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Setting up AMS education/training and measuring engagement with training

When educating staff and the public about AMS, there should be an appropriate evaluation of the competencies of trained staff and of the engagement of the public to assess the effectiveness of training.

Education of healthcare workers (HCW) should preferably target all staff and be delivered with the following clusters of competencies in mind:

  • Awareness/prevention of antimicrobial resistance, including infection control (IC) principles.

  • Knowledge of pharmacological principles of antimicrobials, such as pharmacokinetics and pharmacodynamics, and adverse events.

  • Education on basic microbiology principles, such as bug-drug compatibility and selective sensitivity reporting.

  • Basic knowledge of infection management, such as the proper selection of antibiotics according to the site of action.

  • Establishing an ASP and choosing and implementing interventions, mainly antimicrobial restriction, de-escalation, and intravenous to oral switch.

    • You can find out more about intravenous to oral switch with the FutureLearn course on IVOST.

In addition to the above, it is essential to train HCW on the internal guidelines specific to every hospital setting, while emphasising the need to abide by those guidelines. HCW are assessed according to the initial set of competencies and are expected to meet a certain level for every competency. The assessment could be achieved through in-house examinations or comparative questionnaires taken before and after training.

Training methods can be varied and should be tailored to the competencies identified, the target audience, the leader designated to provide the education, and the time allocation. Discussion of real cases is highly encouraged. The main methods described include the following:

  • Pre- and in-service training

  • Face-to-face workshops

  • Blended learning (mix of technology and direct instruction)

  • On-the-job learning

  • E-learning and the role of social media in staying up to date with AMS literature

A summary of learning methods is available as a pdf below and in Figure 1. A summary of learning methods: University, educational workshops, networks, on-the-job training, e-learning, continuing medical education, professional organisations, and other.

In general, active learning methods, such as discussion groups, audit and feedback, and case scenarios are more effective than passive ones (conferences, printed material, and guidelines).

One example of a successful method on the implementation of stewardship principles in a primary care setting is the use of accountable justification and peer comparison as behavioural interventions that resulted in reduced rates of inappropriate prescribing for acute respiratory tract infections.

Another method is encouraging providers to take part in pledging with commitment posters to enable more appropriate antibiotic prescription.

example of a commitment pledge for for physicians to encourage the prescription of antibiotics that comply with stewardship efforts

Click to enlarge or find a pdf version in the see also section below

Educating the public about AMS is as important as educating HCW. Education sessions can be provided by HCW. With the proper training, these sessions may also be given by non-healthcare individuals, such as social advocates or school teachers.

The messages need to conform to the level of health literacy in the community and address the main concerns of the general population. They must be given in lay language and raise awareness concerning the fear of not being on antibiotics and knowledge gaps. The messages should also integrate IC practices such as proper hand hygiene and immunisations.

Awareness videos, posters, advertisements during or away from antibiotic awareness week could be beneficial. An example of public outreach for antimicrobial awareness was a project by the Alliance for the Prudent Use of Antibiotics (APUA-ISAC), where a team of scientists led by a Lebanese microbiologist, prepared workshops for school children. The activities consisted of tangible and fun experiments that aim at introducing children to the microbial world and demonstrating the importance of hand hygiene.

Assessing the engagement of the public with AMS could be through digital outreach or comparative questionnaires. For example, polls/short questionnaires that comprise concise and quick Q&As could be sent online or shared on social media. For example, asking the public a single “True or False” question of “Antibiotics kill viruses as much as bacteria” would help assess the level of knowledge in a population.

Please look at the “see also” section below for further reading on this subject.

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This article is from the free online course:

Antimicrobial Stewardship for the Gulf, Middle East and North Africa

BSAC