Second UK-Russia roundtable discussion «Antimicrobial resistance (AMR): actions, plans, implementation» CURRENT STEWARDSHIP AND EDUCATIONAL ACTIVITY IN RUSSIA FINDINGS FROM A SURVEY Ivan Palagin Institute of Antimicrobial Chemotherapy (IAC), Smolensk State Medical University 20-21 February 2017, Moscow, Russia
Purpose of the survey to define and make recommendations for an educational training framework Development and implementation of interventions that will improve effective prescribing Reduce antibiotic resistance rate across Russia
Murmansk Yakutsk Krasnodar Ekaterinburg Novokuznetsk Ulan-Ude Krasnodar (n=637) Murmansk (n=191) Yakutsk (n=239) Ulan-Ude (n=160) Novokuznetsk (n=52) Ekaterinburg (n=79) Total number of surveyed - 1358
Public or governmental hospital 97.7% Primary care center (outpatient department) 1.6% Perinatal / maternity welfare clinic 0.4% Private hospital 0.2% Research organization 0.1%
53% Part of your job in relation to antimicrobials: Prescribe 33% 42% Monitor the need and appropriateness of the antimicrobial during therapy 16% Teach about infection diagnosis and treatment 6% Develop antimicrobial prescribing policy and guidelines 2% Purchase 1% None of the above 60% 1% 1% 3% Nurse Doctor Microbiologist Pharmacist Other
Therapy 31% Surgery Intensive care medicine 20% 19% Obstetrics/ Gynaecology 11% Microbiology 4% Healthcare admin 2% Clinical pharmacology Pharmacy Epidemiology 1% 1% 0.4% Other 10% No answer 0.2%
HAVE YOU RECEIVED UNDERGRADUATE EDUCATION OR TRAINING IN ANTIMICROBIAL STEWARDSHIP? YES 57% NO 34% NOT SURE 5% NOT RELEVANT 2% No answer 2% HAVE YOU RECEIVED POSTGRADUATE EDUCATION OR TRAINING IN ANTIMICROBIAL STEWARDSHIP? YES 39% NO 52% NOT SURE 5% NOT RELEVANT 1% No answer 3% Who was the training provided by? Employing hospital 28% Medical university or college 22% Conference 13% Professional organisation (society) 5% Another hospital 4% National or regional governmental agency 4% Pharmaceutical company 3%
ROLE OF MICROBIOLOGISTS IN INSTITUTION / ORGANISATION Do microbiologists have clinical component of work (ward rounds, prescribing etc.)? YES 47% NO 37% NOT SURE 14% NO ANSWER 2% Are the microbiologists based largely in the microbiological laboratory? YES 64% NO 6% NOT SURE 9% NO ANSWER 21%
ANTIMICROBIAL STEWARDSHIP IN INSTITUTION / ORGANISATION Is there a committee or group for infection control and/or antimicrobial stewardship? YES 73% NO 11% NOT SURE 14% NO ANSWER 2%
ANTIMICROBIAL STEWARDSHIP IN INSTITUTION / ORGANISATION Does it have initiatives or interventions that target antimicrobial prescribing? YES 69% NO 12% NOT SURE 16% NO ANSWER 3%
ANTIMICROBIAL STEWARDSHIP IN INSTITUTION / ORGANISATION Role of healthcare professionals in antimicrobial stewardship Doctors 81% Microbiologists 63% Pharmacists 62% Epidemiologists 58% Clinical pharmacologists 7% Nurses 7%
EDUCATION IN ANTIMICROBIAL STEWARDSHIP IN INSTITUTION / ORGANISATION Is there a formal strategy or framework for developing and delivering education and training in antimicrobial stewardship? YES 63% NO 14% NOT SURE 20% NO ANSWER 3%
DO HEALTHCARE WORKERS RECEIVE EDUCATION OR TRAINING IN ANTIMICROBIAL STEWARDSHIP? At induction During employment YES NO NOT SURE 24% 55% 17% 57% 25% 15% NO ANSWER 4% 3%
IS EDUCATION OR TRAINING IN ANTIMICROBIAL STEWARDSHIP MANDATORY? At induction During employment YES NO NOT SURE NOT RELEVANT 16% 32% 14% 1% 50% 4% 8% 1% NO ANSWER 37% 37%
Covered topics At induction During employment Minimize unnecessary prescribing of antimicrobials 18% 34% Ensure adequate and prompt timing of antimicrobial administration 23% 38% Ensure appropriate duration of antibiotic treatment and duration as a driver for resistance 19% 34% Adopt necessary infection prevention and control measures 22% 49% Intravenous administration only in severely ill and/or unable to tolerate oral treatment 13% 33% Obtain biological samples for microscopy, culture and sensitivity testing 14% 38% Review micro results daily, deescalate to narrow-spectrum treatment promptly 8% 16% Review intravenous treatment daily, switch to oral route promptly 8% 16% Therapeutic drug monitoring, following adequate and/or adjusted dosing 12% 20% Require single dose surgical prophylaxis regimens as appropriate 9% 18% The role of pharmacokinetics and/or pharmacodynamics in optimising prescribing The role of behaviour change and improvement science in supporting better prescribing 9% 14% 5% 10%
