Ana Clemmer

IR 2/10-GT
6/5/19
Data Collection Report
Part 1:
Topic:
I am researching antimicrobial resistance. Mainly, I am focusing on the knowledge, attitudes,
and practices of healthcare professionals in the United States regarding antimicrobial resistance.
This includes prescription, general cleanliness, and handwashing.

Collection Method:
Survey, using a questionnaire. This is the most efficient way for me to collect data because my
data is based on people’s responses, however I need it to be quantifiable.

Citations:
García, C., Llamocca, L. P., García, K., Jiménez, A., Samalvides, F., Gotuzzo, E., &
Jacobs, J. (2011). Knowledge, attitudes and practice survey about antimicrobial resistance
and prescribing among physicians in a hospital setting in Lima, Peru. BMC clinical
pharmacology, 11, 18.
Khan A K, A., Banu, G., & K K, R. (2013). Antibiotic Resistance and Usage-A Survey
on the Knowledge, Attitude, Perceptions and Practices among the Medical Students of a
Southern Indian Teaching Hospital. Journal of clinical and diagnostic research : JCDR,
7(8), 1613-6.
Klein, E. Y., Martinez, E. M., May, L., Saheed, M., Reyna, V., Broniatowski, D. A.
(2017). Categorical Risk Perception Drives Variability in Antibiotic Prescribing in the
Emergency Department: A Mixed Methods Observational Study. Journal of General
Internal Medicine. 32(10), 1083-1089.
Labricciosa, F. M., Sartelli, M., Correia, S., Abbo, L. M., Severo, M., Ansaloni, L.,
Coccolini, F., Alves, C., Melo, R. B., Baiocchi, G. L., Paiva, J. A., Catena, F., …
Azevedo, A. (2018). Emergency surgeons' perceptions and attitudes towards antibiotic
prescribing and resistance: a worldwide cross-sectional survey. World journal of
emergency surgery : WJES, 13, 27.
Smith, C. R., Pogany, L., Foley, S., Wu, J., Timmerman, K., Gale-Rowe, M., & Demers,
A. (2017). Canadian physicians' knowledge and counseling practices related to antibiotic
use and antimicrobial resistance: Two-cycle national survey. Canadian family physician
Medecin de famille canadien, 63(12), e526-e535.

