Education Dutch Antimicrobial Stewardship

Why Radboudumc?

The Radboudumc offers small classes, excellent and reknown clinical and implementation scientists as well as tutors, clear learning goals, modern teaching skills, examination and certification. Furthermore, we cooperate with other Centers of Excellence in Infectious Diseases exchanging guest professors.

We are ideally placed for groups, responsible for the implementation of an Antimicrobial Stewardship Program, including clinicians (micro, ID, clinical pharmacy) and policymakers.

Participants in 2019 awarded the masterclass a 9.2 (on a scale from 1 to 10).

Tutors of the masterclass

Marlies Hulscher PhD, professor of Quality of Care for infectious diseases

Marlies is a senior researcher at the Scientific Institute for Quality of Healthcare (IQ healthcare) of the Radboud University Medical Center, Nijmegen. IQ healthcare has a multi-disciplinary health services research staff with a background in e.g. sociology, social psychology, humanities, (bio)medical sciences, and economics and management. Marlies has more than 25 years experience in implementation research and behavioral science. Implementation scientists seek to understand the behavior of healthcare professionals and other stakeholders as a key variable in the uptake of evidence-based interventions into routine practice. Such insight into factors that underpin behaviors is crucial so that theories on behavioral change can be selected to generate ideas for the planning of effective interventions to change professional and stakeholder behavior and improve patient health.

As a Principal Investigator Marlies has performed numerous studies on defining, measuring, understanding and improving appropriate hospital antibiotic use and infection prevention. She is experienced in qualitative and quantitative research and in effect, process and economic evaluations.

Read more about Marlies or visit the Dutch Antimicrobial Stewardship team page.

Heiman Wertheim, professor in clinical microbiology

Heiman is clinical microbiologist and heads the clinical microbiology department at Radboud University Medical Center.  He is board member for the Nederlandse Vereniging voor Medische Microbiologie (NVMM) and member of the ‘Raad voor Wetenschap en Innovatie’ at the Federatie Medisch Specialisten.

One of his main interests is antibiotic resistance in both resource rich and resource constrained settings and does this through a multidisciplinary approach: health systems, policy development, behavior, surveillance, prevention, genomics, stewardship and clinical trials. Heiman is currently part of a WHO expert panel to develop a priority pathogens list (PPL) for antimicrobial resistant bacteria.

Read more about Heiman or visit the Dutch Antimicrobial Stewardship team page.

Jaap ten Oever MD PhD, infectious disease physician

Jaap’s interest are community- and hospital-acquired infections and antimicrobial stewardship, in which he has extensive hands-on experience, is involved in research and policy-making. He was trained as an infectious disease specialist at the Radboud university medical center and obtained his PhD in 2014 with his thesis “Footprints of infections novel diagnostic strategies in infectious diseases”. Besides being a member of the Radboud university medical center antimicrobial stewardship team, he participates in the antibiotic resistance & infection prevention network Gelderland (GAIN), is secretary of the Dutch working Party on Antibiotic Policy (SWAB) working group on antimicrobial stewardship, and a board member of the SWAB. He coordinates the development and implementation of the Dutch antimicrobial stewardship monitor. He is the vice-coordinator of the infectious diseases training program.

Read more about Jaap or visit the Dutch Antimicrobial Stewardship team page.

Jeroen Schouten MD PhD, intensivist and senior researcher

Jeroen is an intensivist at Radboud University Medical Center in Nijmegen and is a senior researcher at IQ healthcare. Jeroen earned a PhD in Infectious Diseases and Implementation Science and has been involved in qualitative research with a focus on antimicrobial stewardship ever since, focusing on its application in Intensive care medicine. As senior researcher, Jeroen has performed numerous studies on understanding and improving hospital antibiotic use. He is experienced in qualitative and quantitative research methods and has been involved in many (inter)national initiatives to improve antibiotic prescribing (e.g. SWAB, ECCMID, ECDC, WHO).

Read more about Jeroen or visit the Dutch Antimicrobial Stewardship team page.
Roger Brüggemann PhD, hospital pharmacist and clinical pharmacologist
Roger is a hospital pharmacist and clinical pharmacologist at Radboud University Medical Center in Nijmegen. He is responsable for translational farmacological research into anti-infectives (antifungal and antibacterial). His research interests cover three domains: from in vitro and experimental work in animals to research in  specific patient populations (ICU, hematology, neonatology and pediatrics, obese patients) in a model of strong national and international collaboration. The focus of his research is to unravel influencing factors on pharmacokinetics and pharmacodynamics of anti-infectives. Roger co-authors treatment guidelines on TDM for antifungals. Clinically, Roger is responsible for pharmacological consultation at the departments of Hematology and Intensive Care medicine. He is a member of Radboudumc A-team.

Read more about Roger or visit the Dutch Antimicrobial Stewardship team page.

Masterclass program

Program

The course consists of a pre-course and a 5 day course. After the course, you will keep in contact with you dedicated tutor-coach for 6 months.

• Pre-course

  Pre-course study material is provided. Participants are required to study the suggested material and follow the WHO MOOC on Antimicrobial stewardship. Participants are also required to submit an abstract (format is provided by the organization) for an ongoing or planned antimicrobial stewardship project in their organization (e.g. implementation of guidelines, improving prescribing practice etc.)  This project will be used as a thread throughout the course. The required preparation time is approx. 8 hours.
   

• Day 1

  Afternoon
  Workshop Implementation in practice  part I “What is exactly my problem ?”

