Implementation of Antimicrobial Stewardship Program in A Tertiary Surgery Hospital: Barriers and Challenges

Abstract

Abstract Introduction Many interventions have been demonstrated to beat the spread of antimicrobial resistance, one of which is the antimicrobial stewardship programs on the international, national and facility levels. One of the major pillars of the antimicrobial stewardship programs is the perioperative antibiotic surgical prophylaxis (PAP) which is critical to preventing the emergence of bacterial resistances. On the other hand, it is critical to preventing surgical site infections (SSIs), which are the second most common healthcare-associated infection and complicate approximately 5% of surgical procedures each year, according to the Centers for Disease Control (CDC). Materials and Methods In our study, we conducted improvement project with the use of FOCUS PDCA method to implement antimicrobial stewardship program and find the barriers to implementation. Results According to the WHO assessment checklist, almost all of the core elements declared by CDC concerning ASP were implemented. Leadership commitment elements increased from 33% to 66%. Accountability and education elements were 100% implemented although none of them were implemented before. ASP actions were increased from 57% to 100 as well. Although there was a trained clinical pharmacist representing 100% of pharmacy expertise elements, only 50% of tracking antibiotics use and outcomes elements were implemented. On the other hand, Reporting antibiotics Use and Outcomes elements were increased from 50% to 100%. The main challenge we faced was the behavioral change and proper tracking of the dispensed antibiotics. Conclusions Preauthorization combined with training, monitoring and reporting were effective in the implementation of the ASP but some challenges may interfere with the full implementation of the program.