Where to start? An example from Nigeria

Hello. I am Dr. Iretiola Fajolu, a consultant paediatrician with the Lagos University Teaching Hospital, a member of the Hospital Antimicrobial Stewardship Committee, and chairman of my departmental Antimicrobial Stewardship Committee. I’ll be talking about when and where to start, using my experience in the department. Where to start. Involving the key stakeholders is important to ensure a successful programme. It is also important to identify the members of your AMS team and keep them informed. It is necessary to have a baseline data to use as a starting point to identify the need for stewardship, and also to measure the success of the programme.

The Hospital Antimicrobial Stewardship Committee made a presentation of the results of the Global Point Prevalence Survey of Antimicrobial Consumption and Resistance to all members of the department. This helped create awareness of the problem of high rates of antimicrobial use in our hospital. A case presentation was also done, which highlighted the gaps in the routine investigations and antibiotic management of infections in our department. A commencement for an intervention to improve antibiotic prescribing was obtained from all members, and the Departmental Antimicrobial Stewardship Committee was set up. The members of the department also decided on the stewardship strategy to use and prospective audits, intervention, and feedback was agreed upon.

The duties of the Departmental AMS Committee were to draw up an antibiotic guideline and also to monitor compliance to the guideline and hospital antibiotic policy. Our first challenge was developing the antibiotic guideline. There was no antibiogram to base our choice of antibiotics on, so the first draft was based on existing guidelines from other countries and also on our knowledge of common causative agents and the likely sensitivity. The initial draft was sent to individual members of the department for input, but the response was poor. It was then resent, this time asking for input from units instead of from individuals. This resulted in a better response.

The final draft was then sent out, and we asked that it be used in the departments. This process took some time, and it was almost discouraging. This also coincided with the dissemination of the hospital antibiotic policy. Our next duty was to monitor compliance to the antibiotic guideline and also to the hospital antibiotic policy. The areas of focus were targeted prescription, close prescription, de-escalation, collection of culture samples before commencing antibiotic therapy, and also the use of biomarkers for diagnosing infections. The next challenge, however, was manpower to carry out prospective audits, intervention, and feedback.

We decided to do a study to assess the feasibility of involving medical students for data collection on antibiotic use with the help of a checklist, to reduce the work burden for health care professionals. This was a retrospective review of case notes. It’s afforded the medical students early training and practise in rational antibiotic use. This was found to be feasible and was incorporated as part of the training of medical students in the department. It is now being done as a prospective audit. The aspect of feedback is, however, yet to be assessed, as the programme is still in the early phase, or in the departments. Thank you.