Knowledge, perceptions and experiences of nurses in antimicrobial optimization or stewardship in the intensive care unit

J Padigos; S Reid; E Kirby; J Broom

doi:10.1016/j.jhin.2020.12.003

Knowledge, perceptions and experiences of nurses in antimicrobial optimization or stewardship in the intensive care unit

J Hosp Infect. 2021 Mar:109:10-28. doi: 10.1016/j.jhin.2020.12.003. Epub 2020 Dec 5.

Authors

J Padigos¹, S Reid², E Kirby³, J Broom⁴

Affiliations

¹ Intensive Care Unit, Sunshine Coast University Hospital, Birtinya, Queensland, 4551, Australia; Faculty of Medicine, The University of Queensland, Herston, Queensland, 4006, Australia. Electronic address: Junel.Padigos@health.qld.gov.au.
² Faculty of Medicine, The University of Queensland, Herston, Queensland, 4006, Australia.
³ Centre for Social Research in Health, University of New South Wales, Sydney 2052, New South Wales, Australia.
⁴ Faculty of Medicine, The University of Queensland, Herston, Queensland, 4006, Australia; Department of Infectious Diseases, Sunshine Coast University Hospital, Birtinya, Queensland 4551, Australia.

PMID: 33290817
DOI: 10.1016/j.jhin.2020.12.003

Abstract

There is an urgent and recognized need for an interprofessional collaborative approach to support global action in addressing antimicrobial resistance (AMR). Antimicrobial stewardship (AMS) refers to systematic approaches for antimicrobial optimization within healthcare organizations. In areas with high antimicrobial utilization such as intensive care units (ICUs), specific roles for nurses in AMS are not clearly defined. This review aimed to identify and to critically evaluate primary studies that examined knowledge, perspectives and experiences of nurses associated with antimicrobial use and optimization in ICUs. A systematic search of Medline, CINAHL, PsychINFO, EMBASE, PubMed, SCOPUS, Cochrane Library and Web of Science databases for primary studies published from 1^st January 2000 to 20^th March 2020 was performed. A convergent synthesis design was used to synthesize quantitative and qualitative data. Of the 898 studies initially screened, 26 were included. Most (18/26) studies were quantitative. All qualitative studies (6/26) were of high methodological quality. Studies where interventions were used (10/26) identified significant potential for ICU nurses to reduce antimicrobial use, time-to-antibiotic administration, and error rates. Barriers to nursing engagement included knowledge deficits in antimicrobial use, interprofessional dissonance and the culture of deference to physicians. Enhancing education, technology utilization, strong nursing leadership and robust organizational structures that support nurses were perceived as enablers to strengthen their roles in optimizing antimicrobial use. This review showed that nursing initiatives have significant potential to strengthen antimicrobial optimization in ICUs. Barriers and enablers to active engagement were identified.

Keywords: Antimicrobial resistance; Antimicrobial stewardship; Intensive care unit; Interprofessional collaboration; Nurses; Systematic review.

Publication types

Review
Systematic Review

MeSH terms

Anti-Bacterial Agents
Antimicrobial Stewardship*
Health Knowledge, Attitudes, Practice*
Humans
Intensive Care Units*
Nurses*

Substances

Anti-Bacterial Agents