Knowledge, attitudes and practices of administration of intravenous antimicrobial medicines among intensive care nurses: A descriptive cross-sectional study.

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. Objectives: To describe intensive care nurses' knowledge, attitudes and practices of intravenous antimicrobial infusion administration in the context of access to AMS teaching. Methods: 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. Contribution of the study: This study highlights that a lack of antimicrobial stewardship guidance to bedside nurses persists; that nurses do not always have access to in-service training and policies, protocols, and guidelines; and that flushing the IV administration line following the administration of an intermittent antimicrobial infusion, should be viewed as best practice to ensure the complete delivery of the dose.