Knowledge and perceptions of antimicrobial resistance and antimicrobial stewardship among staff at a national cancer referral center in Uganda

Abstract

Objectives: As access to cancer care has improved throughout sub-Saharan Africa, treatment-associated infections have increased. Assessing healthcare worker knowledge of antimicrobial stewardship and identifying the barriers to infection management will inform the development of contextually appropriate antimicrobial stewardship programs, improving cancer outcomes in sub-Saharan Africa.

Design: Cross-sectional survey.

Setting: The Uganda Cancer Institute (UCI), a national cancer referral center in Kampala, Uganda.

Participants: We surveyed 61 UCI staff: 29 nurses, 7 pharmacists, and 25 physicians.

Methods: The survey contained 25 questions and 1 ranking exercise. We examined differences in responses by staff role.

Results: All 60 respondents who answered the question had heard the term "antimicrobial resistance." Only 44 (73%) had heard the term "antimicrobial stewardship." Nurses were less likely than pharmacists or physicians to be familiar with either term. Also, 41 respondents (68%) felt that loss of antibiotic susceptibility is a major issue at UCI. Regarding barriers to diagnosing infections, 54 (93%) of 58 thought that it was difficult to obtain blood cultures and 48 (86%) of 56 thought that it was difficult to regularly measure temperatures.

Conclusions: Although most recognized the term "antimicrobial resistance," fewer were familiar with the term "antimicrobial stewardship." Inappropriate antibiotic use was recognized as a contributor to antimicrobial resistance, but hand hygiene was underrecognized as a contributing factor. We identified numerous barriers to diagnosing infections, including the ability to obtain blood cultures and consistently monitor temperatures. Educating staff regarding antimicrobial selection, allocating resources for blood cultures, and implementing strategies to enhance fever detection will improve infection management.

Fig. 1.

Factors that physicians, pharmacists, and nurses working at the Uganda Cancer Institute (UCI) perceive as contributing to antimicrobial resistance at the UCI. Percentages shown next to bars represent the combined total percentage of respondents reporting that the factor does not or usually does not contribute (left of bars, main chart), occasionally or frequently contributes (right of bars, main chart), or neither contributes nor does not contribute (right of neutral chart).

Fig. 2.

Factors that physicians, pharmacists, and nurses working at the Uganda Cancer Institute consider to be important when choosing antibiotics to treat infections. Percentages shown next to bars represent the combined total percentage of respondents reporting that the factor is somewhat or very unimportant (left of bars, main chart), somewhat or very important (right of bars, main chart), or neither important nor unimportant (right of neutral chart).

Fig. 3.

Sources of antibiotic information for physicians, nurses, and pharmacists working at the Uganda Cancer Institute. Figure 3A shows the current sources of information used when answering specific antibiotic questions. Figure 3B shows the educational formats felt to be useful for future antibiotic training. Results are arranged by median category for frequency of use (3A) or degree of usefulness (3B).

Fig. 4.

Factors that physicians, pharmacists, and nurses working at the Uganda Cancer Institute perceive as limiting the ability to diagnose infections and obtain blood cultures.

Fig. 5.

Interventions that nurses, pharmacists, and physicians perceive to be the most important to improving infection management at the Uganda Cancer Institute. Respondents ranked each intervention based on order of importance, with 1 being the most important and 6 the least important. Respondents who ranked all interventions were included (n = 30).