Knowledge, attitudes and practices of administration of intravenous antimicrobial medicines among intensive care nurses: A descriptive cross-sectional study
Main Article Content
Abstract
Background. Antimicrobial stewardship (AMS) has become integral to healthcare. In the case of antimicrobial medicines, nurses are responsible for preparing medication, and ensuring its correct and safe administration.
Objective. To describe intensive care nurses’ knowledge, attitudes and practices of intravenous antimicrobial infusion administration in the context of access to AMS teaching.
Method. Convenience sampling was conducted of all 161 bedside nurses working in three general intensive care units. The nursing unit manager from each unit was requested to provide information detailing unit demographics and AMS activity within the unit (e.g. existence of AMS; nurse inclusion on the AMS team; frequency of AMS rounds; availability of AMS policies, protocols or guidelines; and training on the administration of intravenous antimicrobial medicines).
Results. Intensive care nursing management reported cessation of AMS programmes in all three units during COVID-19, with minimal activity in one intensive care unit even before the onset of the pandemic. Responses from bedside nurses emphasised the unavailability of in-service AMS teaching in the units (46.4%). Questions on antibiotic groups scored poorly (55.7%). Respondents (63.8%) indicated that the hospital intravenous antibiotic policy was useful but 21.7% reported that they had never seen this policy in their unit. Opportunities for training on intravenous administration of antimicrobial medications were provided on induction to the hospital (14.5%), or in-service (30.4%) by the clinical facilitators (34.8%), or by doctors (24.6%). Fifty-one percent of respondents reported administering antibiotics through a dedicated antibiotic infusion line. Forty-five percent of respondents used a non-dedicated line, and 56.5% of respondents flushed the line between doses.
Conclusion. Results suggest inadequate training. This, coupled with the evident poor access to policies and protocols, may adversely affect nurse knowledge of principles to prevent antimicrobial resistance.
Article Details

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
The SAJCC is published under an Attribution-Non Commercial International Creative Commons Attribution (CC-BY-NC 4.0) License. Under this license, authors agree to make articles available to users, without permission or fees, for any lawful, non-commercial purpose. Users may read, copy, or re-use published content as long as the author and original place of publication are properly cited.
Exceptions to this license model is allowed for UKRI and research funded by organisations requiring that research be published open-access without embargo, under a CC-BY licence. As per the journals archiving policy, authors are permitted to self-archive the author-accepted manuscript (AAM) in a repository.
How to Cite
References
1. Kollef M, Bassetti M, Francois B, et al. The intensive care medicine research agenda on multidrug-resistant bacteria, antibiotics, and stewardship. Intensive Care Med 2017; 43(9):1187- 1197. https://doi.org/10.1007/s00134-017-4682-7
2. Arulkumaran N, Routledge M, Schlebusch S, Lipman J, Conway Morris A. Antimicrobial- associated harm in critical care: A narrative review. Intensive Care Med 2020;46(2):225- 235. https://doi.org/10.1007/s00134-020-05929-3
3. Murray C, Antimicrobial Resistance Collaborators. Global burden of bacterial antimicrobial resistance in 2019: A systematic analysis. Lancet 2022;399(10325):629-655. https://doi. org/10.1016/S0140-6736(21)02724-0
4. Gotterson F, Buising K, Manias E. Nurse role and contribution to antimicrobial stewardship. An integrative review. Int J Nurs Stud 2020;117:103787. https://doi.org/10.1016/j.ijnurstu.2020.10378
5. Van Huizen P, Kuhn L, Russo P, Connell C. The nurses’ role in antimicrobial stewardship:
A scoping review. Int J Nurs Stud 2020;113:103772. https://doi.org/10.1016/j.ijnurstu.2020.1037
6. Royal College of Nursing. Antimicrobial Resistance. RCN Position on the Nursing Contribution.
London: RCN; 2014. https://www.nric.org.uk/node/52607 (accessed January 2022).
7. American Association of Nurses. White paper: Redefining the antibiotic stewardship team: Recommendations from the American Nurses Association/Centers for Disease Control and Prevention Workgroup on the Role of Registered Nurses in Hospital Antibiotic Stewardship Practices. Maryland: AAN; 2017. https://www.cdc.gov/antibiotic-use/healthcare/pdfs/ANA-
CDC-whitepaper.pdf (accessed July 2021).
8. Centers for Disease Control and Prevention. The core elements of hospital antibiotic stewardship
programs. 2019. https://www.cdc.gov/antibiotic-use/healthcare/pdfs/hospital-core-elements-H.
pdf (accessed January 2022).
9. International Council of Nurses. Position Statement. Antimicrobial Resistance. 2017. https://www.
icn.ch/sites/default/files/inline-files/PS_A_Antimicrobial_resistance.pdf (accessed August 2021).
10. World Health Organization. Competency Framework for Health Workers’ Education and Training on Antimicrobial Resistance. Geneva: WHO; 2018. https://www.who.int/hrh/resources/
WHO-HIS-HWF-AMR-2018.1/en/. (accessed September 2021).
