Assessment of antimicrobial stewardship programs and barriers to effective implementation in Ugandan Intensive Care Units

Abstract

Background: Intensive Care Units (ICUs) are at the epicenter of the war against antimicrobial resistance (AMR). Therefore, quality improvement strategies like Antimicrobial stewardship programs (ASPs) that mitigate AMR are an essential component of patient care. Currently there is a lack of information on ASPs in Ugandan ICUs. This study assessed characteristics of ASPs in Ugandan ICUs and any barriers to effective implementation. Objectives: To assess ASPs and the barriers to effective implementation in Ugandan ICUs. Methods: We conducted a mixed- methods cross-sectional study among core members of the ICU teams between August and November 2021. An interviewer administered questionnaire and a topic guide were used to collect data. The data was analysed using descriptive statistics. Results: We enrolled a total of seventeen (17) ICUs from which thirty-four (34) ICU staff were interviewed. The majority were specialist doctors (n=25, 73.5%), the rest being doctors in training (n= 3, 8.8%), general doctors (n= 2, 5.9%), pharmacist (n = 1, 2.9%), nurses (n= 1, 2.9%), and allied staff (n= 1, 2.9%). Of the selected ICUs, 4 (23.5%) had a documented AMS plan, 3 (17.6%) reported the presence of multidisciplinary AMS, and one (5.9%) had a stewardship champion. Standard treatment guidelines (STGs) were found in 4 (23.5%) ICUs and only 1(5.9%) ICU used a prospective audit and review strategy. Monitoring & surveillance, reporting and feedback was done in 1 ICU. The barriers to effective implementation of ASPs were: poorly enacted national stewardship policy, a lack of education and training and a lack of expertise. Conclusion: This study found a minority of ICUs in Uganda having ASPs. However, the available ASPs were functionally limited. We recommend that ICU staff are trained and supported in establishment of ASPs by hospital management.