DEPARTMENT FOR SCIENCE, INNOVATION AND TECHNOLOGY

Studying Hygiene Interventions to reduce Nosocomial Infections in southeast Asian Intensive Care Units (SHINIA-ICU )

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Description

It has recently been estimated that 1.7 million AMR-associated deaths in low-income and middle-income countries (LMICs) are due to health-care associated infections. A substantial proportion of these deaths could be prevented through improving infection prevention and control programmes through low-cost multimodal interventions, but achieving these reductions requires overcoming chronic under-investment in such interventions in LMICs. Such underinvestment stems from the limited evidence base regarding the effectiveness and cost-effectiveness of such multimodal interventions in LMIC settings, lack of knowledge about the potential health gains achievable, and uncertainty about the best way to spend limited budgets to achieve these gains. Our proposal aims to address these evidence gaps by generating robust and generalisable evidence about multimodal hygiene interventions in hospitals in LMICs in southeast Asia and to equip regional decision-makers with the knowledge and tools needed to enable appropriate investments in hospital infection prevention and control programmes. The role of hospital environment-mediated pathogen transmission is well-recognized in healthcare-associated infections, which are often caused by micro-organisms which are resistant to multiple drugs. Contaminated surfaces harbouring these pathogens sustain the spread of drug-resistant bacterial clones and mobile genetic elements (which can spread drug-resistance between bacterial species) in outbreak and non-outbreak settings. Despite an emphasis on environmental hygiene and the availability of international guidelines, there is insufficient evidence in the current literature to identify the most effective (and cost-effective) setting-specific cleaning strategies to reduce transmission of multidrug-resistant organisms, especially in LMICs. This contributes to the low awareness and prioritisation of environmental cleaning in these resource-limited settings and potentially to underutilisation of low cost and high impact interventions. Our prior work has highlighted the fundamental role of hospital environment hygiene in breaking the vicious cycle of antimicrobial overuse and the resultant high burden of multidrug-resistant healthcare-associated infections. Firstly, the epidemiology of healthcare-associated infections in the LMIC setting has shown an overwhelming predominance of environmental organisms such as Acinetobacter spp. and Pseudomonas spp. Secondly, lack of trust in infection prevention and control policies and rapid colonization by multidrug-resistant organisms amongst newly admitted patients are important drivers of broad-spectrum antibiotic prescriptions, especially in 'high-stake' wards such as intensive care units (ICUs). Thirdly, multimodal cleaning strategies have been shown to substantially reduce multidrug-resistant infections in high income countries, most prominently demonstrated in the REACH and CLEEN trials in Australia, with the latter reducing the chance of ICU patients acquiring infections from 17% to 12%. Aims and objectives The overall aim is to determine setting-appropriate and cost-effective interventions for improving environmental cleaning in low-resource settings, with a goal of reducing multidrug-resistant hospital-acquired infections and health-economic burden. Primary objective: Evaluate the effectiveness of locally optimized multimodal cleaning bundles to reduce multidrug-resistant hospital-acquired bloodstream infections and ventilator-associated pneumonia in ICUs. Secondary objectives: Evaluate the effectiveness of the cleaning bundles to reduce patient colonization by multidrug-resistant organisms in ICUs; Identify multidrug-resistant organism reservoirs and their respective ecological niches in the ICU environment; Assess thoroughness of cleaning for high-touch points; Model the transmission dynamics of multidrug-resistant organisms taking into account human and environmental hidden reservoirs; and, Evaluate the cost-effectiveness of cleaning bundles for preventing hospital-acquired bloodstream infections and ventilator-associated pneumonia 6. Develop an qualitative and quantitative understanding of the causal pathways between the intervention and any resulting changes in drug-resistant infections

Objectives

It has recently been estimated that 1.7 million AMR-associated deaths in low-income and middle-income countries (LMICs) are due to health-care associated infections. A substantial proportion of these deaths could be prevented through improving infection prevention and control programmes through low-cost multimodal interventions, but achieving these reductions requires overcoming chronic under-investment in such interventions in LMICs. Such underinvestment stems from the limited evidence base regarding the effectiveness and cost-effectiveness of such multimodal interventions in LMIC settings, lack of knowledge about the potential health gains achievable, and uncertainty about the best way to spend limited budgets to achieve these gains. Our proposal aims to address these evidence gaps by generating robust and generalisable evidence about multimodal hygiene interventions in hospitals in LMICs in southeast Asia and to equip regional decision-makers with the knowledge and tools needed to enable appropriate investments in hospital infection prevention and control programmes. The role of hospital environment-mediated pathogen transmission is well-recognized in healthcare-associated infections, which are often caused by micro-organisms which are resistant to multiple drugs. Contaminated surfaces harbouring these pathogens sustain the spread of drug-resistant bacterial clones and mobile genetic elements (which can spread drug-resistance between bacterial species) in outbreak and non-outbreak settings. Despite an emphasis on environmental hygiene and the availability of international guidelines, there is insufficient evidence in the current literature to identify the most effective (and cost-effective) setting-specific cleaning strategies to reduce transmission of multidrug-resistant organisms, especially in LMICs. This contributes to the low awareness and prioritisation of environmental cleaning in these resource-limited settings and potentially to underutilisation of low cost and high impact interventions. Our prior work has highlighted the fundamental role of hospital environment hygiene in breaking the vicious cycle of antimicrobial overuse and the resultant high burden of multidrug-resistant healthcare-associated infections. Firstly, the epidemiology of healthcare-associated infections in the LMIC setting has shown an overwhelming predominance of environmental organisms such as Acinetobacter spp. and Pseudomonas spp. Secondly, lack of trust in infection prevention and control policies and rapid colonization by multidrug-resistant organisms amongst newly admitted patients are important drivers of broad-spectrum antibiotic prescriptions, especially in 'high-stake' wards such as intensive care units (ICUs). Thirdly, multimodal cleaning strategies have been shown to substantially reduce multidrug-resistant infections in high income countries, most prominently demonstrated in the REACH and CLEEN trials in Australia, with the latter reducing the chance of ICU patients acquiring infections from 17% to 12%. Aims and objectives The overall aim is to determine setting-appropriate and cost-effective interventions for improving environmental cleaning in low-resource settings, with a goal of reducing multidrug-resistant hospital-acquired infections and health-economic burden. Primary objective: Evaluate the effectiveness of locally optimized multimodal cleaning bundles to reduce multidrug-resistant hospital-acquired bloodstream infections and ventilator-associated pneumonia in ICUs. Secondary objectives: Evaluate the effectiveness of the cleaning bundles to reduce patient colonization by multidrug-resistant organisms in ICUs; Identify multidrug-resistant organism reservoirs and their respective ecological niches in the ICU environment; Assess thoroughness of cleaning for high-touch points; Model the transmission dynamics of multidrug-resistant organisms taking into account human and environmental hidden reservoirs; and, Evaluate the cost-effectiveness of cleaning bundles for preventing hospital-acquired bloodstream infections and ventilator-associated pneumonia 6. Develop an qualitative and quantitative understanding of the causal pathways between the intervention and any resulting changes in drug-resistant infections

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Location

The country, countries or regions that benefit from this Programme.

Far East Asia, regional

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