International train the trainer neonatal antibiotic stewardship program for South African pharmacists

Hospital-acquired antimicrobial-resistant infections are a leading cause of neonatal mortality in South African (SA) neonatal intensive care units (NICU). There is an urgent need for NICU Antibiotic Stewardship Programs (ASP). We describe the development of an international Train-the-Trainer (TTT) NICU-ASP mentoring program for SA pharmacists. A partnership between the South Africa Antimicrobial Stewardship Program (SAASP) and ASP experts from two United States (US) hospitals was formed in 2019. A baseline assessment of four SA NICUs was done to guide the development of a TTT NICU-ASP mentoring of SA pharmacists utilizing the existing workforce. The program included bilateral site visits. Pre-post surveys were used to assess SA mentee's NICU experiences, barriers to clinical pharmacy services and confidence to train additional pharmacists in NICU ASP. Four mentees from private (n = 1) and public hospitals (n = 3) completed a 2-week TTT NICU-ASP in the US that included; education, patient care rounds, role-playing, peer-to-peer sessions and behavioral interventions followed by ongoing support and mentoring by SAASP mentors. None of the hospitals had pharmacists participating in daily patient care rounds or had multidisciplinary NICU-ASPs due to lack of NICU trained pharmacists and dedicated time for ASP. Post surveys showed improved confidence to train additional pharmacists in NICU-ASP. Subsequently, these SA mentees provided NICU-ASP education to over 700 health care professionals and trained six additional pharmacists in NICU-ASP. Mentors and mentees developed a comprehensive NICU ASP toolkit for ongoing training of additional pharmacists. A new research collaboration between TTT NICU-ASP mentors, mentees and physician members of the South Africa National Neonatal Sepsis Task Force has formed and the first national NICU-ASP study is underway in 12 hospitals. Shared leadership between U.S. and SA mentors led to developing a TTT NICU-ASP for pharmacists tailored to existing resources and local needs.