Exploring barriers to guideline implementation for prescription of surgical antibiotic prophylaxis in Nigeria

Caroline E. Wood; Susanne Luedtke; Anwar Musah; Funmi Bammeke; Bamidele Mutiu; Rufus Ojewola; Olufemi Bankole; Adesoji Oludotun Ademuyiwa; Chibuzo Barbara Ekumankama; Folasade Ogunsola; Patrick Okonji; Eneyi E. Kpokiri; Theophilus Ayibanoah; Neni Aworabhi-Oki; Laura Shallcross; Andreea Molnar; Sue Wiseman; Andrew Hayward; Delphine Soriano; Georgiana Birjovanu; Carmen Lefevre; Olajumoke Olufemi; Patty Kostkova

doi:10.1093/jacamr/dlac044

Exploring barriers to guideline implementation for prescription of surgical antibiotic prophylaxis in Nigeria

Caroline E. Wood^*, Susanne Luedtke, Anwar Musah, Funmi Bammeke, Bamidele Mutiu, Rufus Ojewola, Olufemi Bankole, Adesoji Oludotun Ademuyiwa, Chibuzo Barbara Ekumankama, Folasade Ogunsola, Patrick Okonji, Eneyi E. Kpokiri, Theophilus Ayibanoah, Neni Aworabhi-Oki, Laura Shallcross, Andreea Molnar, Sue Wiseman, Andrew Hayward, Delphine Soriano, Georgiana BirjovanuCarmen Lefevre, Olajumoke Olufemi, Patty Kostkova

^*Corresponding author for this work

Research output: Contribution to journal › Article › peer-review

4 Citations (Scopus)

Abstract

Background: In Nigeria, the prescription of surgical antibiotic prophylaxis for prevention of surgical site infection tends to be driven by local policy rather than by published guidelines (e.g. WHO and Sanford). Objectives: To triangulate three datasets and understand key barriers to implementation using a behavioural science framework. Methods: Surgeons (N=94) from three teaching hospitals in Nigeria participated in an online survey and in focus group discussions about barriers to implementation. The theoretical domains framework (TDF) was used to structure question items and interview schedules. A subgroup (N=20) piloted a gamified decision support app over the course of 6months and reported barriers at the point of care. Results: Knowledge of guidelines and intention to implement them in practice was high. Key barriers to implementation were related to environmental context and resources and concern over potential consequences of implementing recommendations within the Nigerian context applicable for similar settings in low-to-middle-income countries. Conclusions: The environmental context and limited resource setting of Nigerian hospitals currently presents a significant barrier to implementation of WHO and Sanford guidelines. Research and data collected from the local context must directly inform the writing of future international guidelines to increase rates of implementation.

Original language	English
Article number	dlac044
Journal	JAC-Antimicrobial Resistance
Volume	4
Issue number	2
DOIs	https://doi.org/10.1093/jacamr/dlac044
Publication status	Published - 1 Apr 2022
Externally published	Yes

Bibliographical note

Publisher Copyright:
© 2022 The Author(s) 2022. Published by Oxford University Press on behalf of British Society for Antimicrobial Chemotherapy.

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Wood, C. E., Luedtke, S., Musah, A., Bammeke, F., Mutiu, B., Ojewola, R., Bankole, O., Ademuyiwa, A. O., Ekumankama, C. B., Ogunsola, F., Okonji, P., Kpokiri, E. E., Ayibanoah, T., Aworabhi-Oki, N., Shallcross, L., Molnar, A., Wiseman, S., Hayward, A., Soriano, D., ... Kostkova, P. (2022). Exploring barriers to guideline implementation for prescription of surgical antibiotic prophylaxis in Nigeria. JAC-Antimicrobial Resistance, 4(2), Article dlac044. https://doi.org/10.1093/jacamr/dlac044

@article{c29c3cc7f6bf4cb19095307fc31b4fce,

title = "Exploring barriers to guideline implementation for prescription of surgical antibiotic prophylaxis in Nigeria",

abstract = "Background: In Nigeria, the prescription of surgical antibiotic prophylaxis for prevention of surgical site infection tends to be driven by local policy rather than by published guidelines (e.g. WHO and Sanford). Objectives: To triangulate three datasets and understand key barriers to implementation using a behavioural science framework. Methods: Surgeons (N=94) from three teaching hospitals in Nigeria participated in an online survey and in focus group discussions about barriers to implementation. The theoretical domains framework (TDF) was used to structure question items and interview schedules. A subgroup (N=20) piloted a gamified decision support app over the course of 6months and reported barriers at the point of care. Results: Knowledge of guidelines and intention to implement them in practice was high. Key barriers to implementation were related to environmental context and resources and concern over potential consequences of implementing recommendations within the Nigerian context applicable for similar settings in low-to-middle-income countries. Conclusions: The environmental context and limited resource setting of Nigerian hospitals currently presents a significant barrier to implementation of WHO and Sanford guidelines. Research and data collected from the local context must directly inform the writing of future international guidelines to increase rates of implementation.",

