The Antimicrobial Stewardship Program: validation of a tool to assess pharmacists’ perceptions

Authors

DOI:

https://doi.org/10.17058/reci.v15i1.19282

Keywords:

Antimicrobial Stewardship, Drug Resistance, Microbial, Pharmacists, Hospitals, Anti-Bacterial Agents

Abstract

Background and Objectives: The Antimicrobial Stewardship Program has shown satisfactory results in fighting antimicrobial resistance. Despite this, the program does not seem to be consolidated in Brazilian hospitals, which requires an understanding of the factors interfering in its consolidation according to the pharmacists' perspective. No validated tool was found in the literature to meet this objective. The objective of this study was to develop and test a tool for assessing the Antimicrobial Stewardship Program and the obstacles to its implementation in Brazilian hospitals from the perspective of pharmacists. Methods: The tool was developed based on literature searches and experiences in clinical practice. Content validation was carried out by a panel of experts, and semantic validation was done by the target audience. The Validity and Content Index (IVC/Ave) and the Suitability Assessment of Materials (SAM) were used in the data analysis, requiring an IVC/Ave > 90% and SAM > 80% to validate the tool. Results: In its final version, which contained 62 items, an IVC/Ave > 90% was found for all attributes evaluated, and the average SAM was 82%. Conclusion: The tool proved to be suitable for the purpose that led to its development, presenting itself as innovative, accessible, low-cost, and easy to apply by researchers.

Downloads

Download data is not yet available.

Author Biographies

Doctor, Ribeirão Preto School of Nursing, University of São Paulo

Graduated (1999) and obtained her Master's degree (2006) and PhD (2010) in Nursing from the Ribeirão Preto College of Nursing, University of São Paulo (EERP-USP). After graduation, has worked as the Coordinator Nurse (2001-2004) of the Integrated Group of Liver Transplantation from the Clinics Hospital at the School of Medicine of Ribeirão Preto – University of São Paulo (FMRP-USP). From 2004 to 2019 was worked as a Specialized Nurse at EERP-USP and Nurse-Tutor of the Academic League of Organ and Tissue Transplantation of EERP. Is a researcher at the Research Group on Evidence-Based Health Research (EERP-USP) and took part of the Group of Studies on Organ and Tissue Transplantation from 2009 to 2016 (GEDOTT - UNIFESP). Has experience in the fields of Fundamental Nursing and Surgical Nursing, particularly in the healthcare process of adults with acute and chronic-degenerative diseases, acting on the following subjects: liver transplantation, organ transplantation, tissue and organ procurement, perioperative nursing, evidence-based practice, patient education, research, and extension. Member of the International Transplant Nurses Society (ITNS) since 2009 and the Brazilian Association of Organ Transplantation (ABTO) since 2001. Has worked in the Transplant Nursing Department of Brazilian Association of Organ Transplantation (ABTO) for 2008-2009, 2012-2013 and 2014/2015. Serves as a member of the Board of Directors of the International Transplant Nurses Society and of the Department of Transplant Nursing at ABTO (2020-2021).

Doctor, Faculty of Pharmaceutical Sciences of Ribeirão Preto, University of São Paulo

Pharmacist graduated from the Faculty of Pharmaceutical Sciences of Ribeirão Preto at the University of São Paulo (FCFRP-USP), master and doctor in Sciences from FCFRP-USP. Line of research focused on Medicine Use Studies, evaluation of strategies to promote the rational use of medicines, Antimicrobial Stewardship. Professor of the Medicine course at the Faculty of Health Sciences of Barretos Dr. Paulo Prata - FACISB. Participated as a tutor (course II and course IV - 2 edition and 1 edition, 2 three-year period) and tutoring coordinator (course 1 edition) of the training courses of the Basic Care project, qualification of Pharmaceutical Assistance services and integration of care practices in health team, created and developed by HAOC, in partnership with SAPS - MS and CONASEMS since 2019, currently works as a Specialist in Pharmaceutical Clinical Services for Remote Technical Support in Support of the Implementation of Pharmaceutical Care in Primary Care in Counties. Participated in the technical analysis service of the REMUME cast.

