing a well-framed system that provides a conducive working environment, remuneration, and greater autonomy could improve job and career satisfaction. This study provides evidence to support investment in early-career training, stated in the FIP Development Goal 2.

Comparing the effectiveness of hand hygiene techniques in reducing the microbial load and covering hand surfaces in healthcare workers: Updated systematic review.

BACKGROUND: This review, commissioned by the World Health Organization (WHO), examined the effectiveness of the WHO 6-step hand hygiene (HH) technique in reducing microbial load on hands and covering hand surfaces, and compared its effectiveness to other techniques. METHODS: Medline, CINAHL, ProQuest, Web of Science, Mednar, and Google Scholar were searched for primary studies, published in English (1978-February 2021), evaluating the microbiological effectiveness or hand surface coverage of HH techniques in healthcare workers. Reviewers independently performed quality assessment using Cochrane tools. The protocol for the narrative review was registered (PROSPERO 2021: CRD42021236138). RESULTS: Nine studies were included. Evidence demonstrated that the WHO technique reduced microbial load on hands. One study found the WHO technique more effective than the 3-step technique (P = .02), while another found no difference between these 2 techniques (P = .08). An adapted 3-step technique was more effective than the WHO technique in laboratory settings (P = .021), but not in clinical practice (P = .629). One study demonstrated that an adapted 6-step technique was more effective than the WHO technique (P = .001). Evidence was heterogeneous in application time, product, and volume. All studies were high risk of bias. CONCLUSIONS: Eight studies found that the WHO 6-step technique reduced microbial load on healthcare workers' hands; but the studies were heterogeneous and further research is required to identify the most effective, yet feasible technique.

Clinical pharmacy services provided in public sector hospitals in Nigeria: a national survey.

OBJECTIVES: Studies show that clinical pharmacy services are effective in optimizing medicines use and patients' outcomes. This study aimed to determine the clinical pharmacy services provided in public sector hospitals in Nigeria. METHODS: This was an online survey of 296 primary, secondary and tertiary care hospitals sampled purposively across the 36 States and Federal Capital Territory in Nigeria. Data analysis was conducted descriptively via χ 2 test and multivariate analysis of variance (MANOVA). KEY FINDINGS: Responses were obtained from 272 hospitals in the country with a survey completion rate of 88%. This included 55 tertiary, 72 secondary and 145 primary healthcare centres (PHCs). Pharmacists provided pharmaceutical care services in all the tertiary care hospitals, 94% of the secondary and in only 6% of the PHCs surveyed. Most of the secondary and tertiary care hospitals provided medicines information, patient education and counselling, and in-patient dispensing services [n = 97 (79%), 116 (94%), 88 (72%)], respectively. However, fewer than a third reported involvement in multidisciplinary ward rounds, medication chart review and antibiotic stewardship programmes [n = 18 (15%), 33 (27%), 22 (18%), respectively]. Furthermore, medication error reporting and pharmacovigilance services were each routinely provided in only about half of the secondary and tertiary care hospitals [n = 62 (50%)], and this was not associated with the level of care (P > 0.05). CONCLUSIONS: The findings of this study demonstrate disparity in clinical pharmacy service availability across the various levels of care in Nigeria and emphasize the need to prioritize their integration within the primary care sector.

Exploring young pharmacists' and pharmaceutical scientists' needs and expectations within an international pharmacy organization: Findings from FIP's needs assessment survey.

BACKGROUND: Engaging youth in the activities of health organizations is imperative to achieve the Sustainable Development Goals (SDGs). The International Pharmaceutical Federation Young Pharmacists Group (FIP YPG) was formally launched in 2001 to increase the engagement of young pharmacists and pharmaceutical scientists. Additionally, FIP YPG was set up to foster their potential for leadership within the various Sections and Special Interest Groups of FIP in the areas of pharmacy practice, pharmaceutical sciences and pharmacy education. With the new ONE FIP strategy, achieving the goal of advancing pharmacy together as ONE organization, FIP and FIP YPG looked into the needs and expectations of its members to achieve synergy and amplify outcomes. OBJECTIVES: FIP YPG carried out a needs-assessment survey to explore the needs and expectations of its members in order to better align FIP's goals and its members' needs. METHODS: An online survey was conducted between 1 May 2019 and 2 June 2019 of the members of FIP YPG. Invitations to complete the questionnaire were sent out by email to all FIP YPG members. The questionnaire included participant demographics; satisfaction on current FIP YPG activities, participation in FIP YPG activities; preferred activities of FIP YPG; expectations from FIP YPG and presence of national/regional YPG in the members' respective geographies. RESULTS: The survey elicited a response rate of 37.25%. Sixty-seven percent of members were satisfied with current FIP YPG activities. The most preferred activity and the main reason for joining the organization was 'networking opportunities.' 'Newsletter' (as a reader) was the most common resource selected by participants (71%). Newsletters were also the preferred platform for communication (75.32%). 'International YPG conference' was found to be the focus of members' preference (59.49%). Nearly a majority FIP YPG members preferred webinars focused on 'Career development' (44.94%). The preferred type of project to be involved in were 'Inter-professional collaboration projects' (45.57%). 'Exploration of opportunities and incentives for implementing new professional services' was found to be the preferred topic for research survey (33.54%). CONCLUSION: FIP YPG members' needs were descriptively analyzed for the purpose of better alignment of the organization's goals with members' goals. Networking, collaborations, career and leadership development and effective communication, among other aspects, were found to be the main interests of the members surveyed. The survey findings have been employed in the development of strategic plans for FIP YPG members and how FIP YPG can be an effective launching platform for the future roles in FIP.

Interventions to improve the review of antibiotic therapy in acute care hospitals: a systematic review and narrative synthesis.

OBJECTIVES: To synthesize current evidence for the effectiveness of interventions to ensure the timely review of antibiotics in acute care hospitals. METHODS: Five databases were searched from 1 January 2015 to 8 March 2019 for studies in English, focused on the timely review of antibiotics in acute care hospitals. Randomized controlled trials, non-randomized studies, case-control and cohort study designs were eligible. Intervention strategies were categorized according to the Cochrane Effective Practice and Organisation of Care taxonomy of health interventions, then mapped to the intervention functions of the behaviour change wheel. RESULTS: Fourteen studies were included. Most studies (11 out of 14) were conducted in single sites. Nine out of 14 reported intervention delivery by more than one healthcare professional. Physicians were the main targets of interventions in all studies. Thirteen out of 14 studies tested interventions comprising more than one strategy. The three most commonly utilized strategies within interventions were clinical practice guidelines, audit and feedback, and educational materials. Only one study employed theory in intervention evaluation. Reported interventions led to timely review and switch of IV antibiotic therapy, and shortened durations of overall antibiotic therapy. CONCLUSIONS: Interventions to improve the review of antibiotics were found to be effective in the short to medium term, with limited evidence of long-term sustainability in multiple sites. Future research may benefit from the application of theory to intervention design and detailed specifications of interventions to aid their easy replication and implementation in different contexts.