A Survey Assessing Antimicrobial Prescribing at United Nations Relief and Works Agency Primary Health Care Centers in Jordan.

Antimicrobial resistance (AMR) is a public health emergency. There is insufficient information on AMR in the context of humanitarian settings. An understanding of behavioral and institutional-level factors can strengthen antimicrobial stewardship. This study used a semistructured questionnaire to assess both knowledge, attitudes, and practices (KAP) on antimicrobial use, resistance and stewardship, and options to improving prescribing, among prescribers at the Primary Healthcare facilities of the United Nations' Relief and Works Agency Jordan field office. Responses to the KAP questions were evaluated using the Capability, Opportunity, Motivation, Behavior (COM-B) framework and Bloom's cutoffs. For each framework component, Bloom's cutoffs and interpretations were as follows: ≥ 80%, "good"; 60-79%, "moderate"; and < 60%, "poor." Fourteen options to improve prescribing were each assessed using 5-point Likert scales from very unhelpful to very helpful, aggregated by helpful and very helpful and ranked as follows: > 90%, best/most acceptable; > 80-90%, acceptable; and 70-80% as maybe acceptable/good. The questionnaire response rate was 59% (37/63) with a completion rate of 92% (34/37). Aggregate scores for real knowledge on AMR was 97%; opportunity to improve prescribing 88%; and motivation 16%-participants did not believe that there was a connection between their prescribing and AMR or that they had a key role in helping control AMR. Good options (74% aggregate score) to improving prescribing were the availability of guidelines and resistance data. There was good knowledge of AMR and good opportunities, but poor motivation for rational prescribing or behavioral change. There is a clinical need for AMR data to promote rational antibiotic prescribing.

Impact of Early Dressing Removal on Tunneled Central Venous Catheters: A Piloting Study.

Background: Central Venous Catheters (CVC) are linked with Catheter-related bloodstream infections (CLABSI) or exit-site infections. Dressings may reduce the rate of infection, but they are uncomfortable, do not eliminate the risk of infection, and in some cases become the cause of infection. Aim: This study evaluates the impact of early CVC dressing removal on CLABSI, exit-site infections, and patient quality of life in an oncology setting. Method: A quasi-experimental pilot study was conducted over 15 months at a specialized oncology center. Sixteen patients were divided into control (n=8) and experimental (n=8) groups. The control group received the standard protocol of applying CVC dressings, while the experimental group received a "no-dressing" protocol. Results: There was no statistical significance in the infection rate between the two groups (p=1.0). Two cases developed CLABSIs, one in each group. One patient from the experimental group developed an exit-site infection as well. Patients in the experimental group reported high satisfaction and an improved quality of life. Conclusions: Applying a no-dressing protocol to a wellhealed exit site CVC showed encouraging results in terms of exit-site and bloodstream infections. That is to say; it did not predispose patients to increased risk of infections. Furthermore, patients with no dressing protocol feel more comfortable in their life.