Antimicrobial Resistance Safety Stewardship (AMSS): empowering healthcare workers through quality management

Background Quality management (QM) by monitoring quality and safety performance has become essential in recent years. Because of the increasing threat antimicrobial resistance (AMR) poses on the sustainability of modern healthcare, monitoring and providing feedback on performance of antimicrobial resistance safety stewardship (AMSS) is crucial. AMSS comprises all AMR-relevant tasks of healthcare workers (HCW), such as timely and adequate diagnostics, treatment, infection control, logistics, and outbreak management. HCW are expected to take a proactive role in AMSS QM. However, little guidance is provided on how to monitor and provide feedback on AMSS-performance, which is currently only organised for infection control by infection control professionals (ICP). Therefore, this qualitative study in a regional hospital in the Netherlands (687 beds) focused on exploring ICP’ and HCW’ attitudes towards and needs for AMSS-performance monitoring and feedback.Methods A focus group with ICP (n=6) and individual interviews with HCW (n=6 medical specialists; n=5 residents; and n=5 nurses) were held about current AMSS quality management, attitudes towards and needs for monitoring and feedback, and expected effects on quality and safety of care. The interviews were held at the Emergency Room, Intensive Care, Surgery and Urology departments, because of the high emergence of AMR/infections and vulnerable patients treated. A multidisciplinary research team created the focus group and interview schemes, and both were tested with a clinical microbiologist, an ICP and a nurse to assure clarity. The focus group and interviews were recorded, transcribed verbatim and inductively coded. The code scheme was discussed within the research team to define overarching themes. The University’s ethical committee (BCE18321) ethically approved this study.Outcome Currently, HCW don’t play an active role in AMSS QM. ICP and HCW favour improving the proactive role of HCW in AMSS QM to improve all aspects of their daily work that determine the quality of AMSS. To do so, HCW need feedback on AMSS-guideline-adherence, patient outcomes, HRMO contamination and resistance patterns over time. HCW require insights in their AMSS-performance, because it likely raises awareness and promotes competition, which expectedly leads to desired behaviour-changes and thus improved AMSS quality. However, AMSS QM heavily depends on a safe communication culture, in which feedback on each other’s behaviour can be provided. Some still experience hierarchy as a barrier for effective communication. Therefore, HCW believe that feedback should be positive and include a good sense of humour to have optimal effect. This can be facilitated by incorporating feedback in structural topic-driven discussions and targeted training.Conclusion Infection control professionals and healthcare workers should cooperate to support HCW’ proactive role in improving their AMSS-performance, which in turn will improve the quality and safety of care for patients and limit AMR. AMSS QM is expected to support HCW in taking ownership of AMSS, because it shows where improvements are required. One of the biggest challenges for AMSS QM is creating a safe and open culture, which requires long-term efforts. Having objective AMSS performance measures would help to discuss AMSS more easily. This study provided a first step towards empowered HCW through AMSS QM. By incorporating a participatory, holistic, and human centred approach in future development and implementation of AMSS QM, a fit between AMSS-QM, HCW’ needs and the context (i.e. AMSS in hospitals) can be ensured.