As the growing danger of AMR threatens to crumble our healthcare ecosystems, Navsangeet Saini, Deepali Verma and Samayita Ghosh, Max Institute of Healthcare Management, ISB, urge that efficient AMS frameworks are more critical than ever
Navsangeet Saini, Deepali Verma and Samayita Ghosh, Max Institute of Healthcare Management, ISB
“We have a weekly outcome meeting where we discuss the critical patients across all intensive care units. We gather relevant data on hospital-acquired pneumonia, the number of patients affected, the resistance patterns and such. Our goal is to reduce carbapenem use”, says an intensivist from a medium-sized hospital in India. Carbapenem, once effective for pneumonia, has shown underwhelming results lately. The culprit: hypervirulent Klebsiella pneumoniae, a bacterium resistant to most antibiotics, including carbapenem. This is just one example of the growing threat of drug-resistant pathogens, collectively known as Antimicrobial Resistance (AMR), which has unleashed a wave of hard-to-treat infections on millions of patients worldwide.
Globally, 1.27 million deaths are attributed to AMR each year (1), making every antimicrobial prescription the difference between life and death for millions. In light of this, WHO’s Global Action Plan and India’s National Action Plan on Antimicrobial Resistance (NAP-AMR) aim to curb AMR by coordinating efforts across sectors and industries, strengthening surveillance systems and regulating antimicrobial use (2). At the heart of these efforts are Antimicrobial Stewardship (AMS) programs – structured initiatives to promote responsible antimicrobial use (3).
Despite the strategic implementation efforts, AMS programs face several challenges. Foremost, there is a lack of effective adaptation of these protocols across different settings with varying levels of resources. In India, while larger hospitals have a robust AMS program, medium and small-sized hospitals adapt the Indian Council of Medical Research guidelines to best suit their needs (4). This flexibility allows adaptability of the program to available resources, but also leads to fragmented frameworks, a lack of clarity in roles, and diminished accountability, thus compromising AMS efficiency.4 “I am aware that there is a restricted antibiotic form that we must fill out before prescribing such medications. I think we are also supposed to send some data to a government authority. I am not sure, though,” admits a quality control staff member, illustrating the confusion.
This is where the AMS champion comes in: a dedicated professional who brings teams together and turns policy into practice. What exactly do AMS champions do, and why do we need them? Key stakeholders/champions in an AMS framework, including the administrators, clinicians, nurses, microbiologists and pharmacists, are ascribed nuanced roles that are vital for a functional framework.4 This collaborative multi-disciplinary approach to AMS brings together diverse expertise and unique perspectives. However, the absence of a defined hierarchy and clear leadership results in accountability gaps and weakens the AMS frameworks.4 In this context, the lead AMS champion is uniquely positioned to coordinate multidisciplinary teams, ensure consistent implementation and bring coherence to the AMS frameworks. Ensuring seamless communication, raising awareness about protocols, conducting training, holding regular stakeholder meetings, and fostering accountability are some of the ways in which AMS champions lead AMS frameworks and collaborative actions.
AMS Champions can ensure all healthcare cadres within the setup adhere to AMS protocols.4 They can effectively regulate the prescription, dispensing and use of antimicrobials by streamlining the processes and establishing a clear chain of command. For instance, through collaborations and tie-ups with external labs in the case of the absence of an in-house testing facility, they can foster targeted prescription and treatment. This is key to regulating antimicrobial prescription and use.
This could be someone with expertise in infection control or clinical practice, as a microbiologist corroborates, “There is a need for AMS champions—someone the doctors will listen to. The infection control team can be looked at as outsiders from another department, and their intervention can be misconstrued as interference. So, a senior member from within a certain department can better guide the AMS efforts in their department.” In smaller hospitals, external consultants working as champions, along with higher management, can usher in clarity, vigilance and coordination (4).
As the growing danger of antimicrobial resistance threatens to crumble our healthcare ecosystems and thwart the progress we have made in public health, efficient AMS frameworks are more critical than ever. The need for guided AMS effort, clear accountability and a defined hierarchy within the framework is paramount. AMS champions can be the unifying force, the leaders who bring teams together and policies alive. In this battle against superbugs, AMS champions can be the rallying point–coordinating efforts, driving consistent AMS implementation and ensuring every stakeholder is aligned to mount a unified attack.
References:
- Murray, C. J., Ikuta, K. S., Sharara, F., Swetschinski, L., Aguilar, G. R., Gray, A., … & Tasak, N. (2022). Global burden of bacterial antimicrobial resistance in 2019: a systematic analysis. The Lancet, 399(10325), 629-655.
- World Health Organization. (2015). Global Action Plan on Antimicrobial Resistance. https://iris.who.int/bitstream/handle/10665/193736/9789241509763_eng.pdf?sequence=1
- World Health Organization. (2019). Antimicrobial Stewardship Programmes in Health-Care Facilities in Low- and Middle-Income Countries: A WHO Practical Toolkit [Report]. https://iris.who.int/bitstream/handle/10665/329404/9789241515481-eng.pdf
- Max Institute of Healthcare Management, Indian School of Business. (2024). Antimicrobial Stewardship Programs in Health Facilities: A behavioural Science Approach. https://shorturl.at/XQ7q9