RESUMO
Introduction and methods Blood culturing has become one of the backbone investigations for septicemia, fever of unknown origin, etc. This study was conducted to test the effect of multimodal interventions on the practical skills of healthcare workers (HCWs), raise awareness regarding the importance of aseptic blood culture collection practices, and increase compliance with the specific steps to be followed. Hence, this current interventional study was aimed at comparing the rate of isolation of contaminants grown among the blood culture specimens, assessing the knowledge, attitude, and practice (KAP) of HCWs collecting the blood culture specimen on various aspects of sample collection, educating the nursing staff regarding blood sample collection using a structured, pre-formed checklist, and emphasizing best practices for blood culture collection. All of the study's objectives were successfully met within the time frame specified. Using a pre-formed checklist and a Google form for KAP analysis eased the calculation. Results On analysis, the blood culture contamination rate in the pre-interventional phase dropped drastically from 6.16% to 3.03% in the post-interventional phase. The educational sessions conducted are a paramount reason for the reduction in the contamination rate. The HCWs were the least compliant towards the eighth step in the checklist (regarding palpation of skin); however, that too increased from 66.93% and 64.51% to a whopping 82.25% and 83.06%, respectively, with a chi-square value of 0.03 and a p-value of 0.85 (not significant). Conclusion Implementation of interventional studies as an audit like this in tertiary care hospitals can result in a significant reduction in blood culture contamination rates and can also improve the compliance of HCWs with blood culture protocols. This, in turn, can overall improve the effectiveness of blood culture (BC) testing and reduce mortality and morbidity in tertiary care hospitals. Further research can be conducted to brainstorm more methods to increase the compliance of HCWs. Better monitoring strategies can also be set to ensure low contamination rates. Additionally, some other methods can be derived to locate the source of contamination within the hospital environment and thus eliminate it. Similar interventions can be conducted for a longer duration of time to further reduce the blood culture contamination rate below 3% (as per the recommendations).
RESUMO
Purpose: Antimicrobial resistance (AMR) presents a significant threat to human health. The root cause for this global problem is irrational antimicrobial usage. Antimicrobial stewardship (AMS) emphasises on the appropriate use of antibiotics and ensures strict implementation of antimicrobial policy guidelines. This study was conducted to evaluate the impact of auditing of AMS programme on regulating the antimicrobial policy adherence and antimicrobial usage in hospital intensive care units. Materials and Methods: This was a prospective interventional study. It consisted of pre-implementation and implementation phases 6 months each. Two hundred and eighty patients were enrolled. Details of antibiotic consumption, surgical prophylaxis, culture/sensitivity patterns, de-escalation rates, etc., were collected in both phases. The implementation phase, in addition, included stewardship audit rounds. Results: In pre-implementation phase and implementation phases: policy adherence rates were 23.7% and 41.8%, respectively, de-escalation rates were 22.73% and 43.48%, respectively. Cultures were sent before the initiation of antimicrobials in 36.73% cases during the pre-implementation phase, which improved to 60.41% during the implementation phase. Defined daily dose (DDD) for the antibiotics was 98.66 DDD 100BD during the pre-implementation phase, which reduced to 91.62 DDD 100BD in the implementation phase. Total days of therapy (DOT) in the pre-implementation phase were 561 DOT1000BD, which reduced to 463 DOT1000BD during the implementation phase. Conclusions: Implementation of continuous monitoring of the AMS programme, therefore, has a definite role in reducing the antimicrobial consumption and improving the compliance to the policy guidelines. A more robust study for a prolonged period is, however, necessary to have a better analysis of the outcome.
