Healthcare Sector & One Health AMR

Antimicrobial Resistance (AMR) is one of the biggest challenges for healthcare department especially in hospitals to provide safe and effective healthcare system. The patients infected with AMR microbes face ineffective treatment, treatment toxicity, readmissions in hospitals, recurrent infections, delayed recovery, increase rate of fatalities and ultimately high economic losses.

Antibiotic Resistant Infections are usually spread by direct contact of the infected patient with staff and other patients. They can also spread through contaminated surfaces. To help prevent the spread of infections, make sure you adhere strictly to infection prevention and control guidelines, including practicing good hygiene and hand washing.

One Health Antimicrobial Resistance (AMR) program of “PAK AMR Alliance” uses strategies at local, national and international levels to prevent the emergence and proliferation of Antimicrobial Resistance (AMR) microbes. It has been playing a key role in decreasing the number of infections, fatalities, and economic losses in healthcare settings.

Why PAK AMR Alliance is required in Healthcare Sector?

Pakistan ranked 3rd in antibiotic consumption list among low-middle-income countries (LMICs) and 4th among 71 countries. Pakistan is facing AMR related problems with higher resistance rates. There are more than 15,000 Multidrug Resistant (MDR) TB cases per years and it ranks 5th in TB burden countries. In Pakistan the prevalence of TB is at 4th Position that accounts 61% burden in East Mediterranean Region. Methicillin Resistant Staph Aureus (MRSA) found in 49% of S. aureus in Pakistan. In 2016, XDR Salmonella was 100% resistance to Fluoroquinolones. The resistance in E. coli to 3rd generation Cephalosporin’s is 36.0%.

Lack of drug discoveries, lack of funding, low quality drugs productions, and high resistance in microbes are the key factors for AMR program. Currently, there are only 5% of antimicrobial agents in the pipeline and it will take 10 years to be in the market. The efficacy of miracle drugs is decreasing each day that will create problems in surgery, chemotherapy, organ transplantation and care of premature infants and there will be no treatment options available in 2050.

Roles of Practitioner in AMR Eradication

  • Implementation of appropriate prescription practices.
  • Use of rapid diagnostic tests to get support in clinical decisions.
  • Use infection prevention control measures such as vaccines to protect patients from infections
  • Include environmental criteria in antibiotic procurement decisions
  • Support administrative policy changes to purchase food raised without routine antimicrobials
  • Improve sanitation in hospitals to prevent healthcare associated infections
  • Improve waste management to efficiently remove pharmaceuticals and microbes
  • Advise patients about the risks associated with antimicrobial therapy and use preventative measures when possible
  • Educate patients on the safe, recommended methods for disposing or returning unused antimicrobial drugs
  • Hand hygiene with soap or alcohol-based rub are key to protect patients from avoidable infections contracted in health-care settings and prevent the spread of AMR

Hospital Leadership Commitments in AMR Eradication​

  • Consider any safe alternatives to an immediate antibiotic prescription
  • Prescribe in accordance with therapeutic guidelines, and where possible use diagnostics to inform treatment decisions
  • Talk to your patients about the importance of appropriate antibiotic use and the dangers of antibiotic resistance
  • Give your patients advice on how to manage symptoms without antibiotics
  • Apply Infection Prevention & Control (IPC) strategies and provide consultations to patients about infection prevention to control their spreading (e.g. vaccination, good hygiene and hand washing.

Hospital Staff to Counter AMR

  • Establish an Infection Prevention & Control (IPC) committee and use rapid point-of-care diagnostics, whenever available, to support clinical decisions and further develop where inadequacies persist. The committee should develop “Standardized Antimicrobial Surveillance Systems”.
  • Laboratory staff that include Microbiologists and laboratory technologists can help in Practicing safety, environmental, and/or infection control methods
  • Nursing department plays an important role in combating Antimicrobial Resistance (AMR) as it is directly or indirectly linked with doctors, surgeons, patients, sanitary staff and other departments. The nurses are more informed on Antimicrobial Resistance (AMR) fact sheet and can help in Infection Prevention and AMR eradication. Nurses can help in treatment options, medication administration and management, recording of administration drugs, and patient’s health record.
  • Timely and correctly specimens’ collection and transportation can help in AMR eradication and it can be effective in controlling AMR proliferations.
  • Pharmacist can play their part by implementation of new agents across the trust, prescribing of antimicrobials, outpatient parenteral antimicrobial therapy (OPAT) services. The monitoring, surveillance, auditing, anti-infective formulary decisions and review of antimicrobial.
  • The hospital staff can prevent AMR proliferation through disposal of solid waste properly, including unused and expired antimicrobials to prevent exposure to microorganisms in the environment.
  • Hospital department and staff can ensure hygienic food and safety practices, and consumption of safe water to minimize proliferation of AMR bacteria and bacterial genes.