A novel framework to guide antibiotic stewardship nursing practice

Research priorities for antimicrobial stewardship nurses in a middle-income country: a nominal group technique study

BACKGROUND

Antimicrobial stewardship programs (ASPs) have become important strategies for addressing antimicrobial resistance (AMR). Despite the increasing number of international publications identifying the important roles played by nurses as part of ASPs in low- and middle-income countries, this topic is yet poorly researched. This study aimed to identify priority research gaps in the Brazilian context concerning nurses' performance in ASPs from the perspective of nursing professionals and explore the main themes among the ideas generated by these nurses.

METHODS

This qualitative study used the modified Nominal Group Technique (mNGT) during a three-day online workshop. Content analysis was performed on the basis of the ideas proposed by the participants after the clarification stage.

RESULTS

The participants suggested 68 ideas in the first phase. After the idea's clarification phase, 45 ideas were included in the voting rounds. The ideas prioritized by participants voting addressed (i) attributions and competencies of nurses in the ASP; (ii) planning and implementation of ASP nurses' activities; and (iii) use of information and communication technologies to assist nurses. The content analysis highlighted nine main themes in the initial ideas.

CONCLUSIONS

The study identified significant gaps in research related to nurses' roles in ASPs in the Brazilian context. These findings suggest that further investigation into nurses' competences, the implementation of their roles, and the application of digital tools are priority subjects of future research to improve nurses' participation in ASPs. These themes should be further studied in the Brazilian context but may be applicable to other similar socioeconomic contexts.

Effectiveness of A Nurse-Led Multimodal Intervention in Preventing Blood Culture Contamination: A Before-and-After Study

Blood culture is crucial for accurate and timely bacteremia diagnosis and guide antibiotic therapy. However, during culture sampling, contamination can occur, resulting in misdiagnosis, unnecessary antibiotic exposure, and prolonged hospitalization. This before-and-after intervention study aimed to evaluate the effectiveness of a multimodal intervention in preventing blood culture contamination. The study was conducted in a 170-bed hospital in Portugal and included a total of 23,566 blood cultures. Contamination rates were assessed in two phases: Phase 1 (before intervention, month 0) included 10,928 cultures, and Phase 2 (after intervention, month 6) included 12,638 cultures. During the study period, a multimodal intervention targeting the nursing staff was implemented, consisting of training actions, guideline updates, regular data monitoring and feedback, and introduction of a blood culture pack. Following the intervention, blood culture contamination decreased from 6.8% (Phase 1) to 3.9% (Phase 2). A comparative analysis revealed that the risk of contamination before the intervention was nearly four times higher in first culture, OR = 3.97 (CI 2.86-5.49). Our findings suggest that the multimodal intervention enhanced nurses' adherence to recommended practices, resulting in a reduced risk of blood culture contamination, earlier identification of infectious agents, and improved accuracy of antibiotic therapy.

Nurses' contribution to antimicrobial stewardship: business as usual?

BACKGROUND

Antimicrobial Stewardship (AMS), the set of actions to ensure appropriate antimicrobial use, is increasingly considered a multidisciplinary endeavour. However, it is unclear how Dutch hospital-based nurses envision their contribution to AMS.

OBJECTIVE

To explore the views and visions of Dutch bedside nurses on their role regarding appropriate antimicrobial use.

METHODS

A qualitative study using semi-structured interviews was conducted. Fourteen bedside nurses in nine different Dutch hospitals participated. Data were analysed using a thematic content analysis.

RESULTS

Nurses considered their role regarding appropriate use of antibiotics as an integral part of their daily nursing practice. They envisioned their future role as an expansion of their current practice, improving or intensifying this contribution. Prompting review of antimicrobial treatment by nurses was seen as regular practice. Ward rounds were considered the best moment to exert their nursing role, by showing leadership in communicating about different aspects of AMS. Patient advocacy ("striving for the best possible care for their patient") appears to be a driver of the nursing contribution. Nurses perceived a shared responsibility with prescribers on certain aspects of the antimicrobial treatment and wished for a clarification of this role. Education and cognitive reminders such as antibiotic checklist to be used in ward rounds, can support the uptake of the nurses' role.

CONCLUSION

Nurses envision their future role in AMS as an enhanced, elaborated and empowered version of their current daily practice. Education, formal acknowledgment and increased awareness of the nursing role, may advance the contributing role nurses already have.

Bedside nurses' antimicrobial stewardship practice scope and competencies in acute hospital settings: A scoping review

AIM

To identify and map bedside nurses' practice scope and competencies regarding antimicrobial stewardship in acute hospital settings, and develop a competency framework for them.

BACKGROUND

Antimicrobial stewardship requires multidisciplinary engagement including nursing. However, bedside nurses' antimicrobial stewardship practice scope and competencies in acute hospital settings remain unclear.

DESIGN

Scoping review.

METHODS

Using a five-stage framework proposed by Arksey and O'Malley and following the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews guidelines.

RESULTS

A total of 1422 records were retrieved, and 41 studies were included. In addition to the six practices recommended, this review summarized bedside nurses' contributions to five additional fields as well. Correspondingly, the competencies required by bedside nurses were summarized into eight domains: specialized knowledge, safety medication administration, leadership, education, diagnostic stewardship, infection prevention and control, professional development and professional quality.

CONCLUSION

Nurses' practice scope overlaps greatly with routine nursing practice in antimicrobial stewardship, confirming the evidence that nurses are ideal partners in antimicrobial stewardship. This review developed a competency framework at both basic and advanced levels. Among them, professional knowledge is the foundation, while professional quality motivates nurses to participate. In addition to competency assessment, it can also be used for training and human resource deployment based on seniority or professional level. This could bridge the knowledge gap and improve the engagement of nurses in heavy workload situations.