Distribution Plan:
I have shared my questionnaire with two healthcare professionals. One of them is sharing it with
his colleagues in the hospital he works in, and the other is doing the same, in addition to posting
it to two closed facebook groups consisting of many types of healthcare professionals who she
has worked with or went to school with. For my second survey, I am posting it to a neighborhood
Facebook group. Additionally, I am posting about my survey on my personal Instagram story,
encouraging people to take the survey. The link is in my bio so people can follow it easily.
Part 2:
Survey 1
1. What is your profession?
a. Family Practitioner
b. Other Physician
c. Physician’s Assistant
d. Nurse
e. Nurse Midwife
f. Other
2. Years of experience
a. <5
b. 5-9
c. 10-14
d. ≥15
3. What type of facility do you work in?
a. University Hospital
b. Community Hospital
c. Clinic
d. Private Practice
e. Other
Knowledge
4. Antimicrobial resistance occurs when people become resistant to antimicrobials. True or
false?
a. True
b. False
5. Antimicrobial resistance occurs when bacteria become resistant to antimicrobials. True or
false?
a. True
b. False
6. Use of antimicrobials is associated with disturbances of the normal microbial flora. True
or false?
a. True
b. False
7. Proper hand-washing technique prevents spread of organisms that are on the hands. True
or false?
a. True
b. False
8. If someone in a household is sick, taking antimicrobials will prevent other household
members from getting sick. True or false?
a. True
b. False
9. How much have you been educated about antimicrobial resistance?
a. 1 - My knowledge is minimal
b. 2
c. 3
 d. 4
e. 5 - I consider myself an expert
10. Do you periodically receive reports on local antimicrobial resistance data?
a. Yes
b. No
c. Unsure
11. Do you prescribe antimicrobials if a patient is requesting them even if you aren't sure if
they need it or not? (with 1 representing "Never")
a. 0 - Not Applicable
b. 1 - Never
c. 2
d. 3
e. 4
f. 5 - Always
Attitudes: Causes of antimicrobial resistance (Please rank each of the causes of
antimicrobial resistance by its importance.)
12. Use of antimicrobials for self limited bacterial infections
a. 1 - Not Important
b. 2
c. 3
d. 4
e. 5 - Very Important
13. Use of antimicrobials with a broader than necessary spectrum
a. 1 - Not Important
b. 2
c. 3
d. 4
e. 5 - Very Important
14. Use of antimicrobials for longer than standard duration
a. 1 - Not Important
b. 2
c. 3
d. 4
e. 5 - Very Important
15. Use of antimicrobials for shorter than standard duration
a. 1 - Not Important
b. 2
c. 3
d. 4
e. 5 - Very Important
16. Poor hand hygiene
a. 1 - Not Important
b. 2
c. 3
d. 4
 e. 5 - Very Important
17. Poor infection control practices by healthcare professionals
a. 1 - Not Important
b. 2
c. 3
d. 4
e. 5 - Very Important
18. Wrong practices in management of invasive devices
a. 1 - Not Important
b. 2
c. 3
d. 4
e. 5 - Very Important
19. Poor health facility cleaning practices
a. 1 - Not Important
b. 2
c. 3
d. 4
e. 5 - Very Important
Attitudes: How much of a problem is antimicrobial resistance?
20. Antimicrobial resistance is a problem worldwide.
a. 1 - Strongly agree
b. 2
c. 3
d. 4
e. 5 - Strongly disagree
21. Antimicrobial resistance is a problem in the United States.
a. 1 - Strongly agree
b. 2
c. 3
d. 4
e. 5 - Strongly disagree
22. Antimicrobial resistance is a problem in Maryland.
a. 1 - Strongly agree
b. 2
c. 3
d. 4
e. 5 - Strongly disagree
23. Antimicrobial resistance is a problem in my daily practice.
a. 1 - Strongly agree
b. 2
c. 3
d. 4
e. 5 - Strongly disagree
24. Antimicrobial resistance is being addressed well.
 a. 1 - Strongly agree
b. 2
c. 3
d. 4
e. 5 - Strongly disagree
Practices: Antimicrobial prescription process (Please respond how confident you are in
each of the scenarios during an antimicrobial prescribing process. (with 1 representing
"Very Unconfident")
25. Making an accurate diagnosis of infection
