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As part of the CAPTURA II/TACE project’s ongoing efforts to strengthen antimicrobial stewardship (AMS) systems in Nepal, the Antimicrobial Stewardship Program (AMSP) core committee of Bir Hospital conducted a cross-learning visit to Grande International Hospital. 

Facilitated by Anweshan, the local implementation partner for CAPTURA, the exchange brought together two of Nepal’s leading healthcare institutions at Grande’s premises in Tokha, Kathmandu. The visit aimed to provide practical insights into established AMS practices, foster collaboration, and enable both hospitals to reflect on and enhance their strategies in response to the growing challenge of antimicrobial resistance (AMR). 

Grande International Hospital’s AMS Experience 

Grande International Hospital has been implementing its AMS program since 2014. Led by a multidisciplinary team, the hospital has developed a robust system featuring: 

• A dedicated AMS committee with representatives from clinical departments, microbiology, pharmacy, nursing, and administration. 
• An in-house antibiotic reference guide regularly updated based on international guidelines. 
• A formulary restriction system for high-risk antibiotics, supported by a daily approval process operating seven days a week. 
• Clear protocols for infection prevention, resistance monitoring, and prescribing practices. 

Grande’s team highlighted the crucial role of strong internal communication, consistent staff training, and leadership support in maintaining effective stewardship practices. 

Bir Hospital’s AMS Journey 

Nepal’s oldest public hospital, Bir Hospital, began its AMS journey in 2023 after participating in WHO-led AMS mentorship training. Since then, the hospital has: 

• Formed AMS core and governance committees. 
• Developed a detailed work plan aligned with Nepal’s National AMR Action Plan. 
• Conducted hospital-wide staff orientation sessions. 
• Created an antibiogram to guide local prescribing. 
• Initiated interventions such as AMS rounds, prescriber feedback, and integration of infection prevention and control (IPC) practices. 

During the visit, Ms. Sangita Shrestha, Nursing Director and AMS committee member, shared Bir’s progress and ongoing challenges. These included limited data systems, difficulties in interdepartmental coordination, and the need for greater physician engagement. 

Shared Learning and Key Takeaways 

An engaging discussion followed the presentations, where both hospitals exchanged experiences on topics such as: 

• Antibiotic approval workflows and compliance tracking. 
• Routine creatinine clearance monitoring for ICU patients. 
• Patient challenges in adhering to diagnostic testing. 
• Use of antibiograms in managing multidrug-resistant organisms (MDROs). 
• Strategies for staff motivation and mandatory AMS orientation. 
• Integration of IPC during outbreak investigations. 

Grande also described how its IPC team manages reports of MDRO-positive cases through targeted isolation, testing, and environmental sampling. 

Next Steps for Bir Hospital 

Inspired by Grande’s practices, Bir Hospital plans to: 

• Appoint AMS “champions” in each clinical department. 
• Develop regulatory guidelines for antibiotic formulary restrictions. 
• Accelerate the creation of AMS training modules. 
• Submit a training budget for review and support under CAPTURA II. 

The cross-learning visit underscored the power of collaboration in advancing stewardship efforts and contributing to Nepal’s national AMR goals. It highlighted the value of adapting existing models to local contexts, ensuring that AMS programs are both effective and sustainable. 

“The engagement between Bir and Grande is a strong example of how peer learning can drive meaningful change in AMS implementation,” said Manish Gautam, Managing Director of Anweshan. “Through CAPTURA II/TACE, we aim to facilitate more of these exchanges across Nepal and the region.” 

As both hospitals move forward with renewed strategies and shared knowledge, the visit serves as a reminder that combating antimicrobial resistance requires not only policy but also dedicated people working together—openly, practically, and continuously.