RELEVANCE TO CLINICAL PRACTICE

This practice scope will provide opportunities for nurses to engage in antimicrobial stewardship. Moreover, nursing competencies identified in this field could facilitate the development of competency-based education interventions, talent assessments, training and recruitment programs.

DATA RESOURCES

PubMed, EMBASE, Web of Science, CINHAL, PsycINFO, Cochrane Library, ProQuest and Scopus were searched from inception to November 2022, with an updated search in March 2023.

IMPACT

This scoping review provides evidence for best nursing practice scope and competency in antimicrobial stewardship in hospitals. However, it is also in line with the commitment of all nurses in the global community to combat antimicrobial resistance, which has become a global threat. An antimicrobial stewardship competency framework for bedside nurses was developed at both the basic and advanced levels. It would facilitate talent assessment, training, recruitment and human resource management by guiding the development of competency-based education interventions.

PATIENT OR PUBLIC CONTRIBUTION

No Patient or Public Contribution.

An app a day: Results of pre- and post-surveys of knowledge, attitudes, and practices (KAP) regarding antimicrobial stewardship principles among nurses who utilized a novel learning platform

Background

Nurses perform several functions that are integral for antimicrobial stewardship (AMS). However, nurses are underrepresented in research and underutilized in implementation of AMS interventions. The objective of this pilot study was to assess the effect of asynchronous microlearning on inpatient nursing staff knowledge, attitudes, and practices (KAP) regarding AMS principles.

Methods

A team of pharmacists, physicians, and nurses developed 9 case-based, multiple-choice questions with accompanying educational explanations on associated AMS principles. One case was delivered to participants daily via an institutional web-based application (QuizTime). A KAP survey with 20 questions on a 5-point Likert scale was administered before and after the intervention. Survey results were compared using a Wilcoxon signed-rank test.

Results

Participants' mean survey score after the intervention demonstrated statistically significant improvement for 18 (90%) of 20 items compared to before the intervention. Participants' confidence improved in key AMS activities: (1) differentiating between colonization and infection (mean difference, 0.63; P < .001), (2) identifying unnecessary urine cultures and inappropriate treatment of urinary tract infections (mean difference, 0.94; P < .001), (3) recognizing opportunities for intravenous to oral therapy conversion (mean difference, 1.07; P < .001), and (4) assessing for antibiotic-associated adverse effects (mean difference, 0.54; P < .001).

Conclusions

Nursing education provided through an asynchronous, microlearning format via a mobile platform resulted in statistically significant improvement in most KAP topics. Nurses are integral members of a multidisciplinary AMS team, and novel education methods can help equip them with the necessary AMS tools. This pilot study forms the basis for expanded AMS educational efforts in all healthcare professionals.

Electrochemical-enhanced Fe3O4/biochar activates peroxymonosulfate (E/nano-Fe3O4/BC/PMS) for degradation of oxytetracycline

To find cost-effective and environmentally friendly free radical activators to stimulate peroxymonosulfate (PMS) oxidative degradation of organic pollutants, nano-Fe₃O₄/biochar (BC) composites were prepared and characterized in this work to examine their effectiveness in stimulating PMS oxidative degradation of Oxytetracycline (OTC) in water enhanced with electrochemical degradation. When the mass ratio of nano-Fe₃O₄ to BC is 1:1, the catalyst nano-Fe₃O₄/BC exhibits the most obvious degradation effect on OTC. After 4 h of degradation, the OTC concentrations were reduced from 20 to 2.65 mg L^-1, while treated with a single nano-Fe₃O₄ and a single BC are reduced by only 67.7% and 61.8%. Anions HCO₃^- and H₂PO₄^- significantly inhibit OTC degradation, and HCO₃^- has a stronger inhibitory effect than H₂PO₄^-, while Cl^- and NO₃^- can promote OTC degradation. Quenching test and electron spin paramagnetic resonance (EPR) detection showed that singlet oxygen (¹O₂) was the main active species in the degradation process, followed by hydroxyl radical (·OH). When reused for the third time, the removal rate of OTC by nano-Fe₃O₄/BC composites with mass ratios of 1:4, 1:2 and 1:1 was still more than 70%. Therefore, the nano-Fe₃O₄/BC composite is a promising PMS activator, which can realize the rapid oxidative degradation of OTC.

Advancing Antibiotic Stewardship Nursing Practice Through Standardized Education: A Pilot Study

Background Antibiotic resistance is a leading global public health threat. Nurses are well positioned to optimize antibiotic use via targeted antibiotic stewardship (AS) nursing practices. However, standardized AS education for nurses is lacking. The objective of this study was to evaluate the effect of an online AS for nurses continuing education program on nurses' antibiotic resistance, antibiotic, and AS knowledge and their intent to integrate AS into their clinical practice. Method A quasi-experiential pretest-posttest design was used with a convenience sample of nurses at a U.S. academic medical center. Focus groups were conducted with those completing the program. Results Forty-seven of 100 eligible nurses completed the program and the pre- and posttest surveys. Participation resulted in statistically significant increases (p < .05) in antibiotic resistance, antibiotic, and AS knowledge, confidence, and perceptions related to the role of nursing in AS. Focus group participants had multiple recommendations for ways to integrate AS in daily nursing practice. Conclusion Completing a comprehensive AS nursing continuing education program could prove instrumental to motivating nurses to adopt AS nursing practices. [J Contin Educ Nurs. 2022;53(9):417-423.].