MTaPS Jordan Strengthens Health Care Providers’ Capacity on Empirical Antibiotic Treatments to Optimize Antimicrobial Use in Intensive Care Units
Patients in intensive care units (ICUs) are highly susceptible to acquiring antimicrobial-resistant infections. This susceptibility is heightened by the intensity of treatments, the use of invasive devices, and a greater risk of exposure to antibiotics. Contributing factors include inconsistent adherence to clinical guidelines and increased risk of infection.1 With a limited pipeline of new antimicrobial drugs, the establishment of an antimicrobial stewardship program is critical. Such a program is vital for preventing the escalation of antimicrobial resistance (AMR), curtailing costs, shortening hospital stays, and maintaining or enhancing patient health outcomes.
Developing Protocols and Strengthening Capacity to Tackle Resistance to Antibiotics
In 2023, the Jordanian Royal Medical Services (RMS) requested assistance from the USAID MTaPS Jordan program to tackle AMR challenges, specifically within the ICU setting. A collaborative effort among the RMS, MTaPS, and the Jordanian American Physicians at the Mayo Clinic in Arizona led to the development of 27 Empirical Treatment Protocols for Common ICU Infections. These protocols, endorsed by the RMS director, were disseminated across all RMS hospitals nationwide, supporting the fourth objective of Jordan’s AMR National Action Plan to “optimize the use of antimicrobial agents in health.”
Representatives from the King Hussein Medical City participate in the protocols’ orientation sessions on December 4–6, 2023, in Amman, Jordan. Photo credit: USAID MTaPS Jordan
In 2024, MTaPS supported the RMS in leading three orientation workshops across all 14 RMS hospitals nationally, with nearly 200 health care professionals in attendance. The workshops were designed to familiarize health care staff, including physicians, nurses, clinical pharmacists, infection prevention and control focal points, laboratory technicians, and quality officers, with the newly developed protocols.
A dedicated team of specialized physicians, clinical pharmacists, and the head of the quality unit from Al Hussain Hospital facilitated the workshop sessions. The sessions provided comprehensive discussions on the protocols and introduced the protocols’ audit tool and key performance indicators, previously developed with MTaPS support, to monitor and evaluate protocols’ adherence.
Pilot Rollout and Results
Currently, MTaPS is supporting the RMS in rolling out these protocols at one pilot hospital, Al Hussain Hospital. The hospital’s quality unit and clinical pharmacists are collecting data to monitor adherence to the protocols. Thus far, baseline, round 1, and 2 data have been collected (Figure 1), showing a gradual increase in adherence. The Al Hussain Hospital antimicrobial stewardship committee will review the data, with MTaPS providing insights and recommendations for continuous improvement.
Dr. Saleem Al Adayla, an ICU specialist in internal medicine at Prince Hashem bin Abdullah II Military Hospital in Aqaba, stated, “Implementing such protocols in all RMS ICU units will enhance the quality of provided services and standardize the treatment of the most common infections. This will not only improve health outcomes for patients but also rationalize the use of antibiotics, ultimately reducing antimicrobial resistance at our facility.”
Toward Improved ICU Patient Safety and Better Health
This initiative represents a crucial step forward in combating AMR within the ICU setting in Jordan. Activities are not limited to a series of workshops and protocol distributions. By implementing the protocols and ensuring adherence through continuous monitoring and evaluation, the RMS is laying down a foundation for safer patient care, reduced antibiotic resistance, and, ultimately, better health outcomes. This effort aligns with Jordan’s National AMR Action Plan and sets a precedent for antimicrobial stewardship actions that can guide similar initiatives in other countries.