Funders
Pfizer Independent Grants for Learning & Change
The Joint Commission
Principal Investigators
Associate Professor Rogier van Doorn
Dr Vu Thi Lan Huong
Locations
Viet Tiep Hospital, Hai Phong, Viet Nam
Dong Thap General Hospital, Cao Lanh, Dong Thap, Viet Nam
Antimicrobial resistance (AMR) is a major public health problem in Vietnam, with resistance proportions for important pathogens among the highest in Asia and globally.
Antimicrobial stewardship (AMS) programs have been recognized as an essential part of the WHO Global and Vietnam national action plan to combat AMR. However, resources and expertise for implementation and evidence on locally effective strategies are lacking.
A guideline for implementing AMS at hospitals was issued in 2016 (MoH Decision No. 772) and updated in 2020. The guideline recommends establishing an AMS team to develop hospital-specific treatment guidelines and policies, planing intervention activities, and monitoring and evaluating the outcomes of the activities. In response, AMS teams have been formed in 48% of 315 surveyed hospitals, as shown in an MoH report in 2019. Main AMS-related activities reported were hospital-specific guidelines on antimicrobial use (22%) and pre-authorization policy (41%). Limited data are available on the impact of AMS programs; only one report from a large hospital has indicated AMS activities could improve patient outcomes.
In this implementation research study, we employed a participatory action process to establish AMS programs at two provincial-level hospitals in Viet Nam. In this process, hospitals were considered complex adaptive systems consisting of evolving inter-related individuals and non-linear interactions, and the study was conducted under the assumption that interventions cannot be applied in different hospitals with predictable results.
The process also included assessments at both national and local levels and adapted from existing resources from Duke Antimicrobial Stewardship Outreach Network (DASON) in Durham, North Carolina, USA and local guidelines.
The implementation period of AMS programs was between 29 July 2020 – 28 July 2021 in one hospital and 01 June 2020 – 31 May 2021 in the other hospital.
Baseline assessments were conducted one year before the implementation period, and evaluation activities were integrated throughout the implementation process.
