Theoretical exploration of development and implementation of antimicrobial stewardship programs in hospitals in the United Arab Emirates: a qualitative study of the perspectives of key stakeholders and health professionals

Abstract

Background and Objective: Antimicrobial Resistance (AMR) has been declared as a public health emergency and has led to the establishment of Antimicrobial Stewardship Programs (ASP) to enhance prudent use of antimicrobials1. In the United Arab Emirates (UAE), ASP has been mandated by some health authorities; yet few studies report ASP implementation in UAE. The aim of this study is to explore ASP development and implementation in hospitals in UAE and to enable characterization of key facilitators, barriers and solutions at the level of both healthcare providers and key stakeholders. Method: A phenomenological qualitative approach has been adopted using semi-structured interviews with three groups of participants; Local health authority representatives, ASP members and practitioners in hospitals. An interview schedule was developed and piloted based on available literature and grounded in the Consolidated Framework for Implementation Research (CFIR). Participants were recruited via purposeful and snowball sampling. Interviews were conducted, audio recorded, transcribed and independently analyzed by two researchers based on CFIR framework2. Main outcome measures: Outcomes included perspective and views of participants from different groups in relation to ASP development and implementation in UAE. Views will be compared to provide recommendations for optimising ASP implementation and development. Results: Thirty-five interviews (approximately 45–60 min) were conducted with authority representatives (n=4), ASP members (n= 23) and hospital practitioners (n=8) with data saturation achieved. ASP development in UAE was driven by various internal and external factors such as international accreditation and AMR data. ASP structure was adapted from international guidelines and influenced by local hospitals with experience in ASP implementation. Adaptations varied depending on local available resources. Facilitators included; leadership support, availability of continuous education and effective communication across the hospital. Barriers included; lack of financial support, lack of human resource mainly infectious disease physicians, clinical pharmacists and microbiologists, and inadequate information technology. The Covid-19 pandemic was considered a significant set-back for ASP activities. Conclusion: ASP implementation in UAE is progressing with potential for more streamlined and future expansion. There is a need to secure financial support, leadership commitment and human resources to accelerate the implementation process.

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https://rgu-repository.worktribe.com/output/1555762