Dena Van Den Bergh, Esmita Charani, Angela Dramowski, Ama Sakoa Annor, Michelle Gijzelaar, Angeliki Messina, Andriette Van Jaarsveld, Debra A Goff, Pavel Prusakov, Liezl Balfour, Adrie Bekker, Azraa Cassim, Nelesh P Govender, Sandi L Holgate, Sonya Kolman, Hafsah Tootla, Natalie Schellack, Kessendri Reddy, Christine Fisher, Lucinda Conradie, Anika Van Niekerk, Anje Laubscher, Pearl Alexander, Thanusha Naidoo, Magdel Dippenaar, Colleen Bamford, Sharnel Brits, Pinky Chirwa, Hannelie Erasmus, Pieter Ekermans, Lerina Rungen, Teresa Kriel, Dini Mawela, Simthembile Mjekula, Maphoshane Nchabeleng, Ronald Nhari, Marli Janse Van Rensburg, Pablo J Sánchez, Adrian Brink
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引用次数: 0
Abstract
Background: Research on the contextual drivers of antimicrobial stewardship (AMS) programme interventions in neonatal units is limited.
Methods: As part of a prospective mixed-methods multidisciplinary neonatal AMS (NeoAMS) interventional study in 14 South African hospitals, we applied a three-phased process to assess implementation barriers and contextual drivers experienced by participating health professionals. The study included: (Phase one; P1) a survey of pre-intervention barriers and enablers; (P2) written feedback during the study intervention phase; and (P3) semi-structured exit interviews.
Results: Respondents to the P1 survey (n = 100) identified 15 barriers, 9 in the domain of personnel resources, including staffing, time and workload constraints. Other barriers related to limited access to antimicrobial use and surveillance trends, complexity of neonatal care, absence of multidisciplinary team (MDT) AMS and change resistance. For P2, written feedback during implementation (n = 42) confirmed that the MDT approach facilitated systems changes, including policy adaptations, process improvements, strengthened infection control practices, and expansion of AMS MDT roles. MDT benefits were described as aligned team purpose, improved communication, and knowledge sharing. Reported challenges included time to meet and building trust. In P3 interviews (n = 42), improved interpersonal communication, trust, personal growth and confidence building were cited as highlights of working in multidisciplinary AMS teams. Extending the MDT approach to other hospitals, training more health professionals in AMS and increasing management involvement were identified as priorities going forward.
Conclusions: Understanding the organizational and interprofessional context for NeoAMS implementation enabled an MDT approach to develop and optimize neonatal AMS with potential for adoption in similar resource-constrained settings.
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