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

dc.check.date10000-01-01
dc.check.embargoformatBoth hard copy thesis and e-thesisen
dc.check.entireThesisEntire Thesis Restricted
dc.check.infoIndefiniteen
dc.check.opt-outYesen
dc.check.reasonThis thesis is due for publication or the author is actively seeking to publish this materialen
dc.contributor.advisorByrne, Stephenen
dc.contributor.authorFleming, Aoife
dc.contributor.funderHealth Research Boarden
dc.date.accessioned2015-12-08T10:10:07Z
dc.date.issued2015
dc.date.submitted2015
dc.description.abstractBackground: 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.sponsorshipHealth Research Board, Ireland (Scholars Programme in Health Services Research Grant PHD/2007/16)en
dc.description.statusNot peer revieweden
dc.description.versionAccepted Version
dc.format.mimetypeapplication/pdfen
dc.identifier.citationFleming, A. 2015. Antimicrobial stewardship in Ireland, with a focus on long term care facilities. PhD Thesis, University College Cork.en
dc.identifier.urihttps://hdl.handle.net/10468/2126
dc.language.isoenen
dc.publisherUniversity College Corken
dc.rights© 2015, Aoife Fleming.en
dc.rights.urihttp://creativecommons.org/licenses/by-nc-nd/3.0/en
dc.subjectElderlyen
dc.subjectAntimicrobialsen
dc.subjectAntimicrobial prescribingen
dc.subjectLong term careen
dc.subjectQualitative researchen
dc.subjectAntimicrobial resistanceen
dc.thesis.opt-outtrue
dc.titleAntimicrobial stewardship in Ireland, with a focus on long term care facilitiesen
dc.typeDoctoral thesisen
dc.type.qualificationlevelDoctoral Degree (Structured)en
dc.type.qualificationnamePhD (Medicine and Health)en
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