article · Antimicrobial Resistance and Infection Control
A mixed-methods study conducted at the University Teaching Hospital of Kigali evaluated surgical prophylaxis practices and developed targeted antimicrobial stewardship interventions using behavioural frameworks. An audit of 190 patients revealed significant gaps in prescribing practices, with only 16 percent of patients receiving fully appropriate prophylactic treatment across duration, dosage, drug choice, and microbial coverage. The choice of antimicrobial was inappropriate in 77 percent of cases, and duration was inappropriate in 37 percent. Qualitative assessments identified barriers such as limited guideline knowledge, workplace hierarchies, drug access constraints, poor inter-professional communication, and missing infection surveillance. Drawing on the Capability, Opportunity, Motivation, Behaviour model and the Behaviour Change Wheel, the initiative formulated targeted interventions focused on education, training, environmental restructuring, and enablement. These measures centre on creating local guidelines, improving drug availability, and introducing monitoring and feedback mechanisms.
Improper use of antibiotics before and during surgery contributes directly to antimicrobial resistance and compromises patient safety. By identifying the exact behavioural, institutional, and logistical reasons behind poor prescribing habits, hospitals can move beyond generic recommendations. Tailored intervention packages help healthcare facilities improve adherence to clinical protocols, ensure patients receive correct preventative treatments, and safeguard the efficacy of critical medicines.
This research provides an applied, tested behavioural diagnosis and framework for hospital antimicrobial stewardship programmes. The primary users are hospital managers, clinical leaders, and healthcare policymakers seeking structured quality improvement packages. While the study outlines specific interventions ready for local adoption, the abstract does not describe a commercial product or proprietary technology, pointing instead towards operational healthcare implementation and policy development.
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BACKGROUND: Behavioural sciences should be used to design and improve antimicrobial stewardship (AMS) interventions aiming surgical prophylaxis (SP). METHODS: A mixed-methods study at the University Teaching Hospital of Kigali, Rwanda. The study included an audit on SP practices and the development of SP interventions based on determinants of prescription behaviour yielded by 2 group discussions and by applying the Capability, Opportunity Motivation Behaviour (COM-B) model and the Behaviour Change Wheel (BCW) framework. RESULTS: The audit included 190 patients: SP prescription was inappropriate regarding determinable duration in 37% (51/139); dosage in 19% (32/167); choice in 77% (136/177) and adequate coverage of expected micro-organisms in 20% (34/175). In 31 patients (16%), SP was appropriate for all four determinants. Barriers of prescription behaviour change pertained to knowledge of guidelines, hierarchical dynamics, access to antimicrobials, inter-professional communication, entrenched routines, documentation issues and lacking surveillance of surgical site infections and antimicrobial resistance. Facilitators of prescription change were the development of a local guideline and audit and feedback processes after implementing change. Subsequent policies and interventions were developed, focusing on (1) developing a local SP guideline, (2) education and training, (3) strengthening drug availability and (4) monitoring and feedback on SP practices before and after implementing change. CONCLUSIONS: This mixed methods study showed suboptimal SP practices regarding to duration, dosage, choice and adequate coverage. Barriers and facilitators of prescription behaviour change touched on all COM-B categories and informed the development of tailored AMS interventions, focusing on the intervention functions "education", "training", "environmental restructuring" and "enablement".
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DOI: 10.1186/s13756-026-01771-2
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