Boosting Knowledge, Attitudes, and Practices: An Experimental Study Evaluating the Effectiveness of mHealth Training on Antimicrobial Resistance for Hemodialysis Nurses

Introduction

Patients undergoing hemodialysis treatment are at an increased risk for infections because these patients require prolonged healthcare interventions, have weakened immune system, use antibiotics, receive treatment in a shred healthcare setting, and require vascular accesses such as catheters, fistulas and venous central lines. Infection is the second master cause of mortality in hemodialysis population, accounting for 8% of all deaths. to the general population, hemodialysis patients have higher rates of infection, particularly sepsis and its associated mortality.

Due to the high rate of infections among hemodialysis patients, there is a significant utilization of antimicrobial agents in this population. This extensive use has led to the emergence of multidrug-resistant organisms in hemodialysis units. Antimicrobial resistance (AMR) arises when microorganisms, including bacteria, fungi, viruses, and parasites, evolve mechanisms to resist the effects of antimicrobial agents. In recent years, there has been an increase in the prevalence of AMR in hemodialysis facilities worldwide, particularly among bacteria such as Staphylococcus aureus, Escherichia coli, and Klebsiella pneumonia. Staphylococcus aureus causes up to 70 % of vascular access infections in hemodialysis patients, and the problem worsens by the dissemination of methicillin-resistant S. aureus (MRSA) isolates. About 90 % of patients with MRSA infections require hospitalization, and 17 % die during hospital stay.

In Jordan, gram-positive bacterial infections and antibiotic resistance rates were high in Jordan. Methicillin-resistant S. aureus (MRSA) and methicillin-resistant coagulase-negative Staphylococci (MR-CoNS) infections were common and exhibited high rates of antibiotic resistance. Furthermore, streptococcus pneumonia showed increased resistance rates to most antimicrobials. Reports form Jordanian hospitals also showed a high prevalence of AMR, with particular note to methicillin-resistant Staphylococcus aureus (MRSA) that reached a rate of 45% (Ministry of Health National Action Plan, 2018).

Antimicrobial resistance is a complex and multifaceted global public health issue that threatens the effective prevention and treatment of infections. In 2019, the World Health Organization (WHO) announced AMR as one of the top 10 global public health threats facing humanity in 2019. Antimicrobial resistance renders standard treatments ineffective, complicating infection management, and elevating the risk of disease transmission, prolonged illness, and adverse outcomes. It also leads to increased morbidity, mortality, and hospital stays. The cost of AMR to the economy is significant as well. In addition to death and disability, prolonged illness results in longer hospital stays, leading to more expensive medications and increased financial burdens for those effected. AMR is predicted to cost the world economy between $300 billion and $1 trillion by 2050.