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Clinicians' Perceptions of the Problem of Antimicrobial Resistance in Health Care Facilities
Tara Bridget Giblin, MPH;
Ronda L. Sinkowitz-Cochran, MPH;
Patricia L. Harris, RN, BSN;
Sharon Jacobs, RN, MS, CIC;
Kathy Liberatore, RN, BSN, CIC;
Marsha A. Palfreyman, RN, MS, CIC;
Edward I. Harrison, MBA;
Denise M. Cardo, MD; for the CDC Campaign to Prevent Antimicrobial Resistance Team
Arch Intern Med. 2004;164:1662-1668.
Background Many clinicians do not comply with guidelines regarding antimicrobial resistance (AR). In response, the Centers for Disease Control and Prevention developed a national Campaign to Prevent Antimicrobial Resistance in Healthcare Settings that presents 4 strategies and 12 evidence-based steps.
Methods To assess clinicians' perceptions of AR, barriers and facilitators to preventing AR, and how best to reach clinicians, a questionnaire and 4 focus groups were conducted after presentation of the Campaign at 4 Pittsburgh Regional Healthcare Initiative hospitals.
Results One hundred seventeen clinicians completed the questionnaire; 28 participated in the focus groups. Clinicians were significantly more likely to perceive that AR was a problem nationally than in their own institution (95% vs 77%; P<.001) or practice (95% vs 65%; P = .002), consistent with focus group results (93% nationally vs 46% institution or practice). The 3 Campaign steps with the most barriers to implementation were "Treat infection, not colonization" (35%), "Stop treatment when infection is cured or unlikely" (35%), and "Practice antimicrobial control" (33%). Clinicians in the focus groups cited the additional barriers of the health care culture, lack of knowledge, and the nursing shortage; facilitators included education, information technology, and consults. Computer programs, posters, and local data were suggested for reaching clinicians about AR.
Conclusions Clinicians perceive AR to be a complex national problem but less relevant to their own institution or practice. Providing clinicians with information and steps for preventing AR, as in the Campaign, may affect their perceptions of the problem and motivate them to take actions to ensure patient safety.
From the Division of Healthcare Quality Promotion, National Center for Infectious Diseases, Centers for Disease Control and Prevention, US Department of Health and Human Services, Atlanta, Ga (Mss Giblin and Sinkowitz-Cochran and Dr Cardo); Department of Infection Control, the University of Pittsburgh Medical Center (Ms Harris), Department of Infection Control, St Clair Memorial Hospital (Ms Jacobs), and Department of Infection Control, Monongahela Valley Hospital (Ms Liberatore), Pittsburgh, Pa; Department of Infection Control, the Washington Hospital, Washington, Pa (Ms Palfreyman); and the Pittsburgh Regional Healthcare Initiative (Mr Harrison). The authors have no relevant financial interest in this article.
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