E-Learning versus Face-to-Face Methodology for Learning Antimicrobial Resistance and Prescription Practice in a Tertiary Hospital of a Middle-Income Country.

Background: Antimicrobial resistance is a growing health problem worldwide. One strategy to face this problem in a reasonable way is training health personnel for the rational use of antimicrobials. There are some difficulties associated with medical staff to receiving training with E-learning education, but there is a lack of studies and insufficient evidence of the effectiveness of this method compared to face-to-face learning. Methods: An educational intervention on antimicrobial resistance (AMR) and antimicrobial prescription practice (APP) was designed and implemented using two approaches: face-to-face and E-learning among physicians of the intensive care unit (ICU) and internal medicine ward (IMW) at Eugenio Espejo Hospital in Quito. Modalities of interventions were compared to propose a strategy of continuous professional development (CPD) for all hospital staff. An interventional study was proposed using a quasi-experimental approach that included 91 physicians, of which 49 belong to the IMW and 42 to the ICU. All of them received training on AMR­half in a face-to-face mode and the other half in an asynchronous E-learning mode. They then all participated on APP training but with switched groups; those who previously participated in the face-to-face experience participated in an E-learning module and vice-versa. We evaluated self-perception about basic knowledge, attitudes and referred practices towards AMR and APP before and after the intervention. A review of medical records was conducted before and after training by checking antimicrobial prescriptions for all patients in the ICU and IMW with bacteremia, urinary tract infection (UTI), pneumonia, and skin and soft tissue infection. The study received IRB clearance, and we used SPSS for statistical analysis. Results: No statistically significant difference was observed between the E-learning and the face-to-face methodology for AMR and APP. Both methodologies improved knowledge, attitudes and referred practices. In the case of E-learning, there was a self-perception of improved attitudes (p < 0.05) and practices (p < 0.001) for both AMR and APP. In face-to-face, there was a perception of improvement only in attitudes (p < 0.001) for APP. In clinical practice, the use of antimicrobials significantly improved in all domains after training, including empirical and targeted treatment of bacteremia and pneumonia (p < 0.001) and targeted treatment of UTI (p < 0.05). For the empirical treatment of pneumonia, the mean number of antibiotics was reduced from 1.87 before to 1.05 after the intervention (p = 0.003), whereas in the targeted management of bacteremia, the number of antibiotics was reduced from 2.19 to 1.53 (p = 0.010). Conclusions: There was no statistically significant difference between the effect of E-learning and face-to-face strategy in terms of teaching AMR and APP. Adequate self-reported attitudes and practices in E-learning exceed those of the face-to-face approach. The empiric and targeted use of antimicrobials improved in all reviewed cases, and we observed an overall decrease in antibiotic use. Satisfaction with training was high for both methods, and participants valued the flexibility and accessibility of E-learning.

Adherencia a las buenas prácticas de transfusión, observada en el personal de enfermería del Hospital Pediátrico Baca Ortiz / Adherence to good transfusion practices, observed in the nursing staff of the Baca Ortiz Pediatric Hospital

Contexto: el personal de enfermería cumple un rol fundamental en el proceso transfusional; el nivel de conocimientos debe ser periódicamente evaluado a fin de garantizar una buena práctica transfusional. Objetivo: evaluar el nivel de conocimientos que posee el personal de enfermería del Hospital Pediátrico Baca Ortiz (HPBO) previo y posterior a la intervención, frente a los procedimientos para solicitud, administración y monitoreo de los componentes sanguíneos. Sujetos y métodos: estudio no-experimental pre y post-evaluatorio en el personal de enfermería del Hospital Pediátrico Baca Ortiz de la ciudad de Quito. Se diseñó y aplicó una encuesta estructurada a los profesionales de enfermería del Hospital Pediátrico Baca Ortiz a través de la cual se evaluaron aspectos técnicos relativos a la práctica transfusional en lo relativo a solicitud, administración y monitoreo de los componentes sanguíneos. Resultados: la intervención se realizó en 176 profesionales, distribuidos en tres grupos de capacitación; se observó un incremento global del 14,27% en el puntaje post-intervención sobre 20 puntos, con una p<0,002, estadísticamente significativa. La pre-intervención demostró un menor porcentaje de respuestas correctas en lo referente a la toma y envío de muestras (45,2%). Al evaluar el impacto de la intervención se observó que en la etapa relativa a "recepción de hemocomponentes en el servicio hospitalario, verificación, condiciones de envío, validación del paciente y administración de la transfusión" paso del 67,7% al 79,06% de respuestas válidas con una diferencia porcentual de 11,3%. El área hospitalaria que mayor impacto tuvo fue consulta externa, desde un 22,2% de respuestas correctas en la etapa de pre-intervención y la de menor impacto fue el área quirúrgica con 14,15%. Conclusión: la pre-intervención evidenció debilidades y puntos de mejora en los conocimientos del personal de enfermería que fueron fortalecidos significativamente por la intervención realizada. La educación continua reviste utilidad y relevancia para mejorar percepciones y prácticas en medicina transfusional (AU)

