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Wednesday, July 27, 2016

Workshop on Hand hygiene at All India Institute of Medical Sciences (AIIMS), Bhopal

Contributed by: Dr. Megha Sharma and Dr. A.J.Tamhankar; Edited by Siddharth David

The hospital infection control committee (HICC) and Department of Microbiology of All India Institute of Medical Sciences (AIIMS), Bhopal, invited Dr. A.J. Tamhankar, National Coordinator, Indian Initiative for management of Antibiotic Resistance (IIMAR) and Dr. Megha Sharma1, R.D.  Gardi Medical College, Ujjain (RDGMC) (both also affiliated to Karolinska Institute, Stockholm, Sweden) for conducting a 5 day workshop on hand hygiene for all categories of   healthcare workers at AIIMS and also the Medical and Nursing students, in August 2015. The series of workshops was inaugurated by the Medical Superintendent, AIIMS Bhopal Dr. K. C. Tamaria, in presence of Dr. Debasis Biswas, Dr. Shashank Purwar, Dr. T. Karuna and other faculty members. Overall six workshops were conducted for various categories of health care workers (HCWs), one for students and one also for OPD patients and hospital visitors.

The workshop sessions started with a short address on Hand Hygiene by Dr. Tamhankar. Thereafter, Dr. Megha Sharma, the main resource person, who conducted the workshops, took over. Dr. Megha Sharma initially made a presentation focusing on the importance of hands in daily routine and during clinical work. She also explained the ways of spread of microorganisms, including pathogens, from one person to another. She emphasized that healthcare worker`s contaminated hands can transfer various infections not only to the patients they are taking care of, but also to coworkers who are also at the risk for cross infections. These infections, also known as Health care associated infections (HAIs) are responsible for increasing morbidity, which leads to a chain of events like increased antibiotic use, increased antibiotic residues in environment, increased antibiotic resistance in bacteria, increased untreatable infections, increased loss of productive man-hours and in extreme cases mortality, all of which can have a negative impact on the public health and economy of a country.
Dr. Sharma further emphasized on the most effective and worldwide accepted precaution for controlling spread of infections, which is 'Hand Hygiene'. Hand hygiene could be maintained either by use of soap and water or by using alcohol based hand rub, commonly known as sanitizer. The participants were trained to follow steps to maintain hand hygiene using these materials. The steps of 'How and when to wash hands with soap and water?' and 'How and when to use an alcoholic hand rub?' as recommended by world Health Organization; were demonstrated and practiced. Various activities, such as Oath
taking, best slogan competition, and cross word puzzle; were planned in order to maintain a high level of interest amongst the participants. The winning participants received prizes and all participants received a certificate of participation at the end of each workshop.
On the fifth day of the workshop, an exclusive open session was conducted for common public visiting the out-patient departments at AIIMS, Bhopal. Dr. M. Sharma, Dr. T. Karuna (AIIMS) and the team helping Dr. sharma from R. D. Gardi Medical College, Ujjain and AIIMS, Bhopal demonstrated the right way to wash hands using soap and water that was practiced by the participants.  A sticker, developed by the APRIAM2 Hygiene Team, was distributed to each participant showing 'When to wash hands with soap and water'?   An estimated 700 members of the general community benefitted from the session
conducted for OPD patients, their caretakers and relatives.
On the final day, Dr. Tamhankar gave a lecture on the topic “Antibiotic use, Antibiotic Residues, Antibiotic Resistance & Environment” which was attended in large numbers by the faculty and the staff of AIIMS and also the participants. In the lecture Dr. Tamhankar explained the ‘Interrelation between Environment, Antibiotic use, Antibiotic Residues and Antibiotic Resistance’.
In the end, Dr. Tamhankar and Dr. Sharma were felicitated by AIIMS.
Hard work of Mr. Amit Pawar, Mr. Abdul Shadab, Mr. Jeetendra Jat and Ms. Sunita Parmar of APRIAM2 Hand Hygiene Team, RDGMC, Ujjain is appreciated for making these training sessions a success.
1. Dr. Megha Sharma  leads a campaign titled 'Swachcha Bharat- Swastha Bharat' since 2011. The campaign is conducted by APRIAM2 Hygiene Team with an aim to improve hygiene practices among present and future health care workers and the community. The team led by Dr. Megha Sharma interacts with school children, anganwadis and health care workers at C.R. Gardi Hospital, Ujjain charitable trust hospital and Government district hospital, Ujjain. Training sessions and workshops at these places are conducted on regular basis. The linkage between cleanliness, hygiene and health is focused in the activities and presentations. The team has introduced in-house prepared alcohol based hand rub in the hospitals to maintain hand hygiene ( ).
2. APRIAM project is an ongoing collaborative research project between R. D. Gardi Medical College, Ujjain and Karolinska Institutet, Stockholm, Sweden. Prof. (Dr.) Cecilia StÄlsby Lundborg is principal investigator of the project and Dr. A. J. Tamhankar is senior scientific advisor.

