Winning the antimicrobial resistance war

In the war against antimicrobial resistance (AMR), there is one line of defence which stands out to public health expert Dr Susan Jain — and, contrary to expectation, it does not come from a pharmacy.

It is the same tool that was used to curb COVID-19 outbreaks and will be used as an armour against avian influenza — a virus beginning to alarm health authorities around the world.

So what exactly is it, and how can health leaders use it in their own personal combat with AMR?

“Communication,” said Jain, who is the Principal Advisor and COVID-19 Response Lead at the Clinical Excellence Commission.

“Disseminating information is a vital tool in curbing the AMR epidemic. That’s why we are always meeting with local health districts and putting out resources, like public-facing videos and professional documents.”

Staying abreast

However, much like pharmaceuticals, the communication guidelines CEC publish are also continually being tested by changing microbes — a challenge shared by health authorities in the management of COVID-19.

Throughout the pandemic, public health advice changed to mirror the evolution of the virus. This included variations to advice around public movement, personal protection advice including use of masks and handwashing.

In a broader AMR context, health guidelines also shift, as bacteria, viruses, fungi and parasites learn to outsmart the drugs designed to kill them.

Jain says it is crucial to understand the role of infection prevention and control plays in addressing AMR and to be up to date with AMR research.

“Clinicians know they can trust our guidance, because we continuously monitor and verify evidence and disseminate it in a standardised way.

“There is a lot of noise out there in terms of infection prevention and control, so it is important we distil the very best evidence and make it known to colleagues.

“Being one source of truth for clinicians on how to protect their patients (and themselves) from AMR is central to our mission.”

Advice for hospitals

For hospital leaders, communication is also an effective tool when it comes to reducing the impact of AMR. So what can healthcare leaders learn from the CEC’s approach?

Collaborate

When updating its neonatal guidelines for infection prevention and control, the CEC consulted with an NICU specialist group and asked, “Is there anything else we should be doing to make your life easier; and do you agree with the advice we offer clinicians?”

“At the end of the day, they are the ones at the bedside and the ones who need to implement what we write. So, health worker input is vital to all our guidelines,” Jain said.

Having a two-way channel of communication also helps combat dis- and misinformation.

“If a clinician looks at any of our documents and wants to know more, it’s easy for them to approach us. That’s important, because we can confront any concerns people have head on.”

Be approachable

In a similar vein, Jain said it is important for leaders to remain approachable.

“We meet regularly with local health districts, so they know who to contact if they need advice at any time.

“Yes, you need to be a high-level authority, but people also need to feel comfortable dealing with you.”

Be direct

Conveying public health knowledge in a concise and easy-to-understand way helps clinicians stay abreast with continually changing advice.

“It’s important to keep in mind that (a) it’s hard to stay across all the research; and (b) clinicians are busy, so communicating with brevity is crucial.”

Develop a clear governance structure

Having a clear governance structure can help distil high-level research into actionable clinical insights and ensure information being pushed out to clinicians is accurate.

“For us, a clearly defined governance structure has been pivotal in our infection prevention and control programs. It is definitely not something to be overlooked.”

Lifelong learning

While documents and resources can be beneficial, they cannot rival the impact of training, Jain argued.

“Working directly with teams to help consolidate people’s understanding of best practice can make a real difference to clinical outcomes.”

More resources needed

While communication is an essential tool, Jain said it is important to remember that AMR is an extremely complex problem that requires broad action and support across health care.

“Tackling AMR necessitates global efforts focused on several key areas: robust infection prevention and control measures, access to diagnostics and treatment, surveillance and substantial investment in research and development of new medicines, diagnostics and prevention tools.”

While she acknowledges that resource constraints may limit AMR or infection prevention and control programs, there is a lot health workers can do with simple measures.

“Monitoring the latest advice, prescribing antibiotics carefully and being mindful about environmental cleaning and handwashing. When it comes to AMR and infection prevention and control, every little bit helps.

“And I believe that with a combined effort, we can overcome the challenge.”

Image credit: iStock.com/DrAfter123