Barriers to the Implementation of Antimicrobial Stewardship Programmes in Long-term Care Facilities: a Scoping Review

Overview

Journal J Antimicrob Chemother

Publisher Oxford University Press

Specialty Infectious Diseases

Date 2024 Jun 13

PMID 38870077

Authors

Costanza Vicentini

Giulia Libero

Eleonora Cugudda

Paolo Gardois

Carla Maria Zotti

Fabrizio Bert

Affiliations

Soon will be listed here.

Abstract

Background: Long-term care facilities (LTCFs) present specific challenges for the implementation of antimicrobial stewardship (AMS) programmes. A growing body of literature is dedicated to AMS in LTCFs.

Objectives: We aimed to summarize barriers to the implementation of full AMS programmes, i.e. a set of clinical practices, accompanied by recommended change strategies.

Methods: A scoping review was conducted through Ovid-MEDLINE, CINAHL, Embase and Cochrane Central. Studies addressing barriers to the implementation of full AMS programmes in LTCFs were included. Implementation barriers described in qualitative studies were identified and coded, and main themes were identified using a grounded theory approach.

Results: The electronic search revealed 3904 citations overall. Of these, 57 met the inclusion criteria. All selected studies were published after 2012, and the number of references per year progressively increased, reaching a peak in 2020. Thematic analysis of 13 qualitative studies identified three main themes: (A) LTCF organizational culture, comprising (A1) interprofessional tensions, (A2) education provided in silos, (A3) lack of motivation and (A4) resistance to change; (B) resources, comprising (B1) workload and staffing levels, (B2) diagnostics, (B3) information technology resources and (B4) funding; and (C) availability of and access to knowledge and skills, including (C1) surveillance data, (C2) infectious disease/AMS expertise and (C3) data analysis skills.

Conclusions: Addressing inappropriate antibiotic prescribing in LTCFs through AMS programmes is an area of growing interest. Hopefully, this review could be helpful for intervention developers and implementers who want to build on the most recent evidence from the literature.

Citing Articles

Nursing home nurses' opinion profiles on the potential evolution of their role in antimicrobial stewardship and associated factors: a national cross-sectional study in France.

Ishara-Nshombo E, Bridey C, Pulcini C, Thilly N, Bocquier A JAC Antimicrob Resist. 2024; 6(6):dlae189.

PMID: 39568729 PMC: 11577609. DOI: 10.1093/jacamr/dlae189.

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