Post Detail

On 3rd September, 2025, The Bir Hospital successfully hosted a Refresher Training for the Hospital National Antimicrobial Prescribing Survey II (NAPS II) under the CAPTURA project, in collaboration with the International Vaccine Institute (IVI) and the National Centre for Antimicrobial Stewardship (NCAS), Australia. This initiative is part of Nepal’s ongoing commitment to combat antimicrobial resistance (AMR) by improving the quality of antimicrobial prescribing across hospitals.

Understanding NAPS

The Hospital National Antimicrobial Prescribing Survey (NAPS) is a standardised, web-based auditing tool originally developed in Australia. It evaluates antimicrobial use through two key indicators:

• Compliance with clinical guidelines
• Appropriateness of prescribing
  

NAPS enables hospitals to apply a uniform data collection methodology, ensuring consistency, comparability, and benchmarking at both national and international levels.

In Nepal, NAPS was first piloted during Phase I, which established baseline data on antimicrobial use (AMU). The ongoing Phase II builds on that foundation, aiming to assess progress, address gaps, and strengthen antimicrobial stewardship programs.

Objectives of the Refresher Training

The refresher training at Bir Hospital focused on preparing healthcare teams for the second round of NAPS. Its specific objectives were to:

• Track progress in antimicrobial prescribing since Phase I.
• Provide hospitals with benchmarking data for national and international comparison.
• Generate evidence to inform hospital policies and national stewardship initiatives.
• Contribute to the development of a national AMU surveillance system.

Training Approach and Highlights

The refresher training was hands-on and case-based, ensuring participants could build directly on lessons from Phase I. Sessions encouraged auditors to present their experiences, discuss challenges, and practice with real scenarios.

Key clarifications from plenary sessions included:

• Surgical NAPS module: A new tool to audit antimicrobial use before, during, and after surgery.
• Time series tracking: Hospitals can now analyse AMU trends over multiple years.
• Non-compliance criteria: Any unmet indicator automatically categorises a case as non-compliant.
• Guideline adherence: Only locally or nationally endorsed guidelines are valid references.
• Microbiology mismatch: Prescriptions inconsistent with AST results must be flagged.
• Documentation standards: Indications not explicitly recorded must be marked “NO.”
  

These refinements ensure greater accuracy, consistency, and reliability in audit outcomes.

Lessons from Phase I

Participants reflected on the key challenges identified during the first survey:

• Subjectivity in auditing decisions, leading to inconsistencies.
• Clinician input required in 30–35% of cases.
• Incomplete documentation, limiting clear assessments.
• Resident availability influences audit quality.
  

By addressing these challenges, NAPS II aims to strengthen data reliability and support evidence-based antimicrobial stewardship.

Data Collection Schedule at Bir Hospital

The refresher training was immediately followed by ward-level data collection, conducted between 4th and 18th September 2025.

Date	Wards Covered
4th Sept	SICU + Urology
5th Sept	Gastro Surgery + Cabin 2nd
6th Sept	A-ICU + Post OP
7th Sept	FMW + Old Cabin
8th Sept	MMW + Respi ICU + HDU
9th Sept	Orthoplastic + CTVS Ward + CTVS ICU
10th Sept	GSW + 3rd Floor Cabin + KTP
11th Sept	Neurosurgical Ward + Neuro ICU
12th Sept	2nd Floor Cabin + ENT
13th Sept	Cardio Ward + Nephro
14th Sept	Gastro Medicine + CCU
15th Sept	Neuro Endo + Respi Ward + Geriatrics
16th Sept	Hepato Ward + Burn HDU + ICU
17th Sept	Onco + Hepato ICU + 1st Floor Cabin
18th Sept	M-ICU

Participants

The training brought together 25 professionals, representing a wide spectrum of expertise:

• Hospital leadership (Director and Deputy Director)
• Senior consultants and physicians
• Clinical pharmacists
• Nursing officers and infection prevention staff
• Researchers from IVI and NCAS
  

This multidisciplinary collaboration highlights the importance of a team-based approach to antimicrobial stewardship.

Moving Forward

The NAPS II refresher training at Bir Hospital marks a critical step towards strengthening antimicrobial stewardship in Nepal. The data collected will:

• Benchmark progress since Phase I.
• Guide hospital-level improvements in prescribing practices.
• Provide evidence to policymakers for designing targeted AMS programs.
• Contribute to the development of a national AMU surveillance framework.
  

As antimicrobial resistance continues to rise globally, such initiatives are essential in ensuring that antimicrobials remain effective for future generations.