At induction During employment Face-to-face lectures and presentations 17% 55% Face-to-face workshops and seminars 9% 29% Providing with clinical guidelines, recommendations and printed materials 17% 41% On the job learning or learning from practice 17% 4% Web-based or e-learning 4% 8% Mixed methods 5% 9%
How often is it provided? ANNUALLY OR MORE FREQUENTLY 30% ONCE IN 1-2 YEARS 20% ONCE IN 2-5 YEARS 2% AD HOC 10% No answer 38% Is attendance at this education formally recorded? YES 45% NO 5% NOT SURE 13% No answer 37%
1 2 3 4 5 39 22 Isolation as a single topic 10 6 7 41 As a part of infection prevention/control education or training 14 6 9 14 34 As a part of public health education or training 16 11 9 9 As a part of patient safety/quality improvement education or training 25 16 8 12 20
Scale from 1 to 5 with 5 having the greatest importance, % 1 2 3 4 5 1 2 3 4 5 Minimize unnecessary prescribing of antimicrobials, Range (9% - 46%) Administration routes (e.g. intravenous only in severely ill and/or unable to tolerate oral treatment), Range (11% - 33%) Ensure adequate and prompt timing of antimicrobial administration Range (6% - 56%) Ensure appropriate duration of AB treatment and duration as a driver for resistance, Range (8% - 46%) Adopt necessary infection prevention and control measures, Range (5% - 48%) Obtaining of biological samples for microscopy, culture and sensitivity testing, Range (9% - 42%) Therapeutic drug monitoring, adequate and/ or adjusted dosing control, Range (15% - 32%)
Scale from 1 to 5 with 5 having the greatest importance, % 1 2 3 4 5 1 2 3 4 5 Review micro results daily, de-escalate to narrowspectrum antibiotic promptly Range (13% - 21%) Role of pharmacokinetics and/or pharmacodynamics in optimising prescribing Range (29% - 17%) Review intravenous treatment daily, switch to oral route promptly Range (15% - 25%) Require single dose prophylaxis regimens as appropriate, Range (22% - 20%) Role of behaviour change and improvement science in supporting better prescribing, Range (30% - 13%)
1 2 3 4 5 1 2 3 4 5 Face-to-face lectures, Range (15% - 54%) Web-based or e-learning, Range (29% - 13%) Face-to-face workshops and seminars, Range (15% - 37%) Articles and books, Range (20% - 22%) Provide clinical guidelines, recommendations and printed materials, Range (11% - 30%) Mixed methods, Range (23% - 20%) On the job learning or learning from practice, Range (10% - 40%)
Scale from 1 to 5 with 5 having the greatest responsibility, % 1 2 3 4 5 1 2 3 4 5 Employing hospital, Range (4% - 71%) Professional organisation (society), Range (22% - 13%) Employees own responsibility/commitment, Range (28% - 25%) Private healthcare company, Range (45% - 3%) Another hospital, Range (43% - 13%) Pharmaceutical company, Range (40% - 6%) Medical university or college, Range (13% - 23%) National or regional governmental agency, Range (10% - 43%)
Do you think measuring staff participation in education activity should be a metric/indicator for antimicrobial stewardship? YES 78% NO 7% NOT SURE 14% No answer 1%
Are you aware of the global free open online course on antimicrobial stewardship www.futurelearn.com/courses/antimicrobial-stewardship? YES 14% NO 82% NOT SURE 3% Have you participated in that BSAC online course? YES 3% NO 93% NOT SURE 2% Would translation of this course into Russian increase participation in the course? YES 80% NO 9% NOT SURE 9% No answer 1% No answer 2% No answer 2%
ACKNOWLEDGEMENTS COORDINATORS IN THE CENTERS: Nizhegorodtseva Irina (Krasnodar) Gordeeva Svetlana (Murmansk) Portnyagina Ulyana (Yakutsk) Burasova Elena (Ulan-Ude) Domanskaya Olga (Novokuznetsk) Bagin Vladimir (Ekaterinburg)