DEVELOPING AND EVALUATING AN INTEGRATED ANTIMICROBIAL STEWARDSHIP AND INFECTION PREVENTION AND CONTROL TRAINING PROGRAM FOR PRIMARY CARE PHYSICIANS IN TÜRKİYE: A PILOT STUDY

Abstract

Objective: This study aimed to develop and evaluate the effectiveness of a structured training program integrating antimicrobial stewardship (AMS) and infection prevention and control (IPC) for primary care physicians.

Material and Method: We developed a structured AMS–IPC training program for primary care physicians. The program was conducted in Ankara, Türkiye with 34 participants, and knowledge level of each participant was assessed using a pre-test, a post-test, and a follow-up test conducted three months after the training.

Result and Discussion: The mean pre-test score was 9.91 out of a maximum of 18 points, which increased to 14.74 out of 18 in the post-test, indicating a statistically significant improvement. (p<0.001). The mean score at the three-month follow-up was 13.1, demonstrating that most of the knowledge gained was retained (p<0.001). The findings demonstrate that integrated AMS and IPC training programs at the primary care level result in significant and sustained knowledge gains and serve as an effective capacity-building tool in combating AMR.

Keywords: Antimicrobial stewardship, infection prevention and control, primary healthcare services, training 

Keywords

• Antimicrobial stewardship
• infection prevention and control
• primary healthcare services
• training

TÜRKİYE’DE BİRİNCİ BASAMAK HEKİMLERİ İÇİN ENTEGRE ANTİMİKROBİYAL YÖNETİM VE ENFEKSİYON ÖNLEME VE KONTROL EĞİTİM PROGRAMININ GELİŞTİRİLMESİ VE DEĞERLENDİRİLMESİ: BİR PİLOT ÇALIŞMA

Abstract

Amaç: Bu çalışma, birinci basamak hekimlerine yönelik antimikrobiyal yönetim (AMY) ve enfeksiyon önleme ve kontrolün (EÖK) entegre edildiği yapılandırılmış bir eğitim programı geliştirmeyi ve etkililiğini değerlendirmeyi amaçladı.

Gereç ve Yöntem: Birinci basamak hekimleri için yapılandırılmış bir AMY–EÖK eğitim programı geliştirildi. Program, Ankara, Türkiye’de 34 katılımcı ile yürütüldü; her katılımcının bilgi düzeyi eğitim öncesi test, eğitim sonrası test ve eğitimden üç ay sonra uygulanan izlem testi ile değerlendirildi.

Sonuç ve Tartışma: Eğitim öncesi ortalama puan 18 üzerinden 9.91 iken, eğitim sonrası 14.74’e yükseldi ve bu artış istatistiksel olarak anlamlıydı (p < 0.001). Üçüncü ay izlem ortalama puanı 13.1 olup, kazanılan bilginin büyük ölçüde korunduğunu göstermektedir (p < 0.001). Bulgular, birinci basamak düzeyinde entegre AMY ve EÖK eğitimlerinin anlamlı ve kalıcı bilgi artışı sağladığını ve antimikrobiyal dirençle (AMR) mücadelede etkili bir kapasite geliştirme aracı olarak işlev gördüğünü göstermektedir.

Keywords

• Antimikrobiyal yönetim
• birinci basamak sağlık hizmetleri
• eğitim
• enfeksiyon önleme ve kontrol

References

1. 1. World Health Organization. (2023). Antimicrobial resistance. https://www.who.int/news-room/fact-sheets/detail/antimicrobial-resistance. Accessed date: 10.11.2024.
2. 2. Holmes, A.H., Moore, L.S.P., Sundsfjord, A., et al. (2016). Understanding the mechanisms and drivers of antimicrobial resistance. The Lancet, 387(10014), 176-187. [CrossRef]
3. 3. Hersh, A.L., King, L.M., Shapiro, D.J., et al. (2021). Unnecessary antibiotic prescribing in US ambulatory care settings, 2010-2015. Clinical Infectious Diseases, 72(1),133-137.[CrossRef]
4. 4. Gozdzielewska, L., Kc, D., Butcher, J., et al. (2024). Interventions for preventing or controlling healthcare-associated infection in primary care: A scoping review. American Journal of Infection Control, 52(4), 479-487. [CrossRef]
5. 5. World Health Organization. (2016). Guidelines on core components of infection prevention and control programmes at the national and acute health care facility level. https://www.who.int/publications/i/item/9789241549929. Accessed date: 10.11.2024.
6. 6. Bedoya, G., Dolinger, A., Rogo, K., et al. (2017). Observations of infection prevention and control practices in primary health care, Kenya. Bulletin of the World Health Organization, 95(7), 503-516. [CrossRef]
7. 7. Müller, S.A., Landsmann, L., Diallo, A.O.K., et al. (2022). Implementing the WHO multimodal hand hygiene strategy at the primary care level, Guinea. IJID Regions, 3, 27-33. [CrossRef]
8. 8. Suttels, V., Van Singer, M., Clack, L.C., et al. (2022). Factors influencing antimicrobial stewardship in primary care: A narrative review. Antibiotics, 12(1), 30. [CrossRef]