Doctor, Institute of Exact and Biological Sciences, Federal University of Ouro Preto

He has a degree in Pharmacy (UFSM - 2008), a Master's degree (2009) and a PhD in Pharmacology from the University of São Paulo (FMRP/USP) (2012) and a post-doctorate in the Division of Nephrology of the Department of Medicine at the University of California, San Francisco (USA, 2013-14), in which he worked with truncated MMP-2 (paste references). He returned as a CNPq Young Talent Attraction Fellow at the Ribeirão Preto School of Nursing/USP (2014-2016), focusing on cardiovascular changes caused by chronic ethanol consumption that increase susceptibility to sepsis. He was a professor of higher education at the Federal University of Alfenas (UNIFAL-MG) (2015-2020), where he continues to be accredited as a permanent advisor (Annex I) and supervises Master's and Doctoral studies in the Postgraduate Program in Pharmaceutical Sciences (PPGCF- UNIFAL-MG). She is currently a professor of higher education at the Federal University of Ouro Preto (2020-current) and a postgraduate professor at Cipharma at UFOP. It carries out research on hypertension, renal ischemia and reperfusion, sepsis and chronic ethanol consumption and analyzes of drugs and new molecules in the possible treatment of these conditions. Focusing on the study of intracellular pathways such as extracellular matrix metalloproteinases and oxidative stress.

Doctor, Faculty of Pharmaceutical Sciences, Federal University of Alfenas

He has a degree in Pharmacy from the Federal University of Alfenas, a master's degree in Pharmaceutical Assistance from the Federal University of Rio Grande do Sul and a PhD in Sciences from the Faculty of Pharmaceutical Sciences of Ribeirão Preto - University of São Paulo. He worked as a technical consultant in the Department of Pharmaceutical Assistance and Strategic Inputs of the Ministry of Health. He coordinated the Training Course in Medication Dispensing (distance learning). He was a tutor on the Pharmaceutical Assistance Management course-UFSC/MS and at PET-Saúde/GraduaSUS. He was Project Coordinator of the National Forum of University Pharmacies (management 2019-2021). He is currently an adjunct professor at the Faculty of Pharmaceutical Sciences at the Federal University of Alfenas. He acts as Coordinator of the Postgraduate Program in Pharmaceutical Assistance (PPGASFAR / UNIFAL-MG) and is accredited as a collaborating professor in the Postgraduate Program in Pharmaceutical Sciences at UNIFAL-MG. Leader of the Research Group on Pharmaceutical Assistance and member of the Research Group on Health Evidence Synthesis. Has experience in the field of Pharmacy (Clinical Pharmacy, Pharmaceutical Services and Pharmaceutical Care subarea).

References

Almeida AS, Baptista PF, Lima TM. Atuação do farmacêutico no gerenciamento de antimicrobianos no Brasil: uma revisão da literatura. Brazilian Journal Health Pharmacy [Internet]. 2022 Outb 17; 4(2):01-20. https://doi.org/10.29327/226760.4.2-1.

Iregbu KC, Nwajiobi-Princewill PI, Medugu N, et al. Antimicrobial Stewardship Implementation in Nigerian Hospitals: Gaps and Challenges. African Journal of Clinical and Experimental Microbiology. 2021 Jan 16; 22(1):60-6. https://www.ajol.info/index.php/ajcem/article/view/203077.

Organização Pan-americana da Saúde. A resistência aos antimicrobianos, fomentada pela pandemia de COVID-19. Informe de Política, Novembro de 2021. 2021. https://iris.paho.org/bitstream/handle/10665.2/55936/OPASCDEAMRCOVID19220006_por.pdf?sequence=1&isAllowed=y.

