Enhancing Nursing Competencies in Antimicrobial and Diagnostic Stewardship Through Continuing Education

Abstract

Background: Antimicrobial resistance (AMR) is a global health threat, and nurses play a critical role in antimicrobial stewardship (AMS) and diagnostic stewardship. However, gaps in knowledge and practice persist.

Aim: To evaluate the effectiveness of a structured continuing education program in improving nurses' competencies in AMS and diagnostic stewardship.

Methods: A quasi-experimental pre-post study was conducted among 252 nurses across India. Participants completed a 25-item pre-test, attended a three-hour interactive online training, and then completed a post-test. The program emphasized integrated stewardship, including culture collection before antimicrobials, monitoring therapy duration, catheter removal, accurate drug reconstitution, and microbiological diagnostic test sample collection best practices.
Results: Mean scores improved significantly from 11.2 to 17.0 out of 25 (p < 0.001). Domain-wise analysis showed substantial gains in specimen collection (e.g., urine culture indications improved from 25% to 75%), blood culture practices, and specimen handling. Knowledge of pharmacokinetic and pharmacodynamic principles improved significantly, with correct dosing for major antibiotic classes from 32% to 68% and accurate IV reconstitution increasing from 35% to 68%. AMS domain scores increased from 42% to 58%, reflecting better understanding of culture-before-antibiotic principles, therapy de-escalation, and adverse effect recognition. However, surgical site infection (SSI) prevention showed mixed outcomes, with declines in postoperative antibiotic continuation (59% to 41%) and wound handling (61% to 39%), indicating persistent misconceptions requiring targeted reinforcement.
Conclusion: Structured education enhances nurses' AMS and diagnostic stewardship knowledge, but single-session interventions are insufficient for lasting change. Future programs should include regular refreshers, case-based learning, and audit-feedback to sustain improvements and integrate stewardship into routine nursing workflows.