Identifying Factors of Success in Implementing an Intervention for Management of Inpatient Bacteriuria in Nova Scotia’s Community Hospitals

Abstract

Background Antimicrobial resistance (AMR) is a global health threat, exacerbated by inappropriate antibiotic use in hospitals. Antimicrobial stewardship (AMS) programs optimize prescribing but face unique challenges in small and medium-sized hospitals with limited infrastructure and resources. Methods This thesis combines a scoping review and a qualitative study. The scoping review mapped 12 studies on AMS implementation in small-to-medium hospitals in high-income countries. The qualitative study explored a multifaceted audit and feedback intervention for bacteriuria management in four Nova Scotian community hospitals. Semi-structured interviews with feedback deliverers were deductively coded using the Consolidated Framework for Implementation Research (CFIR) and inductively analyzed for context-specific themes. Results Eleven themes spanned CFIR domains. Barriers included time constraints, high turnover, residual prescribing, and feedback fatigue. Facilitators included strong champion relationships, constructive communication, contextual tailoring, and system supports. Conclusion Findings highlight the importance of contextually responsive, relationship-driven strategies to enhance AMS implementation in resource-limited hospital settings.