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The role of the critical care nurse in the implementation of an antimicrobial stewardship programme in a resource-limited country

Du Toit, Briette (2015-12)

Thesis (MSc)--Stellenbosch University, 2015.


ENGLISH ABSTRACT: Antimicrobial resistance has become a major public health threat and is particularly a problem in low- to middle-income countries (LMICs) where there is a high burden of infectious diseases. The implementation of an antimicrobial stewardship programme (AMS) is essential to reduce the development of resistance. However, adequate resources are often a problem, hence the necessity to investigate the availability of alternative, more cost-effective solutions. Including nurses in antimicrobial stewardship teams can add value due to the fact that nurses are in an ideal position to monitor the duration of antimicrobial treatment. Furthermore, nurses are responsible for the administration of medication and the collection of appropriate specimens and are primarily responsible for the care of the patient. The objectives of this study were to examine the role of the critical care nurse in the implementation of an antimicrobial stewardship programme in LMICs and to identify interventions where the critical care nurse plays a significant role as part of the AMS team. A pre- and post-intervention interventional study design was followed where various interventions were implemented to establish which of these interventions can be implemented successfully by nurses with a meaningful impact on an AMS programme. The study found that nurses can play an important role in the implementation of an AMS programme and that they are a cost-efficient resource. Nurses should be an essential part of an AMS team. Additional training about AMS and infection prevention and control (IPC) is necessary and the training should be directed at the team; including nurses, doctors and pharmacists.

AFRIKAANSE OPSOMMING: Antimikrobiese weerstandigheid is ’n wesentlike bedreiging vir publieke gesondheidsorg en dit is veral ’n probleem in lae- tot middel-inkomste lande waar daar ’n groot las is van aansteeklike siektes. Die implementering van ’n antimikrobiese bewusmakingsprogram is belangrik om die ontwikkeling van weerstandigheid te verminder. Voldoende hulpbronne is egter dikwels ’n probleem en gevolglik moet ander beskikbare en koste-effektiewe bronne ondersoek word. Die insluiting van verpleegkundiges in antimikrobiese bewusmakingspanne kan moontlik waarde toevoeg as gevolg van die feit dat verpleegkundiges in ’n gunstige posisie is om die duur van behandeling met ‘n antibiotikum te monitor. Verder is verpleegkundiges ook verantwoordelik vir die toediening van medikasie en die verkryging van toepaslike laboratorium-monsters en is hulle primêr verantwoordelik vir die versorging van die pasiënt. Die doel van die studie was om die rol van die kritieke-sorg verpleegkundige te ondersoek in die implementering van ’n antimikrobiese moniteringsprogram in lae- tot middel-inkomste lande en om verder te bepaal watter intervensies geïmplementeer kan word sodat die kritieke-sorg verpleegkundige ’n betekenisvolle rol kan speel in die implementering van ’n antimikrobiese moniteringsprogram. Die studie-ontwerp was ‘n voor- en na-intervensie studie. Verskeie intervensies is geïmplementeer om te bepaal watter intervensies suksesvol deur verpleegkundiges geïmplementeer kan word om ’n beduidende invloed op ’n antimikrobiese moniteringsprogram te hê. Die bevindinge van die studie was dat verpleegkundiges ’n belangrike rol kan speel in die implementering van antimikrobiese moniteringsprogramme en dat hulle ’n koste-effektiewe hulpbron is. Verpleegkundiges behoort deel te wees van ’n antimikrobiese span. Opleiding in antimikrobiese moniteringsprogramme en infeksievoorkoming en -beheer is egter nodig en moet gerig wees op die hele span, insluitende geneeshere, verpleegkundiges en aptekers.

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