The Sample Error Pre-Antimicrobial Susceptibility Testing and Its Influencing Factors from the Perspective of Hospital Management: A Cross-Sectional Study

Abstract

The overuse of antibiotics remains serious and has led to a dramatic increase in antimicrobial resistance, which poses a significant threat to global public health, although much action has been taken by World Health Organization and countries. As the direct evidence to guide the prescribing of antibiotics, the Antimicrobial Susceptibility Testing (AST) results were biased by sample errors, which was urgent and poorly explored in quality management. This study aimed to analyze sample errors pre-AST and its influencing factors from the perspective of hospital management, to provide evidence for promoting rational antibiotic use and antimicrobial stewardship. A cross-sectional survey of 5963 clinical nurses involved in pathogenic sample collection was conducted in 118 public hospitals in Hubei province, China. Dependent variables were sample errors attributed to resources and technology-oriented, capability-oriented, and attitude-oriented errors, which were measured by times per week. Independent variables were sample management information such as guidelines, record after collection, performance appraisal, training, and publicity activities, in which guidelines, record time, and record method were dummy variables, with 1 indicating having and 0 not. Others were continuous variables ranging from 0 to 4 times per month. Ordinary Least Square regression models were performed to analyze influencing factors on sample error times. The averages of sample errors on resource and technology-oriented, capability-oriented, and attitude-oriented were 1.48, 1.35, and 1.36 times per week, and their proportion were 25.3%, 38.9%, and 35.8%, respectively. The results showed that recording timeliness (r = −0.354, p < 0.01), record using both paper and digital methods(r = −0.060, p < 0.01), performance appraisal(r = −0.188, p < 0.01), and publicity activities (r = −0.186, p < 0.01) significantly reduced times of resource and technology-oriented errors. Performance appraisals(r = −0.171, p < 0.01) and training activities (r = −0.208, p < 0.01) had a positive impact on the reduction of capability-oriented error times. The times of attitude-oriented error decreased significantly when recording timeliness (r = −0.299, p < 0.01), implementing performance appraisal (r = −0.164, p < 0.01), and training activities (r = −0.188, p < 0.01). This study found that there was a high frequency of sample errors in quality management, especially capability-oriented and attitude-oriented errors. Sample information management, performance appraisal, training, and publicity activities were associated with the quality of samples valuable for the rational use of antibiotics.