a. 0 - Not Applicable
b. 1 - Very Unconfident
c. 2
d. 3
e. 4
f. 5 - Very Confident
26. Deciding not to prescribe antimicrobial if not sure about antimicrobial
a. 0 - Not Applicable
b. 1 - Very Unconfident
c. 2
d. 3
e. 4
f. 5 - Very Confident
27. Choosing the correct antimicrobial
a. 0 - Not Applicable
b. 1 - Very Unconfident
c. 2
d. 3
e. 4
f. 5 - Very Confident
28. Choosing the correct dose and interval of administration
a. 0 - Not Applicable
b. 1 - Very Unconfident
c. 2
d. 3
e. 4
f. 5 - Very Confident
29. Choosing between intravenous and oral administration
a. 0 - Not Applicable
b. 1 - Very Unconfident
c. 2
d. 3
e. 4
f. 5 - Very Confident
30. Interpreting microbiological results
a. 0 - Not Applicable
 b. 1 - Very Unconfident
c. 2
d. 3
e. 4
f. 5 - Very Confident
31. Planning the duration of the antimicrobial treatment
a. 0 - Not Applicable
b. 1 - Very Unconfident
c. 2
d. 3
e. 4
f. 5 - Very Confident
Practices: Do you address the following topics with patients during a consultation for an
infectious disease?
32. Getting a flu shot every year
a. 0 - Not Applicable
b. 1 - Never
c. 2
d. 3
e. 4
f. 5 - Always
33. Safe sex
a. 0 - Not Applicable
b. 1 - Never
c. 2
d. 3
e. 4
f. 5 - Always
34. Proper coughing practices
a. 0 - Not Applicable
b. 1 - Never
c. 2
d. 3
e. 4
f. 5 - Always
35. Handwashing practices
a. 0 - Not Applicable
b. 1 - Never
c. 2
d. 3
e. 4
f. 5 - Always
36. Food handling
a. 0 - Not Applicable
b. 1 - Never
 c. 2
d. 3
e. 4
f. 5 - Always
37. Household hygiene
a. 0 - Not Applicable
b. 1 - Never
c. 2
d. 3
e. 4
f. 5 - Always
38. Hand Sanitizer
a. 0 - Not Applicable
b. 1 - Never
c. 2
d. 3
e. 4
f. 5 - Always
39. Antibacterial hand soap
a. 0 - Not Applicable
b. 1 - Never
c. 2
d. 3
e. 4
f. 5 - Always
40. Antibacterial cleaner
a. 0 - Not Applicable
b. 1 - Never
c. 2
d. 3
e. 4
f. 5 - Always
41. Antibacterial dish soap
a. 0 - Not Applicable
b. 1 - Never
c. 2
d. 3
e. 4
f. 5 - Always
42. Correct daily dose and duration of antimicrobial
a. 0 - Not Applicable
b. 1 - Never
c. 2
d. 3
e. 4
 f. 5 - Always
43. Why an antimicrobial is not being given
a. 0 - Not Applicable
b. 1 - Never
c. 2
d. 3
e. 4
f. 5 - Always
44. Not to use others’ antimicrobials
a. 0 - Not Applicable
b. 1 - Never
c. 2
d. 3
e. 4
f. 5 - Always
45. Not to share antimicrobials with someone else
a. 0 - Not Applicable
b. 1 - Never
c. 2
d. 3
e. 4
f. 5 - Always
46. How to dispose of antimicrobials
a. 0 - Not Applicable
b. 1 - Never
c. 2
d. 3
e. 4
f. 5 - Always
Survey 2
K1. How much do you know about antibiotic resistance?
1. My knowledge is minimal
2.
3.
4.
5. I know a lot
K2. Antibiotic resistance occurs when a person becomes resistant to antibiotics.
1. True
2. False
K3. Antibiotic resistance occurs when bacteria become resistant to antibiotics.
1. True
2. False
A1. Antibiotic resistance is a large problem worldwide.
1. Strongly disagree
2.
 3.
4.
5. Strongly agree
A2. Antibiotic resistance is a large problem in the US.
1. Strongly disagree
2.
3.
4.
5. Strongly agree
P1. Do you ever request an antibiotic prescription when your doctor is not offering to write
one for you?
1. Never
2.
3.
4.
5. Often
P2. Does your doctor ever write an antibiotic prescription for you when they seem unsure
you need it?
1. Never
2.
3.
4.
5. Often
P3. During a visit to the doctor when you're sick, does your doctor address hand-washing
practices or use of a hand sanitizer?
1. Never
2.
3.
4.
5. Never
P4. If a doctor does not prescribe an antibiotic when you are sick, does your doctor address
why an antibiotic is not being given?
1. Never
2.
3.
4.
5. Often
P5. When your doctor prescribes an antibiotic to you, does your doctor instruct you on proper
use of the antibiotic?
1. Never
2.
3.
4.
5. Often
P6. Do you see the doctor washing their hands during your visit?
 1. Never
2.
3.
4.
5. Often
P7. When you visit the doctor, do you ever have concerns about antibiotic resistance and ask
about it?
1. Never
2.
3.
4.
5. Often

