Investigating infection management and antimicrobial stewardship in surgery: a qualitative study from India and South Africa

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Title: Investigating infection management and antimicrobial stewardship in surgery: a qualitative study from India and South Africa
Authors: Charani, E
Holmes, A
Bonaconsa, C
Mbamalu, O
Mendelson, M
Surendran, S
Singh, S
Nampoothiri, V
Boutall, A
Tarrant, C
Dhar, P
Pennel, T
Leather, A
Hampton, M
Item Type: Journal Article
Abstract: Objectives To investigate the drivers for infection management and antimicrobial stewardship (AMS) across high infection risk surgical pathways. Methods An qualitative study, ethnographic observation of clinical practices, patient case studies, and face-to-face interviews with healthcare professionals (HCP) and patients was conducted across cardiovascular and thoracic and gastrointestinal surgical pathways in South Africa (SA) and India. Aided by Nvivo 11 software, data were coded and analysed until saturation was reached. The multiple modes of enquiry enabled cross-validation and triangulation of findings. Results Between July 2018–August 2019 data were gathered from 190 hours of non-participant observations (138 India, 72 SA); interviews with HCPs (44 India, 61 SA); patients (6 India, 8 SA), and, case studies (4 India, 2 SA). Across the surgical pathway, multiple barriers impede effective infection management and AMS. The existing, implicit roles of HCPs (including nurses, and senior surgeons) are overlooked as interventions target junior doctors, bypassing the opportunity for integrating infection-related care across the surgical team. Critically, the ownership of decisions remains with the operating surgeons and entrenched hierarchies restrict the inclusion of other HCPs in decision-making. The structural foundations to enable staff to change their behaviours and participate in infection-related surgical care is lacking. Conclusions Identifying the implicit existing HCPs roles in infection management is critical and will facilitate the development of effective and transparent processes across the surgical team for optimised care. Applying a framework approach that includes nurse leadership, empowering pharmacists and engaging surgical leads is essential for integrated AMS and infection-related care. Keywords: antibiotic prescribing, infection control, ethnography, low- and middle-income country, surgery
Issue Date: 1-Oct-2021
Date of Acceptance: 13-Dec-2020
URI: http://hdl.handle.net/10044/1/84881
DOI: 10.1016/j.cmi.2020.12.013
ISSN: 1198-743X
Publisher: Elsevier
Start Page: 1455
End Page: 1464
Journal / Book Title: Clinical Microbiology and Infection
Volume: 27
Issue: 10
Sponsor/Funder: ESRC
Economic & Social Research Council (ESRC)
National Institute for Health Research
Funder's Grant Number: ES/P008313/1
NF-SI-0617-10176
Keywords: Antibiotic prescribing
Ethnography
Infection control
Low- and middle-income country
Surgery
ASPIRES co-investigators
1103 Clinical Sciences
1117 Public Health and Health Services
Microbiology
Publication Status: Published
Online Publication Date: 2021-01-07
Appears in Collections:Imperial College Business School
Department of Infectious Diseases
Faculty of Medicine



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