Protocol to Investigate Factors Impacting Antimicrobial Stewardship (AMS) Implementation Before and During COVID-19 in Two Acute Care Settings to Fight Antimicrobial Resistance v1

This protocol aims to investigate factors affecting the implementation of antimicrobial stewardship (AMS) before and during the COVID-19 pandemic in two acute care settings. The research comprises three sequential studies: a systematic literature review to investigate AMS implementation in the previous two decades, a retrospective medical records review to evaluate AMS practices at two hospitals within one NHS Foundation Trust in the United Kingdom, and a prospective survey study to explore healthcare professionals' knowledge, attitudes, and perceptions (KAP) towards antibiotic prescribing, antimicrobial resistance and AMS. The expected results include identifying AMS measures used before and during the pandemic based on Public Health England's "Start Smart – Then Focus" toolkit. This research will provide insights into healthcare professionals' KAP regarding antibiotic prescribing and AMS implementation, offering a comprehensive understanding of the pandemic's impact on AMS practices.