11. Courtenay M, Castro-Sánchez E, Gallagher R, et al. Development of consensus-based
international antimicrobial stewardship competencies for undergraduate nurse education. J Hosp
Infect 2019;103(3):244-250. https://doi.org/10.1016/j.jhin.2019.08.001
12. Rout J, Essack S, Brysiewicz P. Guideline recommendations for antimicrobial stewardship
education for clinical nursing practice in hospitals: A scoping review. South Afr J Crit Care
2021;37(3):104-114. https://doi.org/10.7196/SAJCC.2021.v37i3.482
13. Davey K, Aveyard H. Nurses’ perceptions of their role in antimicrobial stewardship within the
hospital environment. An integrative literature review. J Clin Nurs 2022;31(21-22):3011-3020.
https://doi.org/10.1111/jocn.16204
14. Marath U, John B, Sojan A, et al. Antibiotic awareness and its usage in hospitals: Do our nurses possess adequate knowledge and practice? Ann Geriatr Ed Med Sci 2022;9(1):10-15. https://doi. org/10.18231/j.agems.2022.003
15. Rout J, Brysiewicz P. Perceived barriers to the development of the antimicrobial stewardship role of the nurse in intensive care: Views of healthcare professionals. South Afr J Crit Care 2020;36(1):51-56. https://doi.org/10.7196/sajcc.2020.v36i1.410
16. Rout J, Essack S, Brysiewicz P. Guidelines for the hospital role of the clinical nurse in antimicrobial stewardship: A scoping review. South Afr J Crit Care 2021;37(2):70-76. https://doi. org/10.7196%2FSAJCC.2021.v37i2.481
17. Mendelson M, Morris A, Thursky K, Pulcini C. How to start an antimicrobial stewardship programme in a hospital. Clin Microbiol Infect 2020;26(4):447-553. https://dx.doi.org/10.1016/j. cmi.2019.08.007
18. Weier N, Nathwani D, Thursky K, et al. An international inventory of antimicrobial stewardship (AMS) training programmes for AMS teams. J Antimicrob Chemother 2021;76(6):1633- 1640. https://doi.org/10.1093/jac/dkab053
19. Morgan S. The infusion nurse’s role in antibiotic stewardship. J Infus Nurs 2019;42(2):75-80.
https://doi.org/10.1097/NAN.0000000000000315
20. Nantamu M. Biosciences for antibiotic resistance: A mixed methods study assessing the level of knowledge and learning experiences among preregistration nursing students in Uganda. Manchester: University of Salford Repository , 2021. https://www.bing.com/ck/ a?!&&p=f87d2a01 05c7cf85JmltdHM9MTY4NDEwODgwMCZpZ3VpZD0xYjEyYWU5My00OTdlLTY3MmItMDk wNi1iZmMzNDg4NjY2NjMmaW5zaWQ9NTIxNg&ptn=3&hsh=3&fclid=1b12ae93-497e-672b- 0906-bfc348866663&psq=Miriam+Nantamu+PhD+Student&u=a1aHR0cHM6Ly91c2lyLnNhbG ZvcmQuYWMudWsvaWQvZXByaW50LzYyNTAxLw&ntb=1 (accessed August 2022).
21. Gorski L, Hadaway L, Hagle M, et al. for the Infusion Nurses Society. Infusion Therapy Standards of Practice. J Infus Nurs 2021;44(1S Suppl 1): S1-S224. https://doi.org/10.1097/ NAN.0000000000000396
22. Rout J, Essack S, Brysiewicz P. Are nursing infusion practices delivering full-dose antimicrobial treatment? J Antimicrob Chemother 2019;74(12):3418-3422. https://doi.org/10.1093/jac/dkz365
23. Rout J, Essack S, Brysiewicz P. Residual fluid after IV infusion drug administration: Risk of suboptimal dosing. Br J Nurs 2020;29(2):S6-S8. https://doi.org/10.12968/bjon.202
24. South African Nursing Council. (2021). Position Statement on the Allocation of Non-Specialised Nurses in Specialised units. SANC Policies and Position Papers – SANC (accessed June 2021). 25. Monthly Index of Medical Specialities. Search Drug Information, Interactions, Images, Dosage &
Side Effects MIMS (accessed July 2022).
26. Abbas S, Lee K, Pakyz A, et al. Knowledge, attitudes, and practices of bedside nursing staff
regarding antibiotic stewardship: A cross-sectional study. Am J Infect Control 2019;47(3):230-
233. https://doi.org/10.1016/j.ajic.2018.09.008
27. Centers for Disease Control and Prevention. Core elements of hospital antibiotic stewardship
programs. 2014. https://www.cdc.gov/antibiotic-use/healthcare/implementation/core-elements.
html (accessed June 2021).
28. Royal College of Nursing. Standards for infusion therapy. 2016.https://www.rcn.org.uk/
professional-development/publications/pub-005704 (accessed December 2021).
29. Rickard C, Marsh N, Larsen E, et al. Effect of infusion set replacement intervals on catheter- related bloodstream infections (RSVP): A randomised, controlled, equivalence (central venous access device)-non-inferiority (peripheral arterial catheter) trial. Lancet 2021;397(10283):1447-
1458. https://doi.org/10.1016/S0140-6736(21)00351-2
30. Bolla B, Buxani Y, Wong R, Jones L, Dube M. Understanding IV antimicrobial drug losses: The
importance of flushing infusion administration sets. JAC Antimicrob Resist 2020;2(3):dlaa061.