Hospital-based Interventions to Contain Antibiotic Resistance in Low-resource Settings (AIM)

Antibiotic resistance (ABR) is a fast-growing problem worldwide, considered as a major threat to public health by the World Health Organization and disproportionally hitting low-resource settings (LRS). Antibiotic resistance is quickly becoming an important public health problem in these contexts because of the high burden of resistant pathogens, the scarce options for diagnosis and therapy, the lack of technical and managerial competencies, or the lack of adapted guidelines and training.

The short course “Hospital-based Interventions to Contain Antibiotic Resistance in Low-resource Settings (AIM)” is a 3-week course that offers interdisciplinary and interactive training on relevant aspects of antibiotic resistance and its containment at the hospital level. The course focuses on hospitals because they concentrate on the illest and vulnerable patients; in addition, they are hotbeds of healthcare-acquired infections, act as referral sites for difficult-to-treat infections, and host trainees and postgraduate educational programs. The short-course consists of a common track and 3 specific tracks on Antibiotic Stewardship (ABS), Infection Prevention & Control (IPC), and Microbiological Surveillance (MS) in the hospital setting. These are closely linked key components in the successful containment of antibiotic resistance.

Healthcare professionals from LRS already involved in ABR containment are invited to apply. Candidates are encouraged to state and motivate their preference for one of the three-course tracks (ABS, IPC, or MS).

Teaching & Learning Methods

The short course offers a mixture of lectures, hands-on sessions (including benchwork, practical exercises, and a carrousel), case discussions, data analysis, and group work. The group work and exercises allow for maximal interdisciplinary interaction, mirror real-life in the hospital, offer the opportunity to exchange ideas and skills, and allow to build up the synergism required for successful action.

During the course each participant will develop and defend a personal project considering a plan to contain Antibiotic Resistance in his/her facility in front of an expert committee, related to the track of participant (ABS, IPC, or MS) The objectives of the personal project are the following:

• define the main problems and challenges in ABR containment in your hospital;
• list ideas and activities for ABR containment in your hospital;
• develop a personal intervention plan, clarifying how these activities will be implemented;
• implement a limited set of activities in your hospital after the course.

As part of the application, candidates are asked to submit a short paragraph (max 250 words). This paragraph includes the title of the chosen personal project and a short description of the challenge and proposed intervention. During the course, each participant receives coaching for his/her personal project by an expert; the topic of the project may change in this process.

Assessment Procedures

Summative assessment of the participants is based on a multiple-choice test at the end of the course, the personal project, and the group work. After successful completion of the course, students receive an ITM Credit Certificate.

After having successfully completed the course, participants should be able to develop and implement actions in the containment of ABR in his/her facility in LRS, in at least one of the three tracks (ABS, IPC, and MS).

In addition, after having successfully completed the Antibiotic Stewardship track, participants should be able to:

• Implement principles of rational use of antibiotics at the patient and hospital levels.
• Collect/interpret quantitative/qualitative data on antibiotic use and antibiotic susceptibility results.
• Translate ABR-data into antibiotic treatment guidelines and a local antibiotic policy.
• Implement and evaluate an antibiotic policy at the hospital level.

After having successfully completed the Infection Prevention & Control track, participants should be able to:

• Develop a strategy to improve hand hygiene, cleaning/disinfection of the environment and equipment.
• Implement and teach principles of transmission-based precautions.
• Propose possible solutions regarding organizational aspects and core components of IPC.
• Outline care bundles for invasive devices and apply the basics of good nursing practices.
• Assess the evidence-based measures with regards to the prevention of surgical site infections.
• Have an understanding of surveillance of healthcare-associated infections and outbreak investigation.

After having successfully completed the Microbiological Surveillance track, participants should be able to:

• Perform quality assured clinical bacteriology, from indications to reporting.
• Collect, interpret and report antibiotic resistance data for individual patients.
• Aggregate laboratory-based data into a meaningful surveillance report.
• Sample, work-up, and report selected specimens as support for infection control.

The course focuses on the three main components of ABR-containment in a low-resource hospital setting as well as on their interactions: Antibiotic Stewardship, Infection Prevention & Control, and Microbiological Surveillance.

It consists of:

A common track addressing topics in common to the three tracks:

• Key aspects of pathogens and antibiotics
• Key aspects in IPC, including hand hygiene, cleaning, and disinfection of environment and equipment
• Interventions to contain ABR including Hospital Committee
• Antiseptics/disinfectants
• Transmission based precautions
• Surveillance on health-care-associated infections and outbreak investigation
• Practical sessions on blood sampling, hand hygiene, and preparation of hand rub
• Blood & other cultures: indications, sampling, and transport
• How to turn laboratory data into a report
• How to communicate individual laboratory results
• Introduction to GLASS and the National Action Plan to contain ABR
• The One Health perspective on ABR

Specific modules for each of the three tracks:

Antibiotic Stewardship track

• (Ir)rational use of antibiotics
• Gathering/understanding antibiotic use data (DDD, PPS)
• From antibiotic susceptibility testing to the surveillance report
• Translation ABR data into guideline
• Prescriber and patient perspective
• Clinical case studies
• Surgical site infections

Infection Prevention & Control track:

• Framework Hospital IPC
• Cleaning/disinfection of the environment and equipment
• Transmission based precautions
• Hand hygiene
• Microbiological sampling and processing of the hospital environment
• Invasive devices and care bundles
• Surgical site infections
• Monitoring IPC

Microbiological Surveillance track:

• Working-up cultures in the laboratory
• Selection of appropriate clinical specimens and samples for analysis
• Reading and interpreting antimicrobial susceptibility testing results
• Use of EUCAST/CLSI guidelines
• Translation ABR data into a guideline
• Aggregate laboratory data into a surveillance report
• Microbiological sampling and processing of the hospital environment