![]() ![]() The difference in the prevalence between the two studies could be attributed to the differences in the methods applied (point prevalence vs. In this hospital-wide GPPS, 56% of hospitalized patients were prescribed antibiotics, compared with 82% reported in 2017. Our AMS program conducted a GPPS, which was critical in the external validation of our AMS experience, because it was easy to complete and the data collection software automatically generated a report which enabled comparison of antimicrobial prescribing at Connaught Hospital with other hospitals in the African continent and worldwide. Through this broader committee, the three subcommittees can share experiences, gain a better understanding of the operations of the different subcommittees, and generally improve the outcomes of their interventions. Our AMS program is unique in that it operates within the remit of a broader IPC, WASH and AMS committee that interweaves IPC, WASH and AMS activities within an integrated framework at the hospital. Consequently, we adopted a multidisciplinary approach in the selection of the AMS subcommittee members and in the implementation of the AMS activities, similar to the recommendations made by Kirchhelle et al. Furthermore, we reflect on the call in 2022 by the WHO Director-General to prioritize IPC as a key to health system strengthening and universal health coverage instrument and the idea that ‘every infection prevented is an antibiotic resistance avoided’. This reinforces the fact that an AMS program should constitute a broad-based membership that includes IPC practitioners. Research from hospitals across Sierra Leone, including Connaught Hospital, found deep-rooted challenges not only in antimicrobial prescribing and antibiotic resistance, but also in IPC. Given that most of the relevant expertise for AMR is based in the capital of Sierra Leone, creation of a guideline that is applicable to other facilities, is evidence of a commitment to spread the benefits from this AMS program across the country. The involvement of key stakeholders enabled the validation and promotion of these guidelines at national level. The review of surgical prophylaxis guidelines for Connaught Hospital was conducted with the view to creating a national guideline which can be shared and implemented across all government hospitals/facilities offering surgical services in Sierra Leone. Stakeholders included representatives from Connaught Hospital, King’s Global Health Partnerships (KGHP), the WHO Country Office and Ministry of Health and Sanitation. It was decided to bring in various stakeholders for the review of the surgical prophylaxis guidelines. The need to review the surgical prophylaxis guidelines was identified through previous research at the hospital and the recent GPPS results. The IPC, WASH, and AMS broader committee developed terms of reference for the AMS subcommittee to support and define its operations. In conclusion, it is feasible to establish and implement an AMS program in low-income countries, where most hospitalized patients were prescribed an antibiotic. Ceftriaxone (60, 34.3%) and metronidazole (53, 30.3%) were the most common antibiotics prescribed to patients. ![]() We performed a GPPS on 175 patients, of whom more than half (98, 56.0%) were prescribed an antibiotic: 63 (69.2%) in the surgical wards and 53 (51.2%) in the medical wards. Connaught Hospital established a multidisciplinary AMS subcommittee in 2021 to provide AMS services such as awareness campaigns, education and training and review of guidelines. The project involved the setting up of an AMS program, capacity building and performing a global point prevalence survey (GPPS) at Sierra Leone’s national referral hospital. ![]() We aimed to describe the processes of establishing and implementing an AMS program at Connaught Hospital in Sierra Leone. Prevention and control of AMR requires functional antimicrobial stewardship (AMS) program, which is complex and often difficult to implement in low- and middle-income countries. Antimicrobial Resistance (AMR) is a growing global health challenge that threatens to undo gains in human and animal health. ![]()
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