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

the ASPIRES co-investigators

doi:10.1016/j.cmi.2020.12.013

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

the ASPIRES co-investigators

Research output: Contribution to journal › Article › peer-review

30 Citations (Scopus)

Abstract

Objectives: To investigate the drivers for infection management and antimicrobial stewardship (AMS) across high-infection-risk surgical pathways. Methods: A qualitative study—ethnographic observation of clinical practices, patient case studies, and face-to-face interviews with healthcare professionals (HCPs) 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 and August 2019, data were gathered from 190 hours of non-participant observations (138 India, 72 SA), interviews with HCPs (44 India, 61 SA), patients (six India, eight SA), and case studies (four India, two 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 are lacking. Conclusions: Identifying the implicit existing HCP roles in infection management is critical and will facilitate the development of effective and transparent processes across the surgical team for optimized care. Applying a framework approach that includes nurse leadership, empowering pharmacists and engaging surgical leads, is essential for integrated AMS and infection-related care.

Original language	English
Pages (from-to)	1455-1464
Number of pages	10
Journal	CLINICAL MICROBIOLOGY AND INFECTION
Volume	27
Issue number	10
DOIs	https://doi.org/10.1016/j.cmi.2020.12.013
Publication status	Published - Oct 2021

Keywords

Antibiotic prescribing
Ethnography
Infection control
Low- and middle-income country
Surgery

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10.1016/j.cmi.2020.12.013

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@article{6fe01e85b7844a54a61bb276749fca2f,

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

abstract = "Objectives: To investigate the drivers for infection management and antimicrobial stewardship (AMS) across high-infection-risk surgical pathways. Methods: A qualitative study—ethnographic observation of clinical practices, patient case studies, and face-to-face interviews with healthcare professionals (HCPs) 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 and August 2019, data were gathered from 190 hours of non-participant observations (138 India, 72 SA), interviews with HCPs (44 India, 61 SA), patients (six India, eight SA), and case studies (four India, two 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 are lacking. Conclusions: Identifying the implicit existing HCP roles in infection management is critical and will facilitate the development of effective and transparent processes across the surgical team for optimized 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, Ethnography, Infection control, Low- and middle-income country, Surgery",

author = "{the ASPIRES co-investigators} and Sanjeev Singh and Marc Mendelson and Surya Surendran and Candice Bonaconsa and Oluchi Mbamalu and Vrinda Nampoothiri and Adam Boutall and Mark Hampton and Puneet Dhar and Tim Pennel and Carolyn Tarrant and Andy Leather and Alison Holmes and Esmita Charani and Raheelah Ahmad and Enrique Castro-Sanchez and Gabriel Birgand and Jules Ndoli and Franco Sassi and Nick Sevdalis and Ramani Moonesinghe and Reda Lebcir and Ewan Ferlie",

note = "Funding Information: The authors declare that they have no conflicts of interest. This work was supported by the Economic and Social Science Research Council (ESRC) and the National Institute for Health Research, UK Department of Health (HPRU-2012-10047) in partnership with Public Health England. This study is part of the ASPIRES project (Antibiotic use across Surgical Pathways?Investigating, Redesigning and Evaluating Systems) (https://www.imperial.ac.uk/arc/aspires/). ASPIRES aims to address antimicrobial resistance and improve clinical outcomes optimizing antibiotic usage along surgical pathways. The support of ESRC as part of the Antimicrobial Cross Council initiative supported by the seven UK research councils, and also the support of the Global Challenges Research Fund, is gratefully acknowledged. The funders had no role in the design and conduct of the study, in the collection, management, analysis, review or approval of the manuscript, or in the decision to submit the manuscript for publication. Funding Information: The authors declare that they have no conflicts of interest. This work was supported by the Economic and Social Science Research Council (ESRC) and the National Institute for Health Research , UK Department of Health ( HPRU-2012-10047 ) in partnership with Public Health England. This study is part of the ASPIRES project (Antibiotic use across Surgical Pathways—Investigating, Redesigning and Evaluating Systems) ( https://www.imperial.ac.uk/arc/aspires/ ). ASPIRES aims to address antimicrobial resistance and improve clinical outcomes optimizing antibiotic usage along surgical pathways. The support of ESRC as part of the Antimicrobial Cross Council initiative supported by the seven UK research councils, and also the support of the Global Challenges Research Fund, is gratefully acknowledged. The funders had no role in the design and conduct of the study, in the collection, management, analysis, review or approval of the manuscript, or in the decision to submit the manuscript for publication. Publisher Copyright: {\textcopyright} 2021 European Society of Clinical Microbiology and Infectious Diseases Copyright: Copyright 2021 Elsevier B.V., All rights reserved.",

