A theoretical exploration of the implementation of antimicrobial stewardship programmes in the United Arab Emirates.

Hashad, Nortan

Abstract

Antimicrobial resistance (AMR) is considered a global health threat and one of the most pressing public health issues. The World Health Organization (WHO) outlined actions to combat the AMR risk including optimising the use of antimicrobials through the introduction of Antimicrobial Stewardship Programmes (ASP). Many collaborative groups have produced bundles of actions that can guide ASP implementation. The Center for Disease Prevention and Control (CDC) have produced a framework of seven core elements driven from key ASP studies demonstrating effectiveness in antimicrobial use. The Gulf Cooperation Council (GCC) states responded to the global health threat of AMR by issuing a five pillars strategic plan. In United Arab Emirates (UAE), local healthcare authorities detected the increased prevalence of resistant microbial strains and responded by issuing mandates demanding hospitals to establish ASP teams and actions tailored to their available resources. The overall aim of the doctoral research was to explore ASP implementation in acute care hospitals in UAE. A number of systematic reviews have been published providing evidence on the effectiveness of ASP interventions and its impact on patient and microbiological outcomes, yet none have explored ASP implementation in relation to international standards. Since it is well recognised that ASP interventions can vary greatly across geographical regions, the need for a systematic review exploring ASP implementation in the GCC region has emerged. The first phase of this doctoral research was a systematic review of 17 studies that aimed to critically appraise and synthesise the evidence of ASP implementation in GCC hospitals in comparison to the CDC framework and identify key facilitators and barriers. The CDC framework was the international standard of choice given its value as a reference point for many GCC hospitals and based on multiple effectiveness studies that used it to identify gaps in ASP implementation in acute care hospitals. Mapping to the CDC framework identified key areas of strengths and weaknesses in reporting implementation where infrastructure elements reporting was heterogeneous and insufficient. It also identified the need for rigorous qualitative in-depth research that utilises implementation frameworks to facilitate identification and understanding of factors that influence the translation of ASP research findings into practice within the healthcare sector in GCC states. The second phase of this doctoral research aimed to explore key stakeholders' perspectives of ASP implementation in UAE hospitals, with a focus on facilitators and barriers. A qualitative study was conducted underpinned by the Consolidated Framework for Implementation Research (CFIR) and involving semi-structured interviews with ASP key stakeholders from UAE hospitals. Data saturation was achieved at the completion of 31 interviews. Multiple CFIR constructs emerged as facilitators (such as stakeholders' engagement and effective communication) or barriers (such as perceived ASP complexity and blame culture) for ASP implementation, which highlighted the value of employing theory as an underpinning in comparison to studies without any theoretical underpinning. Coronavirus Disease 2019 (COVID-19) highly impacted data collection during phase two. Participants' perspectives on the impact of COVID-19 on ASP implementation were separately analysed and presented. The study identified the complexity of ASP implementation which led to initial disruption of the service, yet successful evolvement and restoration of ASP services reflects the high value and adaptability of ASP implementation in UAE hospitals. Future research should focus on obtaining consensus agreement of ASP key stakeholders on recommendations for ASP implementation based on findings of the systematic review and the qualitative study.

Citation

HASHAD, N. 2024. A theoretical exploration of the implementation of antimicrobial stewardship programmes in the United Arab Emirates. Robert Gordon University, PhD thesis. Hosted on OpenAIR [online]. Available from: https://doi.org/10.48526/rgu-wt-2565314

• Thesis Type: Thesis
• Deposit Date: Nov 1, 2024
• Publicly Available Date: Nov 1, 2024
• DOI: https://doi.org/10.48526/rgu-wt-2565314
• Keywords: Antimicrobial stewardship; Antimicrobial resistance; Hospitals; United Arab Emirates (UAE)
• Public URL: https://rgu-repository.worktribe.com/output/2565314
• Award Date: Apr 30, 2024