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This quality improvement project is a successful example of an interprofessional clinical nurse specialist-led initiative that impacts patient/family and organization outcomes through the identification and implementation of evidence-based nursing practice.

BackgroundAntibiotic resistance (ABR) is a serious threat that requires coordinated global intervention to prevent its spread. There is limited data from the English-speaking Caribbean.MethodsAs part of a national programme to address antibiotic resistance in Jamaica, a survey of the knowledge, attitudes and antibiotic prescribing practices of Jamaican physicians was conducted using a 32-item self-administered questionnaire.ResultsOf the eight hundred physicians targeted, 87% responded. The majority thought the problem of resistance very important globally (82%), less nationally (73%) and even less (53%) in personal practices. Hospital physicians were more likely to consider antibiotic resistance important in their practice compared to those in outpatient practice or both (p < 0.001). Composite knowledge scores were generated and considered good if scored > 80%, average if 60–79% and poor if < 60%. Most had good knowledge of factors preventing resistance (83%) and resistance inducing potential of specific antibiotics (59%), but only average knowledge of factors contributing to resistance (57%). Knowledge of preventative factors was highest in females (p = 0.004), those with postgraduate training (p = 0.001) and those > four years post graduation (p = 0.03). Empiric therapy was often directed by international guidelines and cultures were not routinely done. Limited laboratory and human resources were identified as challenges.ConclusionPhysicians in this study were aware of the problem of ABR, but downplayed its significance nationally and personally. These results will guide a national antibiotic stewardship programme.

This paper analyses the situation in countries comprising the WHO South-East Asia Region with respect to water supply and sanitation services, hygiene and the epidemiology of related infectious diseases. Recently, published data from the WHO/UNICEF Global Water Supply and Sanitation Assessment 2000 report was reviewed to depict the situation with respect to consumers' access to improved water supply and sanitation services. It was shown that access to improved drinking water supplies is among the lowest in the world, and that sanitation coverage in this region is below all others. The paper also reviews selected surveys of hygiene behaviours in several countries of the region. Associations are suggested between access to services, hygienic practices and specific infectious diseases. The need is acknowledged to improve the evidence base on linkages between infectious diseases and water, sanitation and hygiene, and specific recommendations are made in this regard. There is a need now and for the foreseeable future to promote low-cost household-level interventions, including behaviour change strategies, that mitigate the health consequences of the current situation with respect to water supply, sanitation and hygiene. The role of health authorities in meeting this challenge, and as advocates for accelerating development of the water and sanitation sector, is highlighted.