12 Dec 2018

Project casts net wide to tackle hospital bug spread

Dr Andrew Stewardson
Series about National Health and Medical Research Council (NHMRC) Project Grant recipients in Central Clinical School (CCS) starting in 2019

by Anne Crawford

The spread of antimicrobial resistance (AMR) in the Australian healthcare system is a major public health concern. Yet despite the fact that this spread occurs between hospitals, as well as within them, infection control has traditionally been considered something to be handled by individual institutions.

A Monash University researcher is leading a bold study to examine patient movements within and between Victorian hospitals, the findings of which may ultimately be used to improve strategies to contain AMR and prevent its dissemination.

The NHMRC-funded project is headed by Chief Investigator - A (CIA) Dr Andrew Stewardson, infectious disease physician and researcher, who has assembled an interdisciplinary team that includes the Victorian Chief Medical Officer, Associate Professor Andrew Wilson, and two infectious diseases mathematical modellers; Dr Tjibbe Donker from the Nuffield Department of Medicine, University of Oxford, UK, and Professor Ben Cooper who works at the Mahidol Oxford Tropical Medicine Research Unit (MORU).

“It’s an ambitious project because we’re trying to take a fresh look at a system that’s been in place for a long time and because we’re working with a very large dataset,” Dr Stewardson said. “We’re aiming to have an impact on what is a reasonably steady spread of antimicrobial resistance – and that’s not an easy problem to solve,” he said.

The need is pressing.

A joint report from the Australian Departments of Health and Agriculture in 2015 warned that AMR is “a significant global health priority that threatens to take modern medical and veterinary practice back into the pre-antibiotic era”.

Access to effective antibiotics is crucial to treating established infections and guarding against infections associated with surgery, chemotherapy, transplantation, and many other life-saving medications. Immune-suppressing treatments are involved in many areas of medicine including cancer treatment. “So we’re reliant on the effectiveness of antibiotics to prevent and treat infections when patients are getting these life-saving treatments.”

A recent multi-facility outbreak of a multidrug resistant superbug known as carbapenemase-producing Enterobacteriaceae (CPE) highlighted the need. CPE are resistant to most antibiotics and can be lethal. Vancomycin-resistant enterococcus (VRE), a major healthcare problem in Australia, is another example.

Although AMR bugs can be found elsewhere, hospitals are a focus for their amplification.
Shared patient populations are created as patients move between institutions whether from acute care to rehabilitation; regional centres to major referral hospitals; or from public to private systems.

“Infection control is traditionally seen as something that’s done in a single hospital. We think we might be able to come up with more effective strategies for preventing the spread of resistant infection if we consider a coordinated approach at a network level,” Dr Stewardson said.

The researchers hypothesise that the position of a hospital within this network has a profound impact on the prevalence of AMR within that institution.

“But we don’t currently have a very clear description of these connections between hospitals,” Dr Stewardson said.

“Our aim is to build a tool that can be used by state authorities to respond to future outbreaks and also to design a central surveillance system for prospective detecting the early spread of new and emerging infections.”

The researchers will link real-world patient and microbiological data using network analysis to develop a novel real-time outbreak management tool.

“The nice thing is we’re a relatively small team of people with complementary skills.”

They anticipate that the simulation model – based on the patient referral network – will be used to inform health policy decisions in Victoria then in other states and territories (or even countries).

Dr Stewardson, who came to Monash University in April 2017, and works in the Department of Infectious Diseases, was previously a Research Fellow working on an infection control program in the University of Geneva Hospitals, Switzerland, at times co-operating with WHO patient safety programs.

He was also program manager of the National Hand Hygiene Initiative in Australia, which introduced a co-ordinated approach to hand hygiene infection control across hospitals, notably the widespread introduction of hand-rub dispensers.

The project supported by this three-year NHMRC grant continues on from research Dr Stewardson has been conducting under an NHMRC Early Career Fellowship.

“There’s a clear recognition that this is an important issue and we’re putting together a team for a project that can have an effective impact on policy,” he said.

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