Project Title: Establishing a National Paradigm for Hospital Antimicrobial Stewardship Programs in Botswana: Princess Marina Hospital (PMH), Gaborone Botswana.

Aims:

• Establish ASP at PMH with accountability structure representation from key stakeholders.
• Identify gaps in PMH antimicrobial usage practices which can serve as priority areas for AMS quality improvement (QI).
• Increase AMS awareness and expertise among healthcare workers at PMH.
• Increase the frequency of correct antimicrobial prescribing by PMH clinicians for empiric treatment of common infections among hospitalized patients, including Pre-op prophylaxis, Community acquired pneumonia (CAP), Skin & Soft Tissue Infection (SSTI), Urinary tract infection (UTI), Bloodstream infection (BSI)
• Provide routine feedback to PMH clinicians regarding antimicrobial consumption (AMC) through audit reports and antimicrobial rounds, and stablish metrics for AMC surveillance, uploading local data to the GLASS-AMC and any national/regional AMC surveillance system.
• Promote innovation by partnering with research teams to pilot novel AMS tools.
• Serve as a model for the development of new ASPs at other facilities in Botswana.

Methods/Progress on Current projects:

1. Pre-op prophylaxis

• Of 70 operation reports queried, 37 (53%) reported PrOP.
• 3rd Generation Cephalosporins (Ceftriaxone, Cefotaxime) were the most prescribed PrOP (49%), followed by augmentin (32%), Flagyl (16%), and Ampicillin (3%).
• Disseminating guidelines to surgery / anaesthesia departments.
• Repeat audit in Jan 2023.

1. Community-acquired pneumonia

• Audit followed by introduction of pathway and training.

Intended outcomes:

• Robust and innovative ASP leadership at PMH.
• Regular audits with feedback to clinicians and regular revision of clinical pathways to optimize adherence.
• Adaptation of pathways to other institutions in Botswana.
• Reporting of AMC by ward, and hospital-wide to AMC tracking system (GLASS-AMC).

Project Title: Preserve the Miracle for our Children.

Aims and Objectives:

To develop Gertrude’s Children’s Hospital (GCH) to become a Centre of Excellence in Antimicrobial Stewardship exercising appropriate antimicrobial use through:

• Strengthening interventions in the following areas:
  • • Training of healthcare professionals in Antimicrobial Stewardship and Antimicrobial Resistance 
    • Antimicrobial ward rounds
    • Automated Antimicrobial Alerts
    • Patient and family’s involvement

• Establishment of systems to monitor antimicrobial prescribing, use and resistance.

Methods:

• Review of the Standard Treatment Guidelines.
• Establishment of decision support system in the Hospital Management Information System to guide prescribing, monitor antimicrobial use and AMR.
• Capacity Building of Healthcare Workers in AMR
  • Train MTC and ASC members.
  • Develop Curriculum for self-learning for clinical staff.
  • Establish Antimicrobial ward rounds.
• Enhance Patient and Families Engagement
  • To conduct AMR awareness survey.
  • Provide information through development of appropriate patient information/education materials.

Intended Outcomes:

• Judicious use of antimicrobials in the hospital demonstrated by adherence to guidelines and policies and overall reduced use of antimicrobials.
• Reduction in multi-drug resistance.
• Change in attitude towards antimicrobials by healthcare workers and patients/families.

Project Title: Establishing a Neonatal Specific Antimicrobial Stewardship Center of Excellence in Lebanon and the Region

Aims:

• Establish a sustainable national neonatal specific AMS accredited Center of Excellence, that can share AMS best practices with other NICUs at different hospitals.
• Build capacity, provide access to training and implementation tools, and support in collecting AMR and antimicrobial use data at the national level. 
• Standardize laboratory techniques and capacity to guide optimal use of antimicrobials in clinical practice and update clinical guidelines specific to neonates. 
• Develop a surveillance system, at the national level, for reporting and tracking neonatal specific AMS data and disseminating best practice for reducing unnecessary antimicrobial use.

Methods: 

• Identify and address current gaps at our center (AUB) .
• Provide certification and training to NICU-AMS team at AUB.
• Conduct Needs assessment at the national level based on the core criteria of BSAC.
• Perform Gap analysis to identify national limitations and challenges in terms of financing, access to technologies, human resources.
• Establish a surveillance system at each hospital through ongoing data collection.
• Report to a centralized national surveillance system.
• Provide training workshops and capacity building to other hospitals.
• Regular Monitoring and evaluation on neonatal AMS activities at other sires.
• Issue recommendations and guidelines at the national level.
• Plan for collaboration at the regional level.

Intended outcomes: 

• Benefits for our organisation – AUB will become a referral center of excellence for Neonatal Specific Antimicrobial Stewardship in Lebanon and the region in term of guideline publications as well as training and building capacity.
• Benefits for our patients – Integrate standard Neonatal AMS practices at the national level to:
  • • Promote judicious use of antimicrobials.
    • Decrease MDRO colonization in newborns.
    • Improve newborn health outcomes (morbidities and mortalities).
    • Decrease hospital length of stay.
    • Reduce healthcare costs.

Project Title: Initiative to improve healthcare and antibiotics prescription process among frontline clinicians in a third level hospital in Mexico City.

Aims: Implement a structured, comprehensive and sustainable program to improve the process of prescribing and managing antibiotics in the INCMNSZ based on three pillars:

To allow adherence among the frontline physicians who prescribe antibiotics to the local clinical management guidelines greater than 80% in the main infectious diagnosis in the Institute evaluated at 6 and 12 months after its implementation.