World Health Organization. Antimicrobial stewardship programs in health-care facilities in low- and middle-income countries: a WHO practical toolkit. Vol. 1. Genebra; 2019. https://www.who.int/publications/i/item/9789241515481.

Lima, M de P, Batista, RS, Moreira, TR, et al. Evaluation of antimicrobial use in the basic health units of Ponte Nova / MG. Ciência E Natura. 2022 May 18; 43, (16). https://doi.org/10.5902/2179460X43575.

Oliveira M, Pereira KDS, Zamberlam RC, et al. Resistência bacteriana pelo uso indiscriminado de antibióticos :uma questão de saúde pública. Rease. 2020 Nov; 6 (11). https://periodicorease.pro.br/rease/article/view/279/141.

Dyar OJ, Huttner B, Schouten J, et al. What is antimicrobial stewardship? Clin Microbiol Infect. 2017; 23(11):793-8. https://www.sciencedirect.com/science/article/pii/S1198743X17304895.

Barlam TF, Cosgrove SE, Abbo LM, et al. Executive Summary: Implementing an Antibiotic Stewardship Program: Guidelines by the Infectious Diseases Society of America and the Society for Healthcare Epidemiology of America. Clin Infect Dis. 2016 Mai 15; 62(10):1197-1202. https://academic.oup.com/cid/article/62/10/e51/2462846.

Abubakar U, Tangiisuran B. Nationwide survey of pharmacists’ involvement in antimicrobial stewardship programs in Nigerian tertiary hospitals. J Glob Antimicrob Resist. 2019 Out 8; 21:148-153. https://doi.org/10.1016/j.jgar.2019.10.007.

Weier N, Tebano G, Thilly N, et al. Pharmacist participation in antimicrobial stewardship in Australian and French hospitals: a cross-sectional nationwide survey. J Antimicrob Chemother. 2017 Out 30; 73(3):804-813. https://pubmed.ncbi.nlm.nih.gov/29237051/.

Magill SS, O'Leary E, Ray SM, et al. Assessment of the Appropriateness of Antimicrobial Use in US Hospitals. JAMA Netw Open. 2020 Mai 31; 4(3). https://pubmed.ncbi.nlm.nih.gov/33734417/.

Menezes RM, Carneiro M, Gonçalves MRS, et al. Desenvolvimento e validação de questionário para autoavaliação dos programas de gerenciamento de antimicrobianos em unidade de terapia intensiva adulto. Revista Científica Multidisciplinar Núcleo do Conhecimento. Ano. 07, Ed. 06, Vol. 05, pp. 175-215. Junho de 2022. ISSN: 2448-0959. https://www.nucleodoconhecimento.com.br/saude/questionario-para-autoavaliacao.

Polit DF, Beck CT. Fundamentos de Pesquisa em Enfermagem: Avaliação de evidências para a prática da enfermagem. 7º ed. Porto Alegre. Artmed. 2011. 669 p. https://pesquisa.bvsalud.org/portal/resource/pt/sms-10133.

Coluci MZO, Alexandre NMC, Milani D. Construção de instrumentos de medida na área da saúde. Cien Saude Colet. 2015 Marc; 20(3):925-36. https://www.scielo.br/j/csc/a/qTHcjt459YLYPM7Pt7Q7cSn/.

Souza CS, Turrini RNT, Poveda VB. Tradução e adaptação do instrumento “Avaliação de Adequação de Materiais” (SAM) para o português. Rev. enferm. UFPE online. 2015 Mar; 9(5):7854-61. https://repositorio.usp.br/directbitstream/3ab8a7a7-5e39-4ed5-8103-dfdfc428576f/TURRINI,%20R%20N%20T%20doc%20110e.p.

Agência Nacional de Vigilância Sanitária. Diretriz Nacional para Elaboração de Programa de Gerenciamento do Uso de Antimicrobianos em Serviços de Saúde. Agência Nacional de Vigilância Sanitária 2017 p. 90. https://antigo.anvisa.gov.br/documents/33852/271855/Diretriz+Nacional+para+Elabora%C3%A7%C3%A3o+de+Programa+de+Gerenciamento+do+Uso+de+Antimicrobianos+em+Servi%C3%A7os+de+Sa%C3%BAde/667979c2-7edc-411b-a7e0-49a6448880d4?version=1.0.

