斐济殖民地战争纪念医院医护人员对抗微生物药物耐药性认识、态度和准备情况：一项干预前后研究。
Knowledge, attitudes, and readiness about critical antimicrobial resistant organisms among healthcare workers at colonial war memorial hospital in Fiji: a pre and post intervention study.
机构信息
The Royal Melbourne Hospital, 300 Grattan Street, Melbourne, VIC, 3052, Australia.
Department of Infectious Diseases, The University of Melbourne, The Peter Doherty Institute for Infection and Immunity, 792 Elizabeth Street, Melbourne, VIC, 3000, Australia.
出版信息
Antimicrob Resist Infect Control. 2024 Sep 4;13(1):98. doi: 10.1186/s13756-024-01439-9.
BACKGROUND
Gram-negative bacteria resistant to carbapenems are also known as critical antimicrobial resistant organisms. Their emergence at Colonial War Memorial Hospital (CWMH), the largest hospital in Fiji, is a major clinical concern. This study was conducted to determine the knowledge, attitudes, and readiness of healthcare workers (HCW) at CWMH regarding management of patients with infections caused by critical antimicrobial resistant organisms.
METHODS
A questionnaire was designed using a Likert scale to assess knowledge, attitudes, and readiness. Two cross-sectional studies were conducted, before and after the implementation of targeted educational activities which were informed by the pre-intervention study findings.
RESULTS
A total of 393 and 420 HCW participated in the pre- and post-intervention studies, respectively. The majority of respondents were female (77.3%) and 18-34 years of age (67%). HCW professional roles included nurses (56.3%), doctors (31.6%), and laboratory personnel (12.2%). In the post-intervention study, significantly more HCW reported having received infection prevention and control (IPC) and antimicrobial resistance education and training (26.8% in pre to 45.5% in post intervention, p < 0.001). The majority of nurses and doctors (> 85% to ≥ 95%) were aware of how AMR organisms spread in healthcare settings and knew the IPC measures to prevent transmission of AMR infections including hand hygiene, standard and transmission-based precautions. Attitudes towards AMR were positive, with 84.2% pre intervention and 84.8% of HCW post intervention expressing their willingness to change their work environment to assist with AMR prevention. Perceived readiness to address the problem showed mixed results. Improvements in laboratory AMR surveillance data availability were noted (29.4-52.4%, p < 0001). Modest improvement in the hospital's capacity for outbreak response (44-51.9%, p = 0.01), and treatment of AMR infections (38.9-44.4%, p = 0.01) was reported.
CONCLUSIONS
Our data revealed high levels of staff awareness and knowledge about AMR and IPC. However, readiness for outbreak response and treatment of critical AMR infections requires more attention. Improving AMR prevention and containment in CWMH will likely require sustained and multisectoral interventions with strong administrative commitment.
背景
对碳青霉烯类药物耐药的革兰氏阴性菌也被称为关键的抗微生物药物耐药生物体。它们在斐济最大的医院殖民地纪念医院（CWMH）的出现是一个主要的临床关注点。这项研究旨在确定 CWMH 的医护人员（HCW）在管理由关键抗微生物药物耐药生物体引起的感染患者方面的知识、态度和准备情况。
方法
使用李克特量表设计了一份问卷，以评估知识、态度和准备情况。在实施以干预前研究结果为依据的有针对性的教育活动之前和之后，进行了两项横断面研究。
结果
共有 393 名和 420 名 HCW 分别参加了干预前和干预后研究。大多数受访者是女性（77.3%），年龄在 18-34 岁之间（67%）。HCW 的专业角色包括护士（56.3%）、医生（31.6%）和实验室人员（12.2%）。在干预后研究中，报告接受感染预防和控制（IPC）以及抗微生物药物耐药教育和培训的 HCW 明显更多（干预前为 26.8%，干预后为 45.5%，p<0.001）。大多数护士和医生（>85%至≥95%）了解 AMR 生物体在医疗环境中的传播方式，并知道预防 AMR 感染传播的 IPC 措施，包括手卫生、标准和基于传播的预防措施。对 AMR 的态度是积极的，干预前有 84.2%的 HCW 和干预后有 84.8%的 HCW 表示愿意改变工作环境以协助预防 AMR。对解决问题的准备情况的看法则好坏参半。注意到实验室 AMR 监测数据的可用性有所提高（29.4-52.4%，p<0.0001）。据报道，医院对爆发的反应能力（44-51.9%，p=0.01）和治疗 AMR 感染（38.9-44.4%，p=0.01）的能力略有提高。
结论
我们的数据显示，员工对抗微生物药物耐药性和 IPC 的认识和知识水平很高。然而，爆发应对和治疗关键 AMR 感染的准备情况需要更多关注。改善 CWMH 的 AMR 预防和控制可能需要持续的、多部门的干预措施，并需要强有力的行政承诺。
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