Intended Outcomes:

• It is expected that this program will directly benefit patient care and safety as it is a program that seeks to optimize the use of antibiotics, aimed at frontline physicians to make the right diagnosis, and select the right drug, at the right dose, with the correct duration and if possible, de-escalate the antibiotic scheme and change the way of administration from IV to PO.
• The expected indirect benefits are for physicians who directly prescribe antibiotics, as well as for nurses involved in the antibiotic administration process and pharmacists, by providing them with tools for their own education and self-incorporation of principles of optimal antibiotic use into their daily practice.

Project Title: Centre of Excellence for Antimicrobial Stewardship (CoExc-AMS)-Fatima Jinnah Institute of Chest Diseases (FJICD).

Aims: 

• Formation of Institute and AMS Committee to systematically implement and oversee three pillars: i) AMS, ii) infection prevention and control and iii) medicine and patient safety.
• Implementation of Health Management Information System and link outpatient, in-patient, pharmacy and lab data.

Methods:

• Quality improvement (QI): Define-Measure-Analyze-Improve and Control (DMAIC).
• Baseline assessment: 
  • • Center for Disease Control and Prevention CoExc-AMS check list.
    • WHO Checklist of essential health-care facility core elements for AMS programmes in LMICs (basic and advanced).
    • Checklist adapted and contextualised according to FJICD.

Intended outcomes:

Immediate:

A structured AMS Committee (officially notified to the Health Dept. Gov of Balochistan)

Antibiotic Awareness Week

Digital archiving of all the AMS, IPC and Quality & Patient Safety activities conducted at FJICD

Intermediate:

Establishment of HMIS

Reporting of Culture and Sensitivity results from across the institution 

Long term:

Retrospective and prospective antimicrobial audits

Sharing of resistance patterns with prescribers

Antibiograms

Project Title: Strengthening prescribers’ capacity for rational antimicrobial prescription and use at lower primary care facilities in Uganda (STRAP study).

Aims:

• Identify barriers and facilitators to rational antimicrobial prescribing among nurses at lower primary care facilities in Mbarara district.
• Determine patterns for antimicrobial resistance at these levels of care to guide appropriate patient management.
• Design an antimicrobial prescribing curriculum for in-service training of nurses, based on the WHO guide to good prescribing in conjunction with the Uganda Clinical Guidelines (UCG).
• Pilot the curriculum to assess its applicability in the targeted setting and effect on rational prescription and use of antimicrobials.

Methods:

• Design an antimicrobial prescribing curriculum for in-service training of nurses, based on the WHO guide to good prescribing in conjunction with the UCG.
• Pilot the curriculum to assess its applicability in the targeted setting and assess its effect on rational prescription and use of antimicrobials.

Intended Outcomes:

• Identified barriers and facilitators to rational antimicrobial prescription will guide:
  • • the in-service curriculum development for prescribers.
    • Development of other focused interventions for antimicrobial stewardship.
• Patterns on AMR will guide appropriate patient management.
• In-service curriculum for nurses on antimicrobial prescription and use.
• Applicability and effect of the in-service curriculum on rational antimicrobial prescription and use for possible scaling up.

Project Title: Kentucky Appalachian Antimicrobial Stewardship Network.

Aim: To improve health outcomes in the population of the Appalachian region of Kentucky by improving antimicrobial use.

Figure 1: United States Antibiotic Prescribing by Zip Code. Figure 2: United States Poverty Estimates by County.

Appalachian Region, Kentucky, USA

Figure 3: Appalachian Kentucky with level of economic distress. Figure 4: Appalachian Kentucky with years of potential life lost.

Methods:

• Establish the Appalachian Antimicrobial Stewardship Network of stakeholders at hospitals and long-term care facilities in Appalachian Kentucky. 
• Define local needs and identify barriers to good stewardship across the Appalachian region using appropriate established tools.
• Determine local capabilities for tracking data relevant to antimicrobial stewardship.
• Work with the Appalachian Antimicrobial Stewardship Network stakeholders to develop and prioritize stewardship action plans.
• Support stakeholders’ implementation of local action plans. 
• Evaluate the impact of action plans on stakeholder organizations and disseminate findings throughout the Appalachian Antimicrobial Stewardship Network and the Antimicrobial Stewardship Centres of Excellence network. 

Intended Outcomes:

• Comprehensive needs assessment of the hospitals and long-term care facilities in the Appalachian region of Kentucky.
• Incremental improvement in facility’s antimicrobial stewardship structure.
• Dissemination of best practices/lessons learned in the establishment and improvement of antimicrobial stewardship programs in the Appalachian region of Kentucky.

Project Title: Establishment of Center of Excellence for Antimicrobial Stewardship Training & Research.

Aims:

• To develop AMS training programmes specific to different health professionals in Zambia
• To undertake AMS training of health workers in Zambia.
• To establish online AMS Continuous Professional Development (CPD) programmes for health professionals in Zambia.
• To estimate antibiotic consumption/utilization levels in selected hospitals in Zambia.
• To establish a centre of excellence for AMS training and research in Zambia.

Intended outcomes:

• Different health professionals have in place AMS training programmes that ensure they understand their role in prevention of antimicrobial resistance.
• Improved awareness of antimicrobial resistance and practice of rational use of antimicrobials among health professionals in Zambia.
• AMS training incorporated in CPD programmes for health professionals to ensure sustainability of the training programme.
• Baseline and post-training antibiotic consumption/utilization data in selected hospitals determined.
• Centre of excellence established and AMS training and research enhanced in Zambia.