Keszei AP, Novaki M, Streiner LD. Introduction to health measurement scales. J Psychosom Res. 2010 Abr; 68(4):319-32. https://doi.org/10.1016/j.jpsychores.2010.01.006.

Aksah H, Ani AIC, Johar S, et al. Evaluating the Content Validity: Development of An Instrument for Measuring Functional Building Performance. International Journal of Global Optimization and Its Application. 2023 Mar.31; 2(1), 12-19. https://doi.org/10.56225/ijgoia.v2i1.161.

Souza GHS, Coelho JAPM, Esteves GGL, et al. Inventário de barreiras e facilitadores ao empreendedorismo: construção e validação de um instrumento. REAd Revista Eletrônica Administração (Porto Alegre). 2016 Dez ; 22(3):381-412. https://doi.org/10.1590/1413-2311.04315.57744.

Tanaka JRV, Sousa KHJF, Alves PJP, et al. Educational Technology on Urinary Incontinence during Pregnancy: Development and Validation of an Online course for the Brazilian Population. Aquichan. 2023 Mar; 23(1):2313. https://doi.org/10.5294/aqu i.2023.23.1.3.

Alvarez LD, Damiance PRM. O Suitability Assesmente of Materials (SAM) e avaliação de materiais educativos em saúde. Revista Intelecto Fema. 2020 Set; (3):13p. ISSN: 2596-0806. https://cepein.fema.edu.br/aplicacoes/extra-fema/consulta-acervo-biblioteca.

Meadows KA. So you want to do research? 5: Questionnaire design. Br J Community Nurs. 2013 Set 27; 8(12):562-570. https://pubmed.ncbi.nlm.nih.gov/14688664/.

Teixeira E. Validação e avaliação de produtos tecnológicos. 2021 Nov 13. http://retebrasil.com.br/arquivos/File/VALIDACAOAVALICAO.pdf.

Lourenço T. Escolas brasileiras ainda formam analfabetos funcionais. 2020 Nov 13. https://jornal.usp.br/atualidades/escolas-brasileiras-ainda-formam-analfabetos-funcionais/.

Pedroso GG, Ferreira ACVV, Silva CC , et al. Coleta de dados para pesquisa quantitativa online na pandemia da COVID-19: relato de experiência. Rev. Enferm. UFSM. 2022 abr. 7; 12(13):1-14. https://periodicos.ufsm.br/reufsm/article/view/67023.

Downloads

Published

2025-01-21

How to Cite

Martins, J., Dal Sasso, K., Borges Pereira, L., Speroni Ceron, C. ., & Marques dos Reis, T. (2025). The Antimicrobial Stewardship Program: validation of a tool to assess pharmacists’ perceptions. Revista De Epidemiologia E Controle De Infecção, 15(1). https://doi.org/10.17058/reci.v15i1.19282

Issue

Vol. 15 No. 1 (2025)

Section

ORIGINAL ARTICLE

License

Copyright (c) 2025 Jéssica Martins, Karina Dal Sasso, Lucas Borges Pereira, Carla Speroni Ceron, Tiago Marques dos Reis

Creative Commons License

This work is licensed under a Creative Commons Attribution 4.0 International License.

The author must state that the paper is original (has not been published previously), not infringing any copyright or other ownership right involving third parties. Once the paper is submitted, the Journal reserves the right to make normative changes, such as spelling and grammar, in order to maintain the language standard, but respecting the author’s style. The published papers become ownership of RECI, considering that all the opinions expressed by the authors are their responsibility. Because we are an open access journal, we allow free use of articles in educational and scientific applications provided the source is cited under the Creative Commons CC-BY license.