Integrating Antimicrobial Stewardship and Infection Prevention Through Repeated Assessment and Feedback: A Multisite Quality Improvement Initiative in Viet Nam

Background

Antimicrobial stewardship (AMS) and infection prevention and control (IPC) are complementary strategies to improve patient safety and address antimicrobial resistance (AMR). In low- and middle-income countries (LMICs), they are often implemented separately, reducing effectiveness. Evidence on integrating AMS and IPC in routine hospital practice remains limited.

Objective

To evaluate the feasibility of an integrated AMS-IPC improvement approach and describe changes in implementation in Vietnamese hospitals.

Methods

We conducted a multisite quality improvement initiative in four hospitals within the national AMR surveillance network in Viet Nam (March-September 2025). We used US-CDC’s tools to guide the implementation, including the Global Antibiotic Stewardship Evaluation Tool (G-ASET) and the Infection Control Assessment and Response (ICAR) tool. Baseline assessments were followed by feedback, multidisciplinary action planning, and targeted capacity building. Follow-up occurred 2-5 months later. Changes were analysed descriptively using quantitative scores and qualitative synthesis, and reported following the SQUIRE 2.0 guidelines.

Results

All hospitals had established IPC programmes at baseline, while AMS maturity varied. G-ASET scores improved across all sites, with greater gains in hospitals starting from lower baselines. Key improvements included leadership and governance, education and training, stewardship actions, and monitoring and reporting. IPC practices aligned with AMS priorities also improved, particularly transmission-based precautions, environmental cleaning, and cross-team coordination. Infrastructure-dependent areas, such as water safety, showed limited short-term progress.

Conclusions

An integrated AMS-IPC approach using repeated assessment and feedback is feasible and associated with meaningful improvements. This model offers a scalable strategy for strengthening hospital responses to AMR in LMICs and informs national programmes.

Key messages

• Repeated assessment and structured feedback within an integrated AMS-IPC approach were associated with improved AMS implementation across diverse Vietnamese hospitals.

• Use of G-ASET and ICAR enabled hospitals to identify common system gaps and develop coordinated, locally tailored improvement plans.

• Gains were most evident in domains influenced by leadership, coordination, and behaviour change, whereas areas requiring financial investment showed less improvement over the short term.

• This assessment-guided network model may provide a scalable and cost-effective strategy to strengthen AMS-IPC integration in LMICs and inform future Fleming Fund-type investments.

Summary of main point

This study demonstrates that integrating antimicrobial stewardship and infection prevention through structured assessment and feedback is feasible in Vietnamese hospitals, leading to measurable improvements and offering a scalable, practical model for strengthening AMR responses in low- and middle-income countries.