Healthcare Infection Healthcare Infection Society
Official Journal of the Australasian College for Infection Prevention and Control
RESEARCH ARTICLE

Cultural dimensions relevant to antimicrobial stewardship: the contribution of individualism and power distance to perioperative prescribing practices in European hospitals

Allen C. Cheng A B C and Leon J. Worth A
+ Author Affiliations
- Author Affiliations

A Infection Prevention and Healthcare Epidemiology Unit, Alfred Health, Melbourne, Vic. 3004, Australia.

B Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Vic. 3004, Australia.

C Corresponding author. Email: allen.cheng@monash.edu.au

Healthcare Infection 20(4) 124-127 https://doi.org/10.1071/HI15010
Submitted: 21 April 2015  Accepted: 17 August 2015   Published: 1 October 2015

Abstract

Antimicrobial prescribing practices are influenced by many factors, including culture and societal norms. Sociological researchers have previously proposed dimensions by which cultures may be defined. We sought to examine the association between cultural dimensions and the proportion of surgical prophylaxis inappropriately continued for longer than 24 h (PAP >24) by evaluating published European Centre for Disease Prevention and Control point-prevalence data from European countries. A negative correlation between individualism and PAP >24 was evident, whereas power distance and PAP >24 were positively correlated. A positive correlation was also observed between uncertainty avoidance and PAP >24. Findings imply that prolonged surgical antibiotic prophylaxis is associated with collectivism viz. a preference for a tight-knit societal framework. The impact of societal and cultural factors on antimicrobial prescribing has not been thoroughly evaluated in Australia, and these potential influences require further consideration in formulating targeted interventions for improved prescribing practices.


References

[1]  Chaves NJ, Cheng AC, Runnegar N, Kirschner J, Lee T, Buising K. Analysis of knowledge and attitude surveys to identify barriers and enablers of appropriate antimicrobial prescribing in three Australian tertiary hospitals. Intern Med J 2014; 44 568–74.
Analysis of knowledge and attitude surveys to identify barriers and enablers of appropriate antimicrobial prescribing in three Australian tertiary hospitals.CrossRef | 1:STN:280:DC%2BC2cbotVynsQ%3D%3D&md5=a21fd45b7ae35b593c24d8d419e18d89CAS | 25083531PubMed |

[2]  Whitby M, Pessoa-Silva CL, McLaws ML, Allegranzi B, Sax H, Larson E, Seto WH, Donaldson L, Pittet D. Behavioural considerations for hand hygiene practices: the basic building blocks. J Hosp Infect 2007; 65 1–8.
Behavioural considerations for hand hygiene practices: the basic building blocks.CrossRef | 1:STN:280:DC%2BD28jltVagtA%3D%3D&md5=b1f3dfc26c76c043955bc1393ac5330aCAS | 17145101PubMed |

[3]  Borg MA, Camilleri L, Waisfisz B. Understanding the epidemiology of MRSA in Europe: do we need to think outside the box? J Hosp Infect 2012; 81 251–6.
Understanding the epidemiology of MRSA in Europe: do we need to think outside the box?CrossRef | 1:STN:280:DC%2BC38jhsVyitQ%3D%3D&md5=979aa7a54634a22a58ec74b68358b4f4CAS | 22695171PubMed |

[4]  Hofstede G. Culture’s consequences: comparing values, behaviors, institutions and organizations across nations. 2nd edn. Thousand Oaks, CA: Sage Publications; 2001.

[5]  Borg MA. Prolonged perioperative surgical prophylaxis within European hospitals: an exercise in uncertainty avoidance? J Antimicrob Chemother 2014; 69 1142–4.
Prolonged perioperative surgical prophylaxis within European hospitals: an exercise in uncertainty avoidance?CrossRef | 1:CAS:528:DC%2BC2cXktlOjtLs%3D&md5=9b45f68dc257e5d87bd53563992d847fCAS | 24225527PubMed |

[6]  European Centre for Disease Prevention and Control. Point prevalence survey of healthcare associated infections and antimicrobial use in European acute care hospitals. Stockholm: ECDC; 2013.

[7]  Baquero F, Baquero-Artigao G, Canton R, Garcia-Rey C. Antibiotic consumption and resistance selection in Streptococcus pneumoniae. J Antimicrob Chemother 2002; 50 27–37.
Antibiotic consumption and resistance selection in Streptococcus pneumoniae.CrossRef | 1:CAS:528:DC%2BD3sXhvVOhsrg%3D&md5=ae9a22a665cca6e30bf60e04cc916725CAS | 12556431PubMed |

[8]  Blommaert A, Marais C, Hens N, Coenen S, Muller A, Goossens H, Beutels P. Determinants of between-country differences in ambulatory antibiotic use and antibiotic resistance in Europe: a longitudinal observational study. J Antimicrob Chemother 2014; 69 535–47.
Determinants of between-country differences in ambulatory antibiotic use and antibiotic resistance in Europe: a longitudinal observational study.CrossRef | 1:CAS:528:DC%2BC2cXlvFOltQ%3D%3D&md5=42b67a87fdaa1daccfbd6b62f67e00ffCAS | 24080501PubMed |

[9]  Borg MA. National cultural dimensions as drivers of inappropriate ambulatory care consumption of antibiotics in Europe and their relevance to awareness campaigns. J Antimicrob Chemother 2012; 67 763–7.
National cultural dimensions as drivers of inappropriate ambulatory care consumption of antibiotics in Europe and their relevance to awareness campaigns.CrossRef | 1:CAS:528:DC%2BC38Xit1Ogt7w%3D&md5=784784267131fb0d7e964c072cab3b9dCAS | 22200725PubMed |

[10]  Deschepper R, Grigoryan L, Lundborg CS, Hofstede G, Cohen J, Kelen GV, Deliens L, Haaijer-Ruskamp FM. Are cultural dimensions relevant for explaining cross-national differences in antibiotic use in Europe? BMC Health Serv Res 2008; 8 123
Are cultural dimensions relevant for explaining cross-national differences in antibiotic use in Europe?CrossRef | 18538009PubMed |

[11]  Beugelsdijk S, Maseland R, van Hoorn A. Are Hofstede’s cultural dimensions stable over time? A generational cohort analysis. SSRN 2013; 2336893

[12]  Australian Commission on Safety and Quality in Health Care. Antimicrobial Stewardship Clinical Care Standard. Sydney: ACSQHC; 2014.

[13]  Friedman ND. Infection prevention and antimicrobial stewardship: important in all settings. Healthc Infect 2015; 20 1–3.
Infection prevention and antimicrobial stewardship: important in all settings.CrossRef |

[14]  Ukawa N, Tanaka M, Morishima T, Imanaka Y. Organizational culture affecting quality of care: guideline adherence in perioperative antibiotic use. Int J Qual Health Care 2015; 27 37–45.
| 25502553PubMed |

[15]  Borg MA. Lowbury Lecture 2013. Cultural determinants of infection control behaviour: understanding drivers and implementing effective change. J Hosp Infect 2014; 86 161–8.
Lowbury Lecture 2013. Cultural determinants of infection control behaviour: understanding drivers and implementing effective change.CrossRef | 1:STN:280:DC%2BC2cvlslCisA%3D%3D&md5=2838e54f6deac49447395ab8d64e0085CAS | 24534705PubMed |


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