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A recipe for antimicrobial stewardship success: Using intervention mapping to develop a program to reduce antibiotic overuse in long-term care

  • Andrea Chambers (a1), Sam MacFarlane (a1), Rosemary Zvonar (a2), Gerald Evans (a1) (a3), Julia E. Moore (a4), Bradley J. Langford (a1) (a5), Anne Augustin (a1), Sue Cooper (a1), Jacquelyn Quirk (a1), Liz McCreight (a6) and Gary Garber (a1) (a2) (a7) (a8)...

Abstract

Objective

To better understand barriers and facilitators that contribute to antibiotic overuse in long-term care and to use this information to inform an evidence and theory-informed program.

Methods

Information on barriers and facilitators associated with the assessment and management of urinary tract infections were identified from a mixed-methods survey and from focus groups with stakeholders working in long-term care. Each barrier or facilitator was mapped to corresponding determinants of behavior change, as described by the theoretical domains framework (TDF). The Rx for Change database was used to identify strategies to address the key determinants of behavior change.

Results

In total, 19 distinct barriers and facilitators were mapped to 8 domains from the TDF: knowledge, skills, environmental context and resources, professional role or identity, beliefs about consequences, social influences, emotions, and reinforcements. The assessment of barriers and facilitators informed the need for a multifaceted approach with the inclusion of strategies (1) to establish buy-in for the changes; (2) to align organizational policies and procedures; (3) to provide education and ongoing coaching support to staff; (4) to provide information and education to residents and families; (5) to establish process surveillance with feedback to staff; and (6) to deliver reminders.

Conclusions

The use of a stepped approach was valuable to ensure that locally relevant barriers and facilitators to practice change were addressed in the development of a regional program to help long-term care facilities minimize antibiotic prescribing for asymptomatic bacteriuria. This stepped approach provides considerable opportunity to advance the design and impact of antimicrobial stewardship programs.

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Copyright

This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.

Corresponding author

Author for correspondence: Andrea Chambers, Public Health Ontario, 480 University Avenue, Suite 300, Toronto, ON, Canada, M5G 1V2. E-mail: Andrea.Chaplin@oahpp.ca

Footnotes

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Cite this article: Chambers A et al. (2019). A recipe for antimicrobial stewardship success: Using intervention mapping to develop a program to reduce antibiotic overuse in long-term care. Infection Control & Hospital Epidemiology 2019, 40, 24–31. doi: 10.1017/ice.2018.281

Footnotes

References

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A recipe for antimicrobial stewardship success: Using intervention mapping to develop a program to reduce antibiotic overuse in long-term care

  • Andrea Chambers (a1), Sam MacFarlane (a1), Rosemary Zvonar (a2), Gerald Evans (a1) (a3), Julia E. Moore (a4), Bradley J. Langford (a1) (a5), Anne Augustin (a1), Sue Cooper (a1), Jacquelyn Quirk (a1), Liz McCreight (a6) and Gary Garber (a1) (a2) (a7) (a8)...

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