Context: nurses play a fundamental role in the transfusion process; The level of knowledge should be periodically evaluated in order to guarantee good transfusion practice. Objective: to evaluate the level of knowledge held by the nursing staff of the Baca Ortiz Pediatric Hospital (HPBO) before and after the intervention, as opposed to the procedures for requesting, administering and monitoring the blood components. Subjects and methods: pre and post-evaluation non-experimental study in the nursing staff of the Baca Ortiz Pediatric Hospital in the city of Quito. A structured survey was designed and applied to the nursing professionals of the Baca Ortiz Pediatric Hospital through which technical aspects related to the transfusion practice regarding the application, administration and monitoring of the blood components were evaluated. Results: the intervention was carried out in 176 professionals, divided into three training groups; an overall increase of 14.27% was observed in the post-intervention score over 20 points, with p <0.002, statistically significant. The pre-intervention showed a lower percentage of correct answers regarding the taking and sending of samples (45.2%). When evaluating the impact of the intervention it was observed that in the stage relative to "reception of blood components in the hospital service, verification, delivery conditions, patient validation and administration of the transfusion" step from 67.7% to 79.06% of valid answers with a percentage difference of 11.3%. The hospital area that had the greatest impact was external consultation, from 22.2% of correct responses in the pre-intervention stage and the one with the least impact was the surgical area with 14.15%. Conclusion: the pre-intervention showed weaknesses and points of improvement in the knowledge of the nursing staff that were significantly strengthened by the intervention performed. Continuing education has utility and relevance to improve perceptions and practices in transfusion medicine. (AU)

Unexpected distribution of the fluoroquinolone-resistance gene qnrB in Escherichia coli isolates from different human and poultry origins in Ecuador.

Fluoroquinolone resistance can be conferred through chromosomal mutations or by the acquisition of plasmids carrying genes such as the quinolone resistance gene (qnr). In this study, 3,309 strains of commensal Escherichia coli were isolated in Ecuador from: (i) humans and chickens in a rural northern coastal area (n = 2368, 71.5%) and (ii) chickens from an industrial poultry operation (n = 827, 25%). In addition, 114 fluoroquinolone-resistant strains from patients with urinary tract infections who were treated at three urban hospitals in Quito, Ecuador were analyzed. All of the isolates were subjected to antibiotic susceptibility screening. Fluoroquinolone-resistant isolates (FRIs) were then screened for the presence of qnrB genes. A significantly higher phenotypic resistance to fluoroquinolones was determined in E. coli strains from chickens in both the rural area (22%) and the industrial operation (10%) than in strains isolated from humans in the rural communities (3%). However, the rates of qnrB genes in E. coli isolates from healthy humans in the rural communities (11 of 35 isolates, 31%) was higher than in chickens from either the industrial operations (3 of 81 isolates, 6%) or the rural communities (7 of 251 isolates, 2.8%). The occurrence of qnrB genes in human FRIs obtained from urban hospitals was low (1 of 114 isolates, 0.9%). These results suggested that the qnrB gene is more widely distributed in rural settings, where antibiotic usage is low, than in urban hospitals and industrial poultry operations. The role of qnrB in clinical resistance to fluoroquinolones is thus far unknown.

Unexpected distribution of the fluoroquinolone resistance gene qnrB in Escherichia coli isolates from different human and poultry origins in Ecuador

Fluoroquinolone resistance can be conferred through chromosomal mutations or by the acquisition of plasmids carrying genes such as the quinolone resistance gene (qnr). In this study, 3,309 strains of commensal Escherichia coli were isolated in Ecuador from: (i) humans and chickens in a rural northern coastal area (n = 2368, 71.5%) and (ii) chickens from an industrial poultry operation (n = 827, 25%). In addition, 114 fluoroquinolone-resistant strains from patients with urinary tract infections who were treated at three urban hospitals in Quito, Ecuador were analyzed. All of the isolates were subjected to antibiotic susceptibility screening. Fluoroquinolone-resistant isolates (FRIs) were then screened for the presence of qnrB genes. A significantly higher phenotypic resistance to fluoroquinolones was determined in E. coli strains from chickens in both the rural area (22%) and the industrial operation (10%) than in strains isolated from humans in the rural communities (3%). However, the rates of qnrB genes in E. coli isolates from healthy humans in the rural communities (11 of 35 isolates, 31%) was higher than in chickens from either the industrial operations (3 of 81 isolates, 6%) or the rural communities (7 of 251 isolates, 2.8%). The occurrence of qnrB genes in human FRIs obtained from urban hospitals was low (1 of 114 isolates, 0.9%). These results suggested that the qnrB gene is more widely distributed in rural settings, where antibiotic usage is low, than in urban hospitals and industrial poultry operations. The role of qnrB in clinical resistance to fluoroquinolones is thus far unknown (AU)

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