author = "Wood, {Caroline E.} and Susanne Luedtke and Anwar Musah and Funmi Bammeke and Bamidele Mutiu and Rufus Ojewola and Olufemi Bankole and Ademuyiwa, {Adesoji Oludotun} and Ekumankama, {Chibuzo Barbara} and Folasade Ogunsola and Patrick Okonji and Kpokiri, {Eneyi E.} and Theophilus Ayibanoah and Neni Aworabhi-Oki and Laura Shallcross and Andreea Molnar and Sue Wiseman and Andrew Hayward and Delphine Soriano and Georgiana Birjovanu and Carmen Lefevre and Olajumoke Olufemi and Patty Kostkova",

note = "Publisher Copyright: {\textcopyright} 2022 The Author(s) 2022. Published by Oxford University Press on behalf of British Society for Antimicrobial Chemotherapy.",

year = "2022",

month = apr,

day = "1",

doi = "10.1093/jacamr/dlac044",

language = "English",

volume = "4",

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Wood, CE, Luedtke, S, Musah, A, Bammeke, F, Mutiu, B, Ojewola, R, Bankole, O, Ademuyiwa, AO, Ekumankama, CB, Ogunsola, F, Okonji, P, Kpokiri, EE, Ayibanoah, T, Aworabhi-Oki, N, Shallcross, L, Molnar, A, Wiseman, S, Hayward, A, Soriano, D, Birjovanu, G, Lefevre, C, Olufemi, O & Kostkova, P 2022, 'Exploring barriers to guideline implementation for prescription of surgical antibiotic prophylaxis in Nigeria', JAC-Antimicrobial Resistance, vol. 4, no. 2, dlac044. https://doi.org/10.1093/jacamr/dlac044

TY - JOUR

T1 - Exploring barriers to guideline implementation for prescription of surgical antibiotic prophylaxis in Nigeria

AU - Wood, Caroline E.

AU - Luedtke, Susanne

AU - Musah, Anwar

AU - Bammeke, Funmi

AU - Mutiu, Bamidele

AU - Ojewola, Rufus

AU - Bankole, Olufemi

AU - Ademuyiwa, Adesoji Oludotun

AU - Ekumankama, Chibuzo Barbara

AU - Ogunsola, Folasade

AU - Okonji, Patrick

AU - Kpokiri, Eneyi E.

AU - Ayibanoah, Theophilus

AU - Aworabhi-Oki, Neni

AU - Shallcross, Laura

AU - Molnar, Andreea

AU - Wiseman, Sue

AU - Hayward, Andrew

AU - Soriano, Delphine

AU - Birjovanu, Georgiana

AU - Lefevre, Carmen

AU - Olufemi, Olajumoke

AU - Kostkova, Patty

PY - 2022/4/1

Y1 - 2022/4/1

N2 - Background: In Nigeria, the prescription of surgical antibiotic prophylaxis for prevention of surgical site infection tends to be driven by local policy rather than by published guidelines (e.g. WHO and Sanford). Objectives: To triangulate three datasets and understand key barriers to implementation using a behavioural science framework. Methods: Surgeons (N=94) from three teaching hospitals in Nigeria participated in an online survey and in focus group discussions about barriers to implementation. The theoretical domains framework (TDF) was used to structure question items and interview schedules. A subgroup (N=20) piloted a gamified decision support app over the course of 6months and reported barriers at the point of care. Results: Knowledge of guidelines and intention to implement them in practice was high. Key barriers to implementation were related to environmental context and resources and concern over potential consequences of implementing recommendations within the Nigerian context applicable for similar settings in low-to-middle-income countries. Conclusions: The environmental context and limited resource setting of Nigerian hospitals currently presents a significant barrier to implementation of WHO and Sanford guidelines. Research and data collected from the local context must directly inform the writing of future international guidelines to increase rates of implementation.

AB - Background: In Nigeria, the prescription of surgical antibiotic prophylaxis for prevention of surgical site infection tends to be driven by local policy rather than by published guidelines (e.g. WHO and Sanford). Objectives: To triangulate three datasets and understand key barriers to implementation using a behavioural science framework. Methods: Surgeons (N=94) from three teaching hospitals in Nigeria participated in an online survey and in focus group discussions about barriers to implementation. The theoretical domains framework (TDF) was used to structure question items and interview schedules. A subgroup (N=20) piloted a gamified decision support app over the course of 6months and reported barriers at the point of care. Results: Knowledge of guidelines and intention to implement them in practice was high. Key barriers to implementation were related to environmental context and resources and concern over potential consequences of implementing recommendations within the Nigerian context applicable for similar settings in low-to-middle-income countries. Conclusions: The environmental context and limited resource setting of Nigerian hospitals currently presents a significant barrier to implementation of WHO and Sanford guidelines. Research and data collected from the local context must directly inform the writing of future international guidelines to increase rates of implementation.

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U2 - 10.1093/jacamr/dlac044

DO - 10.1093/jacamr/dlac044

M3 - Article

AN - SCOPUS:85135911062

SN - 2632-1823

VL - 4

JO - JAC-Antimicrobial Resistance

JF - JAC-Antimicrobial Resistance

IS - 2

M1 - dlac044

ER -

Exploring barriers to guideline implementation for prescription of surgical antibiotic prophylaxis in Nigeria

Abstract

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