BASICS: Helping the Fight Against Antimicrobial Resistance

This post is part of a series authored by the BASICS (Bold Action to Stop Infections in Clinical Settings) team. BASICS is a new initiative that will transform healthcare and reduce healthcare-associated infections (HAIs) by at least 50%.

 

Written by the BASICS Team

Every use of an antibiotic, whether appropriate or inappropriate, gives resistant bacteria an advantage and accelerates the development of resistance. Drug-resistant infections are associated with higher morbidity, mortality and health expenditures, and resistant infections are becoming a significant cause of death, particularly for children.

An estimated 700,000 lives are lost to these antimicrobial resistant (AMR) infections every year. Around 200,000 newborns die annually because they catch infections that simply do not respond to drugs. According to the World Health Organization, around 40% of infections contracted by newborn babies resist available treatments[1]

The burden of resistance falls heavily on low- and middle-income countries (LMICs). Here, some population groups suffer from frequent and rapid spread of infectious disease and poor nutrition. Healthcare systems in these countries are often less able to manage this burden, and the situation is exacerbated by increasing rates of antibiotic consumption in humans and animals and by limited standards and regulations that govern access, use and quality of antibiotics[2].

Many infections, both drug-resistant and drug-susceptible, are acquired in hospitals. Healthcare-acquired infections (HAIs), particularly sepsis, are a danger for both neonates and their mothers, who are increasingly being encouraged to seek birth and delivery care at hospitals. Increasing rates of drug resistance render many such infections untreatable.

Professor Clare Chandler, Co-Director of the London School of Hygiene and Tropical Medicine’s Antimicrobial Resistance Centre, and Dr. Laurie Denyer Willis, Assistant Professor at the School, have conducted extensive research in East Africa on the roles that antibiotics play in LMICs beyond their immediate curative effects. Their findings suggest that antibiotics have become a “quick fix” for care available through fractured health systems and, among others, for the lack of hygiene in settings of limited resources.

Although there is no single silver bullet, the most obvious solutions – improved infection prevention and control practices – remain among the most effective interventions[3]. All health care facilities, at a minimum, must have clean running water and sanitation services, and healthcare professionals must follow good hygienic practices such as handwashing[4].  Many LMICs face significant challenges in setting up effective systems that can achieve these basic objectives.

This is the core of what BASICS aims to achieve: supporting the institutionalization of simple, inexpensive hygiene measures in healthcare facilities through effective training platforms, monitoring and accountability systems, reliable supply chains and upgraded water, sanitation and hygiene infrastructure. This will create a clear roadmap for national healthcare systems to take comprehensive action to improve infection prevention and control and dramatically lessen the burdens that HAIs place on under-resourced systems and impoverished families.

BASICS projects a 50% reduction in HAIs in participating facilities based on robust evidence linking improvements in hygiene and cleanliness in healthcare facilities with improved patient outcomes.[1-4] These improvements will significantly reduce the usage of antibiotics – and, in turn, dramatically curb the development of new AMR pathogens.

BASICS is where it can start and it should start now.

To learn more about AMR and how to fight back, watch this roundtable discussion with Professor Chandler – one of our BASICS team members at the London School of Health and Tropical Medicine.

 

Acknowledgements: Professor Wendy Graham and Professor Clare Chandler from LSHTM – a BASICS partner – provided comments and review.

 To learn more about BASICS (Bold Action to Stop Infections in Clinical Settings), visit savethechildren.org.

 

References:

[1]        P.C. Carling et al., “Improving environmental hygiene in 27…,” Crit. Care Med., vol. 38, no. 4, Apr. 2010. https://www.ncbi.nlm.nih.gov/pubmed/20081531

[2]        R. Orenstein et al, “A targeted strategy to wipe out Clostridium…,” Infect. Control Hosp. Epidemiol., vol. 32, no. 11, Nov. 2011. https://www.ncbi.nlm.nih.gov/pubmed/22011546

[3]        S. J. Dancer et al., “Measuring the effect of enhanced cleaning…” BMC Med., vol. 7, p. 28, Jun. 2009. https://www.ncbi.nlm.nih.gov/pubmed/19505316

[4]        B. Allegranzi et al., “A multimodal infection control and patient safety…,” Lancet Infect. Dis., vol. 18, no. 5, May 2018. https://www.ncbi.nlm.nih.gov/pubmed/29519766

 

[1] https://www.who.int/mediacentre/commentaries/antibiotic-resistant-bacteria/en/

[2] https://www.ncbi.nlm.nih.gov/books/NBK525181/

[3] https://www.infectioncontroltoday.com/antibiotics-antimicrobials/antimicrobial-resistance-stewardship-and-strategies-conquering-global

[4] https://www.who.int/mediacentre/commentaries/antibiotic-resistant-bacteria/en/