Infection prevention and control and antibiotic stewardship Two sides of the same coin in the prevention of antimicrobial resistance

Background
Two major strategies at the hospital level that are used to prevent Antimicrobial resistance (AMR) and its consequences are; Infection Prevention and Control (IPC) and antibiotic Stewardship (ABS). This work sought to assess hospitals IPC and ABS capacity to track and tackle efforts to limit antimicrobial resistance in Kenya.
Methods
In the first section, this work used a redesigned Water Sanitation and Hygiene (WASH) facility improvement tool and interviews to collect data across 16 public hospitals in Kenya. The tool modification allowed for assessment of infrastructural, material and human resources to support WASH services and the allocation of responsibilities to improve accountability at various health system levels.
The second section involved an assessment of antibiotic stewardship and use in public hospitals. Using data collected from an antibiotic point prevalence survey, we describe the common antibiotic prescriptions, quality of documentation and guideline use among hospitalised patients in medical, surgical and paediatric units. These findings complemented data from semi-structured interviews with clinicians and managers evaluating stewardship arrangements in these hospitals.
The final section emphasises the need to develop and use treatment guidelines as part of patient care and develop in the longer-term, systems that should derive data on antibiotic prescribing and stewardship from routine information systems.
Conclusion
This work provides a contextual understanding of IPC, antibiotic use and stewardship and some practical improvement solutions. These findings are useful for policy formulation and research in Kenya and beyond, highlighting areas where interventions are needed to contain AMR.