9. 9. Keçik, M., Çelik, M., Hekimoğlu, H.C., et al. (2025). Integrated antimicrobial stewardship-infection prevention and control training for primary care physicians: Literature review. Journal of Faculty of Pharmacy of Ankara University, 49(3), 766-772. [CrossRef]
10. 10. Centers for Disease Control and Prevention. (2014). Core elements of hospital antibiotic stewardship programs. https://www.cdc.gov/antibiotic-use/healthcare/pdfs/core-elements.pdf. Accessed date: 10.11.2024.
11. 11. Kuijpers, S.M.E., Hulscher, M.E.J.L., Prins, J.M., et al. (2025). Training future antimicrobial stewards in the ESCMID antimicrobial stewardship certificate training programme: From knowledge to action. JAC-Antimicrobial Resistance, 7(5), dlaf157. [CrossRef]
12. 12. Lee, C., Jafari, M., Brownbridge, R. (2020). The viral prescription pad: A mixed-methods study. BMC Family Practice, 21(1), 42. [CrossRef]
13. 13. March-López, P., Madridejos, R., Tomàs, R. (2020). Multifaceted antimicrobial stewardship intervention in primary care: A quasi-experimental study. Frontiers in Pharmacology, 11, 398. [CrossRef]
14. 14. Harrigan, J.J., Hamilton, K.W., Cressman, L. (2024). Antibiotic prescribing for respiratory tract infections after an education and feedback intervention. Clinical Infectious Diseases, 78(5), 1120-1127. [CrossRef]
15. 15. Gönen, M., Aksoy, M., İşli, F., et al. (2021). Assessment of quarter-billion primary care prescriptions from a nationwide antimicrobial stewardship program. Scientific Reports, 11(1), 14621. [CrossRef]
16. 16. Gozel, M.G., Hekimoglu, C.H., Gozel, E.Y., et al. (2021). National infection control program in Turkey: Ten-year healthcare-associated infection experience. American Journal of Infection Control, 49(7), 885-892. [CrossRef]
17. 17. World Health Organization. (2021). Strengthening infection prevention and control in primary care: A collection of existing standards, measurement and implementation resources. https://www.who.int/publications/i/item/9789240035249. Accessed date: 10.11.2024.
18. 18. Baur, D., Gladstone, B.P., Burkert, F., et al. (2017). Effect of antibiotic stewardship on the incidence of infection and colonisation with antibiotic-resistant bacteria and Clostridium difficile infection: A systematic review and meta-analysis. The Lancet Infectious Diseases, 17(9), 990-1001. [CrossRef]
19. 19. Lee, C.F., Cowling, B.J., Feng, S. (2018). Impact of antibiotic stewardship programmes in Asia: A systematic review and meta-analysis. Journal of Antimicrobial Chemotherapy, 73(4), 844-851. [CrossRef]
20. 20. Nori, P., Madaline, T., Munjal, I. (2017). Developing interactive antimicrobial stewardship and infection prevention and control curricula for diverse learners. Open Forum Infectious Diseases, 4(3), ofx117. [CrossRef]
21. 21. Mbamalu, O., Surendran, S., Nampoothiri, V. (2023). Healthcare worker perceptions of changes in infection prevention and control and antimicrobial stewardship during COVID-19 in India and South Africa. IJID Regions, 6, 90-98. [CrossRef]
22. 22. D’Hulster, L., Abrams, S., Bruyndonckx, R., et al. (2022). Nationwide implementation of online communication skills training to reduce overprescribing of antibiotics: A stepped-wedge cluster randomized trial in general practice. JAC-Antimicrobial Resistance, 4(3) [CrossRef]
23. 23. Jeffs, L., McIsaac, W., Zahradnik, M., et al. (2020). Barriers and facilitators to the uptake of an antimicrobial stewardship program in primary care: A qualitative study. PLOS ONE, 15(3), e0223822. [CrossRef]