The Review on AMR published their final instalment today: a report on Infection Prevention and Control, and Surveillance. A report on IPC was not planned at the start of the Review, so the existence of this report illustrates the responsiveness of the Review team. Also, having been peripherally involved in reviewing this report, I am aware that it was written within an extremely short timeframe but it does not show: it is comprehensive and thought-provoking (as it should be) with some useful recommendations.
I quite like the way the Review works in blocks of three. Three priority areas, each with three recommendations for improvement. A total of nine “things” in probably stretching the attention span of most readers (me included)! I also love all the infographics that have been produced by the Review.
The report has three sections: access to water and sanitation, IPC in healthcare, and improving surveillance (including brief reference to antimicrobial stewardship). As you may expect, I have more to say about the latter two sections (not wishing to undermine the importance of the first, of course, illustrated by this powerful infographic). The three recommendations for IPC in healthcare are to prioritise IPC in healthcare systems (citing the impressive reductions of MRSA in the UK as evidence), invest in studies to improve the evidence base (and fill the evidence-free zone that exists for some areas of IPC), and understand barriers to compliance with basic IPC measures (such as hand hygiene). I particularly liked the section describing the challenges of assessing novel technologies (a subject close to my heart). The Review described fundamental gaps in the way that these studies should be funded: access to public funding is limited, and manufacturer-funded studies lack the credibility of publically-funded studies! Not quite a catch 22, but a problem.
In terms of surveillance, the Review called for more extensive and better connected surveillance systems. Whilst the CDC, ECDC, UK and other countries have sophisticated, connected surveillance networks, there are parts of the world where we remain largely in the dark around the rate of HCAI, and the rate of AMR. Furthermore, it is in these parts of the world where rates of both HCAI and AMR are likely to be highest. You often tend to see a small number of studies reporting eye-wateringly high rates of both HCAI and AMR from parts of the world where surveillance systems are poor. Folk involved in surveillance also need to work together to make some joint decisions about how to define HCAI and AMR. Finally, how can private databases be mined to improve surveillance? This won’t make a lot of sense to those of us working in the NHS, where private databases are small and rare, but imagine a situation where large pathology companies run the clinical laboratories of most hospitals – how can these companies be engaged to share their pathology data in the most useful way. Actually, perhaps not so far from the situation in the NHS after all…
Many thanks to the Review team for putting together these reports, which I hope will promote issues related to AMR and HCAI towards the top of professional and political agendas.
Image: Review on AMR Infographic.