Part 3:
Prediction:
I predict that my data will show that healthcare professionals are fairly knowledgeable about
antimicrobial resistance and preventative measures, but do not practice such measures. I also
predict that the general population will know a very small amount about antimicrobial resistance,
not consider it a very important issue, and act in ways which cause healthcare professionals to
prescribe incorrectly.

Data Analysis:
In the first Knowledge, Attitudes, and Practices survey conducted on healthcare professionals in
the United States, all 7 respondents answered correctly for knowledge questions, and strongly
agreed that AMR is a problem in the United States and in Maryland. Additionally, none of the
respondents receive reports on local AMR data. However, this survey is not statistically
significant due to its low number of respondents.
In the second Knowledge, Attitudes, and Practices survey, this one conducted on the general
population of Maryland, the majority of the 190 respondents, 69.5% answered correctly (False)
to the first and more tricky knowledge question: “Antibiotic resistance occurs when a person
becomes resistant to antibiotics. True or False?” For the next true or false question, “Antibiotic
resistance occurs when bacteria become resistant to antibiotics. True or False?,” 96.8% of
respondents answered correctly (True). Granted, these questions were not very difficult, but they
did show that the general population of Maryland is knowledgeable about antimicrobial
resistance at least at a minimal level. However, the respondents’ opinion of their own knowledge
indicated 41.8% of respondents answered on the lower side (1-2) of the 1-5 scale for the first
question, “How much do you know about antibiotic resistance?” Answer 1 represented minimal
knowledge, with 5 representing “I know a lot.” On the other hand, 29% of respondents think
their knowledge is on the upper side (4-5) of the scale, with 29.5% answering number 3 in the
middle of the scale. This indicates that the general population of Maryland thinks that they have
at least a relatively good understanding of antimicrobial resistance.
Regarding attitudes of Marylanders, only 1.6% of respondents strongly disagreed that
antimicrobial resistance is a large problem worldwide, with 0% strongly disagreeing that
antimicrobial resistance is a large problem in the United States. 28.4% of respondents agree that
antimicrobial resistance is a large problem worldwide, with 32.6% strongly agreeing, resulting in
a majority 61% respondents agreeing that antimicrobial resistance is a large problem worldwide.
35.3% of respondents agree that antimicrobial resistance is a large problem in the United States,
with 37.4% strongly agreeing, resulting in a majority of 72.7% respondents agreeing that
antibiotic resistance is a large problem in the United States. This indicates that Marylanders tend
to think that antimicrobial resistance is more of a problem in the United States more than it is
worldwide.
The practices of Maryland physicians observed by the Maryland general public were quite
revealing. Only 43.6% of respondents often see their doctor wash their hands during their visit.
At less than half, this is a scarily low percentage of doctors to be performing one of the most
basic tasks in the prevention of both the spread of disease and antimicrobial resistance. Similarly,
only 48.9% of respondents reported their doctors often instructing them on proper use of the
antibiotic prescribed. This can be especially detrimental, especially for patients who are less
knowledgeable. Furthermore, 45.8% respondents reported their doctors never or almost never
address hand hygiene while counseling them during a visit. But, 35.8% of respondents said that
their doctors did address hand hygiene with them. For antibiotic counseling, 53.1% respondents
reported their doctors address why an antibiotic is not being prescribed when the patient is sick.
Doing this can help educate patients about antibiotics, thus preventing the patients from taking
actions that may encourage the spread and emergence of antimicrobial resistance or actions that
encourage a healthcare professional to incorrectly prescribe an antibiotic. While 64.2% of
Marylander respondents never or almost never observe their doctors prescribing antibiotics when
the doctor seems unsure if it is needed or not, only 15.3% of respondents said that their doctors
often or occasionally prescribe antibiotics when the doctor seems unsure if they (the patient)
need it.

Visual Representation:
Advantages and Disadvantages of Overall Data Collection:
I believe that my original data collection reached a very small number of individuals, resulting in
such a small number of responses. However, one advantage of that round of data collection was
that I was able to collect data from healthcare professionals only, as opposed to a mixed group of
people. My second survey was successful in reaching a sufficiently large amount of people, and
the population reached was the population that it was intended to reach. One disadvantage is that
the questions did not exactly align with my research question and thesis, though it did allow for
comparison.

10 specific questions:
1. How do patients affect the prescription process?
2. How do the practices of local healthcare professionals compare to the practices of those
who work in this field internationally?
3. What measures of the prevention of antimicrobial resistance are considered to work best?
4. How does the perceptions of healthcare professionals concerning patients’ knowledge
antimicrobial resistance affect how they listen to the patient if the patient requests an
antimicrobial.
5. What encourages the general public to learn more about antimicrobial resistance?
6. What method of education works most efficiently to educate the general public about
antimicrobial resistance?
7. How do healthcare professionals affect the general public’s perceptions of antimicrobial
resistance?
8. What affects perceptions of antimicrobial resistance most?
9. How do perceptions the general populations hold about antimicrobial resistance affect
their attitudes towards healthcare professionals?
10. Why do the practices of international healthcare professionals vary from those of local
healthcare professionals?