Toolkit (an operational framework) designed to support the health professional to improve the prevention and treatment of HAI and antimicrobial resistance.
Healthcare-associated infections (HAIs) are a major cause of morbidity and mortality, therefore, prevention and education are key control strategies. Antimicrobial stewardship programs are interventions designed to improve use of antimicrobials, reducing hospital rates of antibiotic resistant HAIs, saving hospitals and tax-payers’ money.
Some of the good practice goals:
Identify and evaluate HAIs management processes in the participating hospitals;
To collect data about antimicrobial resistant HAIs, highlighting fragilities in the use of antibiotics;
Design, implement and evaluate a new toolkit to assist health professionals dealing with antimicrobial resistant HAIs;
Support health professionals dealing with antibiotic resistant HAIs prevention and control, with the combination of a set of guidelines to implement Antibiotic Stewardship Programs and ARTEMIS’s support (information system to help on decision-making).
The activities include:
• Webpage, to make the toolkit, user manual and demonstrating available videos;
• Roadshow, to promote the toolkit and its implementation throughout the country;
• Reports to the hospitals and national program for HAI control;
• Training and education on antibiotic usage with didactic/pedagogical presentations, through posters and flyers and newsletters;
• Publication of papers an oral/posters communications in national/international scientific journals meetings.
Main stakeholders and beneficiaries: hospitals and medical staff.

Resources needed

HAITool required 200.000€ for fund implementation (during 1,5 years): help hospitals implementing the practice (demonstrating the system’s validation for the initial requirements on the information system within the organizational base, and follow-up).
HAITool counts with 3 full-time collaborators.

Evidence of success

HAITool provides surveillance and clinical decision-support on antibiotic prescription. Recognized as a new tool for the implementation of interventions to improve antibiotic use, it facilitates communication between microbiology laboratory and physicians, with an educational impact. It can be considered an important tool on ASP implementation since it supports five of its’ 7 core elements: Situation Assessment; Interventions to improve antibiotics use; Surveillance; Report; and Education.

Difficulties encountered

A lesson learned was the importance of involving professionals when designing and implementing health systems, considering their ideas and suggestions.
A challenge was the hardship of moving forward, given the lack of human resources within the hospitals.

Potential for learning or transfer

HAITool’s aim is to make hospitals’ internal management autonomous. It’s impact can be easily monitored: rates of antibiotic consumption and resistance can be visualized by ward; it’s locally customized and provides easy access to national and local guidelines. Thus, it is easily transferable regardless of national borders and dimension of institutions, as proved by its implementation in Portugal, Norway, Switzerland and Cape Verde.
It’s an example on the innovation for the health sector: it created a fit between technology and practice, integrated within the clinical practice and the healthcare workers' workflow; enables easy access to microbiology results and local epidemiological data, and it increases the percentage of patients with appropriate empiric therapy by reducing broad spectrum antibiotics prescription.
In conclusion, for public health, operational and financial sustainability reasons, we encourage all public health authorities to consider the implementation of HAITool.

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Main institution
Global Health And Tropical Medicine - Instituto de Higiene e Medicina Tropical
Lisboa, Portugal
Start Date
May 2014
End Date


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