Aligning Antimicrobial Stewardship and Infection Prevention Through Repeated Assessment and Feedback: A Multisite Quality Improvement Initiative in Viet Nam.

Abstract

Background: Antimicrobial stewardship (AMS) and infection prevention and control (IPC) are complementary strategies to improve patient safety and address antimicrobial resistance (AMR). In low- and middle-income countries (LMICs), they are often implemented separately, limiting potential impact.

Objective: To evaluate the feasibility of an aligned AMS-IPC improvement approach and describe changes in implementation in Vietnamese hospitals.

Methods: We conducted a quality improvement initiative in 4 hospitals within the national AMR surveillance network in Viet Nam (March-September 2025). We used US-CDC's tools to guide implementation, including the Global Antibiotic Stewardship Evaluation Tool (G-ASET) and the Infection Control Assessment and Response (ICAR) tool. Baseline assessments were followed by feedback, multidisciplinary action planning, and targeted capacity building. Follow-up occurred 2-5 months later. Changes were analyzed descriptively using quantitative scores and qualitative synthesis and reported following the SQUIRE 2.0 guidelines.

Results: All hospitals had established IPC programs at baseline, while AMS maturity varied. G-ASET scores increased across all sites, with larger absolute gains in hospitals starting from lower baselines. Improvements were seen in leadership and governance, education and training, stewardship actions, and monitoring and reporting. Selected IPC activities aligned with AMS priorities also improved, particularly transmission-based precautions, environmental cleaning, and cross-team coordination. Infrastructure-dependent areas, such as water safety, showed limited short-term progress.

Conclusions: This aligned AMS-IPC quality improvement strategy was feasible and associated with improvements in implementation capacity and program maturity over short follow-up. Further studies with longer follow-up, comparator designs, and outcome-level measures are needed to evaluate effectiveness, sustainability, and generalizability.