Thursday, July 21, 2016

Experts on antibiotics ask the UN to act on improving access to Antibiotics

Contributed by: Siddarth David & Dr. Tamhankar

Experts on antibiotic resistance called on the United Nations General Assembly meeting in September this year to decisively act to reduce the growing number of deaths due to limited access to effective antibiotics. Writing in the Lancet, they say that even though many current antibiotics are losing their effectiveness, millions of people do not have ready access to effective antibiotics. Ramanan Laxminarayan, director of the Center for Disease Dynamics, Economics & Policy, and a lead author of the call to action pointed out that many deaths are caused by insufficient access and delays in getting antibiotics while resistance is being reported at all levels.

To develop an effective plan, both these issues need to considered according to the article. Laxminarayan and his co-authors are calling on the UN General Assembly to establish a UN High-Level Coordinating Mechanism on Antimicrobial Resistance (HLCM) that will also require the involvement of organizations such as UNICEF, UNDP, UNEP, UNESCO, and the World Bank. The effort would have four core responsibilities:

  • Launch a global advocacy campaign to raise awareness about the lack of access to antibiotics and drug resistance
  • Monitor and evaluate defined, enforceable targets to reduce the number of deaths globally due to lack of access and inappropriate use of antibiotics in humans as well as animals
  • Mobilize resources from donors, aid agencies and countries to effectively finance the effort, and
  • Support and coordinate multi-sectoral action to implement the World Health Organization's Global Action Plan on Antimicrobial Resistance alongside national efforts to improve access to effective antibiotics.
The authors state that the UN must play a central role in the fight against a global health problem that could undo much of the progress the world has made against disease and poverty and this can lead to effective tackling of the problem like the HIV/AIDS commitments in 1996.

This is only the third time in its history that the UN General Assembly will use its High-Level Heads of State meeting to deliberate on a health issue that threatens the health of populations worldwide. This is also the first time that a One Health issue, a concept which involves the health of humans, animals and the environment, is being discussed at this high-level forum. Such strong global commitments can lead to greater success in the battle against antibiotic resistance.

Thursday, July 14, 2016

A blood test that significantly strengthen the battle against resistance

Contributed by: Siddarth David & Dr. Tamhankar

Researchers at Stanford University have developed a blood test that could identify if a infection is caused by bacteria or virus in 4-6 hours, greatly improving the diagnosis and thus protocols to be followed in treatment. The test which looks at just seven genes to determine the micro-organism responsible for the infection was tested among school children in Nepal with promising results.

The findings published in Science Translational Medicine, have drastically reduced the time taken for blood tests, which makes it impossible to determine the microbe before starting the drug treatment. To identify the microbe type, the test uses  the gene expressions information that the body extracts from a particular gene to use it to direct protein formation that responds to external agents. The seven-gene test is a vast improvement over earlier tests that look at the activity of hundreds of genes. The researchers are still working to conduct more tests and devise ways of making it cheaper and commercially viable.

Given that a considerable number of prescriptions for antibiotics are often given for viral infections, the creation of such quick tests is a boon. It can help reduce unnecessary prescribing of antibiotics and thus its consumption and eventually reduce antibiotic resistance.  This would be an additional tool in the battle against antibiotic resistance.