Abstract
An increase in antimicrobial drug resistance is a big concern for all hospitals. Thus, effective infection
control (IC) policy and antibiotic stewardship programs (ASP) are crucial to managing the problem.
However, data on such measures in Thai hospitals are limited. This cross-sectional study aims to explore
hospital IC measures, ASP, and barriers to implementation in public tertiary care hospitals (TH), district
hospitals (DH), and private hospitals (PH) in Thailand. The study was conducted during April and May
2012 in nine provinces, purposely selected to represent 5 regions. Among 102 hospitals included (13 TH,
69DH, 6 large PH, 14 small PH), the IC measures were implemented more than the ASP (96% vs. 88%)
with different focus in each hospital group. Non-cooperation from relevant health providers was the
most common barriers to IC and ASP implementation in all groups (38-70%). Inclusion of IC as the
criteria for hospital accreditation had the strongest effect that could introduce IC activities into more than
80% of hospitals. Strengths of the TH were microbiology laboratories and antibiotic susceptibility test.
Concerning ASPs, the TH was a good performer in using antibiograms for the selection of antimicrobials
in hospital formulary. They had IC committee as the core group and tended to implement antibiotic
restrictive strategies. TH’s limitations were staff shortage and disagreement from medical staff towards
some antibiotic guidelines. As for DH, strengths were persuasive measures developed from the
Antibiotics Smart Use program. Plus, DH had Pharmacy & Therapeutics Committee as the core driver.
Limitations were lack of budget, frequent staff rotation and discontinuation of the activities. For PH,
strengths were microbiology laboratories and persuasive measures. In conclusions, hospitals had
different strengths and limitations, thus careful selection of appropriate IC measures and ASP is needed
with participation of stakeholders to tailor the measures to hospital context. Policymakers might start
with activity that raise concern in relevant health providers, support their strengths, alert private
hospitals, and help reducing obstacles that limit further development and sustainability of the IC and
ASP.
