Table 1.

Baseline existing AMS governance e Chapada do Araripe during 2020 and 2022

Required activities	Hospitals reality	Comments
Infection disease physician	No	Specialist absent in the region
Infection control practitioner (nurse)	Yes	There is a nurse responsible for the hospital’s biosafety procedures and infection control according to the ANVISA (Brazil)
Microbiologist Available locally Inter-consultation available	No	There is a general support laboratory, but due to the lack of local logistics and the distance from the region to the centres with microbiologic support, culture collection is carried out twice a week with a delivery deadline for results in about 7 to 10 days
Clinical pharmacist General Antimicrobial use specialist	No	There is a pharmacy dispenser
Systematized infection control programme with periodic reports and action plans	No	There are general procedures on infection control according to ANVISA (Brazilian legislation), but with no integrated systematized processes
IHI (Institution of Health Improvement) bundles Ventilator-associated pneumonia Central line-associated bloodstream infections Catheter-associated urinary tract infections	No	There are no systematized processes implemented on infection control related to healthcare assistance
Systematized ASP with daily multidisciplinary bedside visits. If ‘yes’, what frequency: Daily Once a week Once every 2 weeks Once a month Once every 2 months 4 days per year 1 day per year No frequency Other	No	Owing to the lack of ASP, it is not possible to observe whether the use of antimicrobials is in accordance with required and/or recommended standards In the ICUs, the physicians discuss the cases at convenient times without the participation of multidisciplinary teams
Multidisciplinary professionals available in the institution	Yes	Multidisciplinary professionals according to the health institution’s profile Regime of shifts and/or day labourers
Leadership responsible for the use of antimicrobials in nursery. If ‘yes’: In all nurseries In almost all nurseries In 50% of the nurseries	No	In the ICUs, the person responsible for the antimicrobial’ prescriptions is the physician on duty. In the wards, the person in charge is the prescribing physician according to specialties
Type of patient record: Non-existent Paper Electronic Other	Hospital A: paper Hospital B: electronic
Form for the adequate use of antimicrobial. If ‘yes’: Electronic via Internet Electronic via intranet Electronic via application Printed in a pocket guide Printed in the medical room	No	The antimicrobials are dispensed based on the medical prescription by the various prescribing specialties without the interference or supervision of an ID physician
Use of antimicrobials Empiric Based on microbiology Local protocol Other	Empiric	The health institutions do not have periodic support in microbiology due to the difficulties in the logistics of the collection by local laboratories that outsource this type of exam. There is no antimicrobial use protocol based on institutional guidelines. There is no protocol-based start sequence nor de-escalation The duration of antimicrobial use is not defined, leading to uncontrolled use in many cases