Antimicrobial stewardship in Ireland, with a focus on long term care facilities

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dc.contributor.advisor Byrne, Stephen en Fleming, Aoife 2015-12-08T10:10:07Z 2015 2015
dc.identifier.citation Fleming, A. 2015. Antimicrobial stewardship in Ireland, with a focus on long term care facilities. PhD Thesis, University College Cork. en
dc.description.abstract Background: Antimicrobial resistance is a major public health concern, and its increasing incidence in the Long Term Care Facility (LTCF) setting warrants attention (1). The prescribing of antimicrobials in this setting is often inappropriate and higher in Ireland than the European average (2). The aim of the study was to generate an evidence base for the factors influencing antimicrobial prescribing in LTCFs and to investigate Antimicrobial Stewardship (AMS) strategies for LTCFs. Methods: An initial qualitative study was conducted to determine the factors influencing antimicrobial prescribing in Irish LTCFs. This allowed for the informed implementation of an AMS feasibility study in LTCFs in the greater Cork region. Hospital AMS was also investigated by means of a national survey. A study of LTCF urine sample antimicrobial resistance rates was conducted in order to collate information for incorporation into future LTCF AMS initiatives. Results: The qualitative interviews determined that there are a multitude of factors, unique to the LTCF setting, which influence antimicrobial prescribing. There was a positive response from the doctors and nurses involved in the feasibility study as they welcomed the opportunity to engage with AMS and audit and feedback activities. While the results did not indicate a significant change in antimicrobial prescribing over the study period, important trends and patterns of use were detected. The antimicrobial susceptibility of LTCF urine samples compared to GPs samples found that there was a higher level of antimicrobial resistance in LTCFs. Conclusion: This study has made an important contribution to the development of AMS in LTCFs. The complexity of care and healthcare organisation, and the factors unique to LTCFs must be borne in mind when developing quality improvement strategies. en
dc.description.sponsorship Health Research Board, Ireland (Scholars Programme in Health Services Research Grant PHD/2007/16) en
dc.format.mimetype application/pdf en
dc.language.iso en en
dc.publisher University College Cork en
dc.rights © 2015, Aoife Fleming. en
dc.rights.uri en
dc.subject Elderly en
dc.subject Antimicrobials en
dc.subject Antimicrobial prescribing en
dc.subject Long term care en
dc.subject Qualitative research en
dc.subject Antimicrobial resistance en
dc.title Antimicrobial stewardship in Ireland, with a focus on long term care facilities en
dc.type Doctoral thesis en
dc.type.qualificationlevel Doctoral Degree (Structured) en
dc.type.qualificationname PhD (Medicine and Health) en
dc.internal.availability Full text not available en Indefinite en 10000-01-01
dc.description.version Accepted Version
dc.contributor.funder Health Research Board en
dc.description.status Not peer reviewed en Pharmacy en
dc.check.reason This thesis is due for publication or the author is actively seeking to publish this material en
dc.check.opt-out Yes en
dc.thesis.opt-out true
dc.check.entireThesis Entire Thesis Restricted
dc.check.embargoformat Both hard copy thesis and e-thesis en
dc.internal.conferring Autumn Conferring 2015

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© 2015, Aoife Fleming. Except where otherwise noted, this item's license is described as © 2015, Aoife Fleming.
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