Knowledge, attitudes and behaviour of Swiss healthcare workers on antibiotic use and resistance: A cross-sectional study

The Invisible War Inside the Medicine Cabinet

Imagine a world where the tiny, invisible soldiers we rely on to fight infections—antibiotics—are slowly losing their superpowers. This isn't a sci-fi movie; it's a real phenomenon called antimicrobial resistance (AMR). Think of bacteria like a group of mischievous gamers. Every time we use an antibiotic, it's like hitting them with a "reset" button. But if we hit that button too often or too carelessly, the bacteria learn how to dodge the attack. They evolve, becoming "resistant," which means the medicine that used to cure a simple sore throat or a skin infection stops working.

The people on the front lines of this battle are healthcare workers (HCWs): the doctors, nurses, and paramedics who decide when to hand out these powerful medicines. They are the gatekeepers. If they open the gate too wide, the bacteria learn to dodge the bullets faster. If they keep the gate closed when it's not needed, they save the antibiotics for the real emergencies. But here's the tricky part: just because you know the rules of the game doesn't mean you always play by them. Sometimes, we think the problem is happening "out there" with other people, but we don't realize we might be part of the problem ourselves. This is exactly the puzzle a team of researchers in Switzerland decided to solve.

The Great "Not Me" Mystery

In November 2022, a group of researchers from eastern Switzerland decided to peek behind the curtain of their local hospitals. They invited 3,514 healthcare workers—from doctors and nurses to paramedics and other staff—to answer a giant 141-question quiz. They wanted to know three things: What do these workers know about antibiotic resistance? How do they feel about it? And most importantly, how do they act when it comes to prescribing or taking antibiotics?

The results were a bit like a magic trick where everyone saw the same rabbit, but only some admitted they were holding the wand.

The Knowledge Gap vs. The "Not Me" Attitude
First, the good news: The healthcare workers in this study were actually quite smart about antibiotics. When asked if they knew enough for their jobs, more than 8 out of 10 said, "Yes, I've got this." And when tested on facts—like whether antibiotics kill viruses (they don't) or if using them in farm animals affects humans (it does)—most got the answers right.

But then, the plot twist. When the researchers asked, "Do you think there are too many antibiotics being used in Switzerland?" a huge majority, 64.4%, said, "Yes, way too many!" However, when the question changed to, "Do you think there are too many antibiotics being used in your own hospital?" that number dropped to just 24.6%.

It's like a group of friends all agreeing that "people in this city drive too fast," but when asked, "Do you drive too fast?" almost everyone says, "No, definitely not me." The study found that 73.8% of workers were worried about resistance in the country, but only 37.9% were worried about it in their own workplace. They saw the fire burning in the neighborhood, but didn't realize their own house was smoldering.

The Doctor's Dilemma
This "Not Me" feeling was even stronger among the doctors. When asked if they personally prescribed antibiotics too often, only 13% of the doctors said, "Maybe I do." But when asked if their colleagues were overprescribing, 43.1% said, "Oh yeah, definitely them."

It's a classic case of looking in the mirror and seeing a hero, but looking at a friend and seeing a villain. The study suggests this isn't because they are lying, but because of a mental blind spot. They know the rules, but they don't feel personally responsible for breaking them. In fact, only 43.2% of doctors and a tiny 9.4% of nurses believed they played a "key role" in stopping resistance. It's as if they think the job of saving the antibiotics belongs to someone else, like a superhero in a cape, rather than to the person holding the prescription pad.

The Personal Habit
The study also looked at what these workers did when they got sick. About 18.2% of them admitted to taking at least one antibiotic in the year before the survey. Most of them (93.9%) said they took them exactly as the doctor ordered. But here's the kicker: 11.6% admitted to taking antibiotics without a prescription at all.

This was especially true for the doctors themselves. While only a small chunk of nurses did this, a whopping 38.7% of the doctors said they had taken antibiotics without a prescription. It's a bit like a chef who knows exactly how to cook a perfect meal but sometimes sneaks a bite of the raw ingredients when no one is looking.

What They Want
Despite these mixed feelings, the workers weren't confused about what they needed. More than half (56.1%) said they wanted more training and information. Nurses were the most eager, with 69.1% asking for more help. They knew the game was getting harder, and they wanted better tools to play it.

The Takeaway

This study didn't find a magic cure that instantly fixes antibiotic resistance. Instead, it found a very human problem: awareness doesn't always equal action. The healthcare workers in Switzerland know the facts, but they struggle to see themselves as the main characters in the story of stopping resistance. They think the problem is "out there" with others, not "in here" with them.

The authors suggest that to fix this, we can't just hand out more textbooks. We need to help these workers realize that they are the gatekeepers. They need to see that their own choices matter, and that the "Not Me" attitude is actually part of the problem. By giving them better feedback on their own habits and making local data easier to see, maybe we can turn that "Not Me" into "It's on me." Until then, the invisible war continues, and the bacteria are still learning how to dodge the bullets.