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Etiquette of the antibiotic decision-making process for surgical prophylaxis in Ethiopia: a triangulated ethnographic study.
Alemkere, Getachew; Tegegne, Gobezie T; Molla, Getnet Abebe; Belayneh, Alemu; Muzeyin, Hanan; Shewarega, Wendwosen; Degefaw, Yidnekachew; Melkie, Addisu; Getahun, Workineh; Tadeg, Hailu; Alemayehu, Abebe; Girma, Eshetu; Amogne, Wondwossen.
Afiliación
  • Alemkere G; Department of Pharmacology and Clinical Pharmacy, School of Pharmacy, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia.
  • Tegegne GT; USAID Medicines, Technologies, and Pharmaceutical Services Program, Management Sciences for Health, Addis Ababa, Ethiopia.
  • Molla GA; Department of Pharmacology and Clinical Pharmacy, School of Pharmacy, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia.
  • Belayneh A; Department of Surgery, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia.
  • Muzeyin H; Department of Pharmacology and Clinical Pharmacy, School of Pharmacy, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia.
  • Shewarega W; Department of Pharmacology and Clinical Pharmacy, School of Pharmacy, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia.
  • Degefaw Y; Antimicrobial Resistance Prevention and Control Case Team, Pharmaceuticals and Medical Devices Lead Executive Office, Ministry of Health, Addis Ababa, Ethiopia.
  • Melkie A; Antimicrobial Resistance Prevention and Control Case Team, Pharmaceuticals and Medical Devices Lead Executive Office, Ministry of Health, Addis Ababa, Ethiopia.
  • Getahun W; Division of Nephrology, Department of Internal Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia.
  • Tadeg H; USAID Medicines, Technologies, and Pharmaceutical Services Program, Management Sciences for Health, Addis Ababa, Ethiopia.
  • Alemayehu A; USAID Medicines, Technologies, and Pharmaceutical Services Program, Management Sciences for Health, Addis Ababa, Ethiopia.
  • Girma E; Department of Surgery, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia.
  • Amogne W; Department of Preventive Medicine, School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia.
Front Public Health ; 11: 1251692, 2023.
Article en En | MEDLINE | ID: mdl-38192548
ABSTRACT

Background:

Prophylactic antibiotics reduce surgery-associated infections and healthcare costs. While quantitative methods have been widely used to evaluate antibiotic use practices in surgical wards, they fall short of fully capturing the intricacies of antibiotic decision-making in these settings. Qualitative methods can bridge this gap by delving into the often-overlooked healthcare customs that shape antibiotic prescribing practices.

Aim:

This study aimed to explore the etiquette of the antibiotic decision-making process of surgical prophylaxis antibiotic use at Tikur Anbessa Specialized Hospital (TASH).

Methods:

The observational study was carried out at TASH, a teaching and referral hospital in Addis Ababa, Ethiopia, from 26 August 2021 to 1 January 2022. Overall, 21 business ward rounds, 30 medical record reviews, and 11 face-to-face interviews were performed sequentially to triangulate and cross-validate the qualitative observation. The data were collected until saturation. The data were cleaned, coded, summarized, and analyzed using the thematic analysis approach.

Result:

Surgical antibiotic prophylaxis (SAP) discussions were infrequent during surgical ward rounds in TASH, leading to practices that deviated from established recommendations. Clear documentation differentiating SAP from other antibiotic uses was also lacking, which contributed to unjustified extended SAP use in the postoperative period. Missed SAP documentation was common for emergency surgeries, as well as initial dose timing and pre-operative metronidazole administration. Importantly, there was no standardized facility guideline or clinical protocol for SAP use. Furthermore, SAP prescriptions were often signed by junior residents and medical interns, and administration was typically handled by anesthesiologists/anesthetists at the operating theater and by nurses in the wards. This suggests a delegation of SAP decision-making from surgeons to senior residents, then to junior residents, and finally to medical interns. Moreover, there was no adequate representation from pharmacy, nursing, and other staff during ward rounds.

Conclusion:

Deeply ingrained customs hinder evidence-based SAP decisions, leading to suboptimal practices and increased surgical site infection risks. Engaging SAP care services and implementing antimicrobial stewardship practices could optimize SAP usage and mitigate SSI risks.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Programas de Optimización del Uso de los Antimicrobianos / Antibacterianos Tipo de estudio: Guideline / Observational_studies / Prognostic_studies / Qualitative_research Límite: Humans País/Región como asunto: Africa Idioma: En Revista: Front Public Health Año: 2023 Tipo del documento: Article País de afiliación: Etiopia Pais de publicación: Suiza
Texto completo
Añadir a Mi BVS
Imprimir
XML
PubMed Links
Buscar en Google

Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Programas de Optimización del Uso de los Antimicrobianos / Antibacterianos Tipo de estudio: Guideline / Observational_studies / Prognostic_studies / Qualitative_research Límite: Humans País/Región como asunto: Africa Idioma: En Revista: Front Public Health Año: 2023 Tipo del documento: Article País de afiliación: Etiopia Pais de publicación: Suiza