Vancomycin prescribing and therapeutic drug monitoring: Challenges of real clinical practice.

BACKGROUND: Vancomycin prescription and monitoring guidelines have been reported to be poorly followed by various centers. AIMS: Identifying barriers to compliance with vancomycin dosing and therapeutic drug monitoring guidelines (TDM) and possible ways to enhance compliance based on the healthcare providers' (HCPs) perspective. METHODS: A qualitative study based on semi-structured interviews with HCP (physicians, pharmacists, and nurses) was conducted at two Jordanian Teaching Hospitals. Interviews were audio-recorded and analyzed through thematic analysis. The COREQ criteria for qualitative research were utilized to report the study findings. RESULTS: A total of 34 HCPs were interviewed. HCP perceived several factors as barriers to guideline recommendation compliance. Such factors included negative perception towards prescription guidelines, lack of knowledge regarding TDM guidelines, the hierarchy of medication management, work pressure, and ineffective communication among healthcare providers. Potential strategies to optimize guidelines adaptation included providing HCPs with more training and decision support tools in addition to activating the role of clinical pharmacists. CONCLUSIONS: The main barriers to guideline recommendations uptake were identified. Interventions should address those barriers related to the clinical environment, including enhancing interprofessional communication related to vancomycin prescription and TDM, reducing workload and providing support systems, promoting educational and training programs, in addition to adopting guidelines suitable for the local environment.

Correlation of skin cancer and actinic keratosis-related knowledge and sun protection behaviors and sunscreen use among a sample of Jordanian population.

BACKGROUND: The incidence of skin cancer and actinic keratosis has increased worldwide. Measuring the public awareness, attitude, and knowledge about these diseases and the skin protection behaviors are highly important to undertake preventive measures. METHODS: To investigate skin cancer and actinic keratosis-related knowledge, sun protection behaviors, and sunscreen usage among Jordanians, a questionnaire was developed. The questionnaire was provided as a google form to individuals via social media and the data were analyzed using SPSS® 23. RESULTS: A total of 1277 individuals, aged 18-65 years filled the questionnaire. The median melanoma and actinic keratosis knowledge score were 7 (4-9) and 4 (0-9), respectively. The melanoma knowledge was higher among females, those with a medical background, a high level of education, and in the central region, whereas the AK knowledge was higher among those with a medical background. Overall, 75.9% of the participants used sunscreen at least often to prevent sunburn, uneven skin tone, or tanning, 72% were using sunscreen with an SPF of 30 at least. However, 45.3% and 49.2% of sunscreen users did not comply with application, and reapplication times, respectively. Moreover, 58.4% of participants applied less than the recommended amount of sunscreen. CONCLUSION: Our study revealed that public awareness of actinic keratosis is low among Jordanians. Although it was found that a high proportion of Jordanians use sunscreens there are deficits in sunscreen practice indicating an urgent need to design effective interventions to increase awareness of actinic keratosis and correct use of sunscreen via health campaigns or healthcare professions.

Noncompliance with surgical antimicrobial prophylaxis guidelines: A Jordanian experience in cesarean deliveries.

BACKGROUND: Surgical site infections are common, especially in developing countries. Nevertheless, up to 60% of surgical site infections can be prevented with appropriate perioperative care, which includes among other measures using suitable surgical antimicrobial prophylaxis (SAP). METHODS: After a short interview with patients and retrospective review of medical charts, compliance with 6 SAP parameters was assessed for appropriateness; those parameters are indication, choice, dose, time of administration, intraoperative redosing interval, and duration of prophylaxis in 1,173 operations. RESULTS: Overall compliance was poor; nevertheless, certain components showed high compliance rates, such as indication and choice of antibiotics. The most frequent error noted was extended administration of prophylactic antibiotics, which was observed in 88.2% of the study population. Emergency operations were associated with a lower risk of noncompliance in administering the correct dose at the correct time (odds ratio, 0.63; 95% confidence interval, 0.47-0.83 and odds ratio, 0.21; 95% confidence interval, 0.14-0.3, respectively). On the other hand, women who underwent an emergency operation were associated with a 6-fold higher risk of receiving prophylactic therapy following surgery. CONCLUSIONS: The present study demonstrated the existence of a surprisingly low level of overall compliance with the hospital-adapted SAP guidelines. Factors implicated in noncompliance were investigated, and the present results create a starting point to improve the current practice.

Surgical site infections following caesarean operations at a Jordanian teaching hospital: Frequency and implicated factors.

Surgical site infections (SSIs) following caesarean surgeries are common. The present study aimed to evaluate the frequency of SSIs following caesareans at Jordan University Hospital during the 30 postoperative days and to identify factors associated with increased SSIs risk. Data regarding the occurrence of SSIs were collected both prospectively via follow-up phone calls and retrospectively via reviewing wound culture results and clinical notes. SSI cases were subsequently determined utilizing predefined criteria. Data relating to possible risk factors of SSIs were collected from patient interviews and hospital records. Risk factors for SSIs were identified via logistic regression. A high rate of SSIs (14.4%) was detected; implicated factors included body mass index ≥36 kg/m2 prior to pregnancy odds ratio (OR) 3.8, 95% confidence interval (95% CI) 1.6-9.4, hospital stay longer than 3.5 days OR 2.3, 95% CI 1.4-3.6, having the operation at a gestational age greater than 40 weeks OR 2.2, 95% CI 1.3-3.9. Receiving a higher weight-adjusted dose of the prophylactic antibiotic cefazolin was associated with lower SSIs risk OR 0.967, 95% CI 0.94-0.99.In conclusion, a high rate of SSIs following caesareans was detected, and modifiable risk factors of SSIs should be incorporated into targeted policies aiming to reduce the rate of SSIs.