Diagnostic stewardship – the strategic use of laboratory testing and its data to guide appropriate patient management and antibiotic prescription – is critical implementation of antimicrobial stewardship programs in healthcare facilities and addressing Antimicrobial Resistance (AMR).
Effective diagnostic stewardship depends on strong collaboration and communication among laboratory personnel, clinicians, nursing staff and pharmacists. This ensures appropriate tests are ordered, samples are properly collected, transported and processed, and laboratory results are accurate and effectively utilized for patient management, enabling the appropriate use of antibiotics.
Most of the time, laboratory-generated data on antimicrobial resistance trends in a hospital remains within the laboratory records, while such data is important for clinicians in decision-making for the selection of appropriate antimicrobial therapy. On the other hand, clinicians could support in promoting the practice of requesting culture and sensitivity tests when required for evidence-based antimicrobial selection, enhance AMR surveillance and guide empirical treatment.
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Ms Roshani Tuitui, Chief Nursing Administrator from Sukraraj Tropical and Infectious Disease Hospital (left image) orients nurses on their role and Infection Prevention and Control in combating Antimicrobial Resistance (AMR) and Dr Palpasa Kansakar, National Professional Officer for AMR and laboratories at WHO Nepal, facilitates a session on integrated AMR management in hospitals at Sukraraj Tropical and Infectious Disease Hospital, Bagmati province, Nepal. Photo credit: WHO Nepal/N.Aryal
With the objective of strengthening laboratory-clinician collaboration to enhance AMR surveillance, appropriate use of laboratory tests and interpretation of results for patient management to address AMR in Nepal, the National Public Health Laboratory (NPHL) under the Ministry of Health and Population (MoHP), with support from WHO Country Office for Nepal, organized site-specific laboratory-clinician interaction workshops in 10 hospitals in Koshi, Bagmati, Lumbini and Sudurpashchim provinces.
These workshops conducted between 2023 and 2024, engaged nearly 500 health-care staff (clinicians, laboratory personnel, pharmacists and nursing staff). Participants received orientation on appropriate test selection, sample collection, storage, transport and the interpretation of laboratory results for clinical decision-making. Additionally, they analyzed the resistance patterns of prevalent bacterial pathogens within their institutions and shared findings with their peers.
These workshops also provided a platform for clinicians and laboratory personnel to identify key challenges and propose potential solutions. Clinicians underscored the importance of aligning Antibiotic Sensitivity Test (AST) panels – which determine the susceptibility of microbial pathogens to antimicrobial panels tested – with commonly prescribed antibiotics. Laboratory personnel highlighted the need for proper sample handling, complete documentation and detailed clinical histories to help laboratory reporting.
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Ms Sreska Shrestha, Deputy Chief Medical Technologist from the National Public Health Laboratory, Ministry of Health and Population, orienting laboratory personnel on laboratory-based Antimicrobial Resistance surveillance at Bheri Hospital, Lumbini province, Nepal. Photo credit: WHO Nepal/N.Aryal
Participants acknowledged the need to incorporate AMR discussions in hospital infection prevention and control (IPC) committees, into medical education and conducting periodic resistance trend analyses and data sharing with relevant health-care staff. The sessions further highlighted nurses as key players in IPC and their critical role in appropriate sample collection and its timely transportation to laboratories.
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Ms Lilee Shrestha, Chief Medical Technologist from the National Public Health Laboratory, orients clinicians and lab personnel on laboratory-based Antimicrobial Resistance surveillance at Mahakali Provincial Hospital, Sudurpashchim province, Nepal. Photo credit: WHO Nepal/N.Aryal
“AMR trends from the ongoing surveillance program have been considered in revising the national antimicrobial treatment guideline. Fostering interdisciplinary dialogue and adhering to evidence-based practices are crucial in strengthening AMR surveillance and addressing the threat of AMR. We must now institutionalize laboratory-clinician interaction meetings to integrate local resistance data into stewardship efforts which allows real-time adjustments to prescribing practices," said Dr Ranjan Raj Bhatta, Director of NPHL.
Dr Rajesh Sambhajirao Pandav, WHO Representative to Nepal, highlighted the broader impact: "Through these workshops, Nepal is laying a strong foundation for lab-clinic collaboration and hospitals can institutionalize such interactions to facilitate discussion around test results, treatment plans and strategies for optimizing antibiotic use. Strengthening this interaction not only enhances the quality of data but also provides robust evidence for AMR containment.”
Nepal’s AMR surveillance program, initiated in 1999 collects AMR surveillance data (human health sector) from 26 hospitals, has enabled the national lab to track AMR trends and share findings nationally and internationally.
WHO will continue its ongoing assistance to the MoHP in strengthening AMR surveillance, enhancing laboratory systems and facilitating global reporting of AMR surveillance data through the WHO Global Antimicrobial Resistance and Use Surveillance System (GLASS) - AMR platform.
The workshops are supported by The Fleming Fund.