TY - JOUR
T1 - Defining and responding to the contextual drivers for implementation of antimicrobial stewardship in 14 neonatal units in South Africa
AU - the NeoAMS Study Team
AU - Van Den Bergh, Dena
AU - Charani, Esmita
AU - Dramowski, Angela
AU - Annor, Ama Sakoa
AU - Gijzelaar, Michelle
AU - Messina, Angeliki
AU - Van Jaarsveld, Andriette
AU - Goff, Debra A.
AU - Prusakov, Pavel
AU - Balfour, Liezl
AU - Bekker, Adrie
AU - Cassim, Azraa
AU - Govender, Nelesh P.
AU - Holgate, Sandi L.
AU - Kolman, Sonya
AU - Tootla, Hafsah
AU - Schellack, Natalie
AU - Reddy, Kessendri
AU - Fisher, Christine
AU - Conradie, Lucinda
AU - Van Niekerk, Anika
AU - Laubscher, Anje
AU - Alexander, Pearl
AU - Naidoo, Thanusha
AU - Dippenaar, Magdel
AU - Bamford, Colleen
AU - Brits, Sharnel
AU - Chirwa, Pinky
AU - Erasmus, Hannelie
AU - Ekermans, Pieter
AU - Rungen, Lerina
AU - Kriel, Teresa
AU - Mawela, Dini
AU - Mjekula, Simthembile
AU - Nchabeleng, Maphoshane
AU - Nhari, Ronald
AU - Janse Van Rensburg, Marli
AU - Sánchez, Pablo J.
AU - Brink, Adrian
AU - Cassim, Azraa
AU - Nakwa, Firdose
AU - Thomas, Reenu
AU - Van Kwawegen, Alison
AU - Wadula, Jeannette
AU - Annor, Ama Sakoa
AU - Mawela, Dini
AU - Moncho, Masego
AU - Motau, Martha Tshipo
AU - Nchabeleng, Maphoshane
AU - Brits, Sharnel
N1 - Publisher Copyright:
© The Author(s) 2025.
PY - 2025/2/1
Y1 - 2025/2/1
N2 - Background: Research on the contextual drivers of antimicrobial stewardship (AMS) programme interventions in neonatal units is limited. Methods: As part of a prospective mixed-methods multidisciplinary neonatal AMS (NeoAMS) interventional study in 14 South African hospitals, we applied a three-phased process to assess implementation barriers and contextual drivers experienced by participating health professionals. The study included: (Phase one; P1) a survey of pre-intervention barriers and enablers; (P2) written feedback during the study intervention phase; and (P3) semi-structured exit interviews. Results: Respondents to the P1 survey (n = 100) identified 15 barriers, 9 in the domain of personnel resources, including staffing, time and workload constraints. Other barriers related to limited access to antimicrobial use and surveillance trends, complexity of neonatal care, absence of multidisciplinary team (MDT) AMS and change resistance. For P2, written feedback during implementation (n =42) confirmed that the MDT approach facilitated systems changes, including policy adaptations, process improvements, strengthened infection control practices, and expansion of AMS MDT roles. MDT benefits were described as aligned team purpose, improved communication, and knowledge sharing. Reported challenges included time to meet and building trust. In P3 interviews (n = 42), improved interpersonal communication, trust, personal growth and confidence building were cited as highlights of working in multidisciplinary AMS teams. Extending the MDT approach to other hospitals, training more health professionals in AMS and increasing management involvement were identified as priorities going forward. Conclusions: Understanding the organizational and interprofessional context for NeoAMS implementation enabled an MDT approach to develop and optimize neonatal AMS with potential for adoption in similar resource-constrained settings.
AB - Background: Research on the contextual drivers of antimicrobial stewardship (AMS) programme interventions in neonatal units is limited. Methods: As part of a prospective mixed-methods multidisciplinary neonatal AMS (NeoAMS) interventional study in 14 South African hospitals, we applied a three-phased process to assess implementation barriers and contextual drivers experienced by participating health professionals. The study included: (Phase one; P1) a survey of pre-intervention barriers and enablers; (P2) written feedback during the study intervention phase; and (P3) semi-structured exit interviews. Results: Respondents to the P1 survey (n = 100) identified 15 barriers, 9 in the domain of personnel resources, including staffing, time and workload constraints. Other barriers related to limited access to antimicrobial use and surveillance trends, complexity of neonatal care, absence of multidisciplinary team (MDT) AMS and change resistance. For P2, written feedback during implementation (n =42) confirmed that the MDT approach facilitated systems changes, including policy adaptations, process improvements, strengthened infection control practices, and expansion of AMS MDT roles. MDT benefits were described as aligned team purpose, improved communication, and knowledge sharing. Reported challenges included time to meet and building trust. In P3 interviews (n = 42), improved interpersonal communication, trust, personal growth and confidence building were cited as highlights of working in multidisciplinary AMS teams. Extending the MDT approach to other hospitals, training more health professionals in AMS and increasing management involvement were identified as priorities going forward. Conclusions: Understanding the organizational and interprofessional context for NeoAMS implementation enabled an MDT approach to develop and optimize neonatal AMS with potential for adoption in similar resource-constrained settings.
UR - http://www.scopus.com/inward/record.url?scp=85216562884&partnerID=8YFLogxK
U2 - 10.1093/jacamr/dlae222
DO - 10.1093/jacamr/dlae222
M3 - Article
C2 - 39872681
AN - SCOPUS:85216562884
SN - 2632-1823
VL - 7
JO - JAC-Antimicrobial Resistance
JF - JAC-Antimicrobial Resistance
IS - 1
M1 - dlae222
ER -
