To save content items to your account,
please confirm that you agree to abide by our usage policies.
If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account.
Find out more about saving content to .
To save content items to your Kindle, first ensure email@example.com
is added to your Approved Personal Document E-mail List under your Personal Document Settings
on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part
of your Kindle email address below.
Find out more about saving to your Kindle.
Note you can select to save to either the @free.kindle.com or @kindle.com variations.
‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi.
‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.
Tackling antimicrobial resistance (AMR) through antimicrobial stewardship (AMS) interventions is a key objective within the World Health Organization (WHO)’s Global Action on AMR. We outline the reasons why global collaborations for AMS are needed. We provide examples of global collaborations, and we offer considerations when starting on a global health journey focused on AMS.
Background: Dentists prescribe ~25.7 million antibiotic prescriptions annually. Private practice dentists (PPDs) represent 80% of US dentists who need to implement dental antimicrobial stewardship. We conducted a prospective cohort study of PPDs comparing appropriateness of antibiotic use before and after dental AS education. Methods: PPDs were invited to participate in this study. In phase 1 (pre-education), we collected 3 months (June–August 2019) of retrospective antibiotic use data (indication, dose, duration, penicillin allergy history) and number of dental procedures. We also conducted a preliminary survey to assess baseline antimicrobial stewardship knowledge. In phase 2 (education), PPDs attended 4 televideo education sessions (March–May 2021) taught by an infectious disease– antimicrobial stewardship (ID-AS) pharmacist and physician. In phase 3 (posteducation), we prospectively collected 3 months (June–August 2021) of antibiotic use data (as in phase 1), using an online database with ongoing feedback. In phase 4, we conducted antibiotic use audit and feedback to PPDs after the survey, and we solicited recommendations to reach more PPDs. The Student t test was used for statistical analyses. Results: Study participants comprised 15 PPDs: 2 oral maxillofacial surgeons, 6 periodontists, 4 endodontists, and 3 general dentists. Among them, 10 had been in practice >20 years. The presurvey revealed that 14 were unfamiliar with dental antimicrobial stewardship. All prescribed clindamycin (25% for nonpenicillin allergy), and standard antibiotic duration ranged from 5 to 14 days based on dental school training. In phase 3, despite more procedures, overall antibiotic use and duration decreased, and the use of clindamycin, quinolones, and prophylaxis for joint implant patients, also decreased. Appropriate use improved from 22% to 95%. Postsurvey responses on perceived value of antimicrobial stewardship education were 100% positive, with recommendations to make antimicrobial stewardship a required annual continuing education, similar to opioid continuing education. Study participants invited the ID-AS experts to teach an additional 150 PPDs to date via established PPD study clubs to expand dental antimicrobial stewardship across the United States. Conclusions: After learning dental antimicrobial stewardship guidance from ID-AS experts, PPDs rapidly optimized antibiotic prescribing behavior. PPDs identified their established study clubs as a forum to quickly expand dental antimicrobial stewardship training by ID-AS experts throughout the United States.
Background: A recent study using minimally invasive tissue sampling at Chris Hani Baragwanath Academic Hospital (CHBAH), a public tertiary-care hospital in South Africa, reported that 70% of preterm neonatal deaths were due to healthcare-associated infections (HAIs). Based on these findings, CHBAH in collaboration with the CDC conducted an infection prevention and control (IPC) assessment and identified IPC gaps: limited training and mentorship of staff, medication preparation near the patient zone, and inadequate equipment cleaning and a high infection rates. We implemented a program from February 2019 to February 2020 to address these identified gaps, with the aim of reducing the neonatal sepsis rate. Methods: We focused our interventions on 3 essential activities in the neonatal wards: (1) conducting medication compounding in a safe environment with dedicated trained clinical pharmacy personnel; (2) improving cleaning and reprocessing of medical equipment through use of dedicated ward assistants; and (3) improving infection control–related behavior of frontline healthcare staff through on-site IPC mentorship and training. We captured data on process measures including medication errors and hand hygiene and outcome measures. We also looked at rates of infection, defined as positive cultures from blood and CSF per 1,000 patient days. Results: A NICU satellite pharmacy was established in February 2019 and was managed by a lead pharmacist and pharmacy assistants. Following the intervention, medication errors were reduced from 17% in March to 2% in September; nursing staff previously dedicated to medication preparation were able to spend more time in patient care. Furthermore, 4 full-time ward-assistants were hired in February 2019, and equipment is now cleaned using a standardized protocol in a dedicated cleaning area. A dedicated IPC team was assembled in January 2019 to develop standard operating procedures and conduct frequent trainings with healthcare personnel on IPC practices. Since these trainings were implemented, hand hygiene compliance improved from 25% to 48% over a 4-month period. There has been no significant change in blood/CSF infection rates from before implementation (2018): 17.7 per 1,000 patient days (95% CI, 16.7–18.8) compared to rate of 19.1 per 1,000 patient days (95% CI, 17.7–20.6) after implementation (March–September 2019), with a rate ratio of 1.08 (95% CI, 0.98–1.19). Conclusions: The impact of this program was demonstrated through process improvements and reduction in medication errors. However, to date there has been no change in the overall infection rates, suggesting that additional IPC interventions are needed or that other factors are contributing to the high infection rates.