year = "2021",

month = oct,

doi = "10.1016/j.cmi.2020.12.013",

language = "English",

volume = "27",

pages = "1455--1464",

journal = "CLINICAL MICROBIOLOGY AND INFECTION",

issn = "1198-743X",

publisher = "Elsevier Limited",

number = "10",

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TY - JOUR

T1 - Investigating infection management and antimicrobial stewardship in surgery

T2 - a qualitative study from India and South Africa

AU - the ASPIRES co-investigators

AU - Singh, Sanjeev

AU - Mendelson, Marc

AU - Surendran, Surya

AU - Bonaconsa, Candice

AU - Mbamalu, Oluchi

AU - Nampoothiri, Vrinda

AU - Boutall, Adam

AU - Hampton, Mark

AU - Dhar, Puneet

AU - Pennel, Tim

AU - Tarrant, Carolyn

AU - Leather, Andy

AU - Holmes, Alison

AU - Charani, Esmita

AU - Ahmad, Raheelah

AU - Castro-Sanchez, Enrique

AU - Birgand, Gabriel

AU - Ndoli, Jules

AU - Sassi, Franco

AU - Sevdalis, Nick

AU - Moonesinghe, Ramani

AU - Lebcir, Reda

AU - Ferlie, Ewan

N1 - Funding Information: The authors declare that they have no conflicts of interest. This work was supported by the Economic and Social Science Research Council (ESRC) and the National Institute for Health Research, UK Department of Health (HPRU-2012-10047) in partnership with Public Health England. This study is part of the ASPIRES project (Antibiotic use across Surgical Pathways?Investigating, Redesigning and Evaluating Systems) (https://www.imperial.ac.uk/arc/aspires/). ASPIRES aims to address antimicrobial resistance and improve clinical outcomes optimizing antibiotic usage along surgical pathways. The support of ESRC as part of the Antimicrobial Cross Council initiative supported by the seven UK research councils, and also the support of the Global Challenges Research Fund, is gratefully acknowledged. The funders had no role in the design and conduct of the study, in the collection, management, analysis, review or approval of the manuscript, or in the decision to submit the manuscript for publication. Funding Information: The authors declare that they have no conflicts of interest. This work was supported by the Economic and Social Science Research Council (ESRC) and the National Institute for Health Research , UK Department of Health ( HPRU-2012-10047 ) in partnership with Public Health England. This study is part of the ASPIRES project (Antibiotic use across Surgical Pathways—Investigating, Redesigning and Evaluating Systems) ( https://www.imperial.ac.uk/arc/aspires/ ). ASPIRES aims to address antimicrobial resistance and improve clinical outcomes optimizing antibiotic usage along surgical pathways. The support of ESRC as part of the Antimicrobial Cross Council initiative supported by the seven UK research councils, and also the support of the Global Challenges Research Fund, is gratefully acknowledged. The funders had no role in the design and conduct of the study, in the collection, management, analysis, review or approval of the manuscript, or in the decision to submit the manuscript for publication. Publisher Copyright: © 2021 European Society of Clinical Microbiology and Infectious Diseases Copyright: Copyright 2021 Elsevier B.V., All rights reserved.

PY - 2021/10

Y1 - 2021/10

N2 - Objectives: To investigate the drivers for infection management and antimicrobial stewardship (AMS) across high-infection-risk surgical pathways. Methods: A qualitative study—ethnographic observation of clinical practices, patient case studies, and face-to-face interviews with healthcare professionals (HCPs) 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 and August 2019, data were gathered from 190 hours of non-participant observations (138 India, 72 SA), interviews with HCPs (44 India, 61 SA), patients (six India, eight SA), and case studies (four India, two 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 are lacking. Conclusions: Identifying the implicit existing HCP roles in infection management is critical and will facilitate the development of effective and transparent processes across the surgical team for optimized care. Applying a framework approach that includes nurse leadership, empowering pharmacists and engaging surgical leads, is essential for integrated AMS and infection-related care.

AB - Objectives: To investigate the drivers for infection management and antimicrobial stewardship (AMS) across high-infection-risk surgical pathways. Methods: A qualitative study—ethnographic observation of clinical practices, patient case studies, and face-to-face interviews with healthcare professionals (HCPs) 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 and August 2019, data were gathered from 190 hours of non-participant observations (138 India, 72 SA), interviews with HCPs (44 India, 61 SA), patients (six India, eight SA), and case studies (four India, two 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 are lacking. Conclusions: Identifying the implicit existing HCP roles in infection management is critical and will facilitate the development of effective and transparent processes across the surgical team for optimized care. Applying a framework approach that includes nurse leadership, empowering pharmacists and engaging surgical leads, is essential for integrated AMS and infection-related care.

KW - Antibiotic prescribing

KW - Ethnography

KW - Infection control

KW - Low- and middle-income country

KW - Surgery

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U2 - 10.1016/j.cmi.2020.12.013

DO - 10.1016/j.cmi.2020.12.013

M3 - Article

C2 - 33422658

AN - SCOPUS:85100058929

SN - 1198-743X

VL - 27

SP - 1455

EP - 1464

JO - CLINICAL MICROBIOLOGY AND INFECTION

JF - CLINICAL MICROBIOLOGY AND INFECTION

IS - 10

ER -

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

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Keywords

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