  • 13.30-17.00 Prerogatives of an ASP: what is my current status? Which are my norms? What do I need to do first? ‘prepared homework: where do I come from?’  (Marlies Hulscher / Jeroen Schouten / Jaap ten Oever)
    • 1-3 powerpoint slides about the current situation in your hospital / region/ country, what is your largest problem/concern related to antimicrobial use and what you hope to achieve in your home country
    • Afterwards group work on clarifying goals for the course
  • 18.00-19.30 Dinner 
  • 20.00-21.30 Fire-side conversation: “Cultural determinants of prescribing” (tbd)
     

• Day 2

  Morning: Workshop Implementation in practice part II: “How do I measure the quantity of
  Antimicrobial use?”.

  • 9.00-9.30 Quantity of antimicrobial use: the basics (Stephanie Natsch)
  • 9.30-12.00 Workshop “How to deduct Quantitative Measures from a raw database and how to analyse and present data: a 5 step approach” (Stephanie Natsch, Paul van der Linden, Annemieke van den Broek, Bart Hendriks)
  • 12.00-12.30 How do I do this in my own hospital, a practical example (Bart Hendriks, Leiden)
  • 12.30-13.30 Lunch

  Afternoon: Workshop Implementation in practice part II: “How do I measure the quality of
  Antimicrobial use?”

  • 13.30-14.00 Quality Indicators in Antimicrobial Stewardship, the basics (Marlies Hulscher)
  • 14.00-15.00 Workshop “How to operationalize Quality indicators for appropriate antimicrobial use” (Jaap ten Oever, Stephanie Natsch, Annemieke van den Broek,  Jeroen Schouten, Reinout van Crevel)
  • 15.00-16.00 Performing a Point Prevalence Survey, the basics (Jaap ten Oever) 
  • 15.30-16.30 Workshop “How to conduct a Point Prevalence Survey interpret the results and present results” (Jaap ten Oever, Stephanie Natsch, Annemieke van den Broek, Jeroen Schouten, Reinout van Crevel)
  • 16.30-18.00 Working on Group Project
  • 18.00-19.00 Optional: biking or walking tour in the Nijmegen - Groesbeek area
  • 19.00-20.30 Dinner

  Evening: Free evening.

• Day 3

  Morning: Workshop implementation in practice part III “how do I analyse barriers?”

  • 08.30-09.15 Determinants of Antibiotic use (Marlies Hulscher)
  • 09.15-10.00 How to perform an interview (Anke Oerlemans)
  • 10.00-12.00 Workshop “How to assess barriers and facilitators related to optimal antibiotic use” (Jeroen Schouten, Jaap ten Oever, Anke Oerlemans,  Rita Bos, Anita Huis)
  • Lunch break (on the bus)

  Afternoon: Visit to the National Institute for Public health and the Environment (RIVM).

  • 13.00-14.00 Welcome and tour at RIVM
  • 14.00-14.45 Meetings with Mariken van der Lubben (RIVM),  Merel Langelaar (Dutch Health Care Inspectorate) and Mark de Boer (SWAB, the Dutch Working party on Antimicrobial Stewardship) Tjalling over Cesar project
  • 14.45-15.45 Parallel sessions presenting successful Dutch stewardship projects and initiatives (6 presentations of 15 minutes + 5 minutes discussion)
    • 1. Allergy to Antibiotics? A practical approach - Mark de Boer, Leiden
    • 2. Implementing an Antimicrobial Use Monitoring system in your hospital – Bart Hendriks, Leiden
    • 3. Organising Outpatient Parenteral Antimicrobial therapy (OPAT) – Jaap ten Oever, Nijmegen 
    • 1. Clinical rules, audits and interventions - Winnie de Bruin, Hospital Pharmacist Diaconessenhuis Utrecht
    • 2. Experience with PPS in a small hospital – Marrigje Nabuurs, SMK Nijmegen
    • 3. Deployment of a nurse specialist for the AMS management team – Ingeborg Groothuis, UMC Utrecht
  • 15.45-16.15 Senior experts for AMR, an exemple from a PUM mission to Armenia
  • 16.15-17.00 Panel discussion (RIVM, Mark de Boer, Edmee Bowles):  how to organize stewardship in such a way that it works (interplay MOH-Inspectorate- Medical societies-Hospitals – Insurers etc)
  • 17.00-18.00 Drink at RIVM
  • 18.00-20.00 Dinner in the environment of Utrecht

• Day 4

  Morning: Workshop implementation in practice part IV “How do I choose effective interventions?”.

  • 09.00-09.30 How do I get from a barrier  to a potentially effective intervention (Rob Ruiter, Maastricht)
  • 09.30 – 12.00 Workshop “From barriers to an intervention”: tools and tricks  (Marlies Hulscher, Jeroen Schouten, Rob Ruiter)
  • 12.30-13.30 Lunch break

  Afternoon: Lectures.

  • 14.00-18.00 Group work: finalizing group project
  • 18.00-19.30 Dinner
  • 20.00-21.30 Fire-side conversation: “How to bring across your message” (Enny Das, Nijmegen)

• Day 5

  Morning: Grande finale.

  • 9.30 -12.30 Plenary presentation of personal / team projects to the complete group of experts & discussion (Marlies Hulscher, Jaap ten Oever, Heiman Wertheim, André van der Ven, Monique Keuter, Jeroen Schouten)

  Afternoon: Certificate ceremony, lunch and farewell.

  • 12.30-13.00 Certificate ceremony
  • 13.00-14.00 Lunch and Farewell

• Assistance after the masterclass

  After the course, one dedicated tutor-coach will keep I contact with the group until 6 months after the course. In this period a regular Skype meeting (one month and 6 months after the course) and (if so required) a local visit to the participants’ center can be organized.