Antimicrobial Awareness Week 2021: Recent initiatives of DSPRUD towards AMR containment

DSPRUD, a non-government organisation since 1996, has been working at various levels and contributing from policy to the grass root level with diverse stakeholders on AMR

By Sangeeta Sharma, Renu Gupta
Published: Tuesday 23 November 2021

DSPRUD, a non-government organisation since 1996, has been a leading innovator, convener, partner and driver for introducing the concept of essential medicines and rational medicine use, especially antibiotics in India.

The Society is committed to focus and energise the essential medicines concept, rational medicine use and medication safety agenda to strengthen healthcare systems in both, the public and private sector.

Antimicrobial resistance (AMR), a major public health problem, has numerous biological, behavioural, economic, environmental and social factors contributing to its development and propagation.

DSPRUD has been working at various levels and contributing from policy to the grass root level with diverse stakeholders on the clinical and social dimensions of use / misuse of antibiotics, raising awareness about the impact of AMR and facilitator / barriers to promote rational antibiotic use.

Some of the important activities undertaken by the Society are listed below:

Policy level interventions

National Action Plan (NAP)-AMR, a top-level plan needs implementation at the state level and supplementation at the health facility level.

This is to successfully overcome the threat posed by AMR and to protect the effectiveness of existing and future antimicrobials.

DSPRUD played an instrumental role in the development of a multi-sectoral and multi-jurisdictional State Action Plan to Combat AMR in Delhi (SAP-CARD) in January 2020 with contribution from over 120 experts from the human and non-human sectors.

With this, Delhi became the third state to develop its own state action plan after Kerala and Madhya Pradesh. Besides, DSPRUD has been representing at the national level in National Working Groups on AMR.

Building capacity

Initiatives tackling AMR, including state action plans, can only be fully exploited at the macro level by building the critical capacity for implementation of antimicrobial stewardship (AMS) interventions.

These should be well-integrated with infection prevention & control (IPC) at the hospital level. 

The Society has been at the forefront of conducting training programmes for doctors, pharmacists and nurses to build skills for implementation of the AMS programme (AMSP).

They have developed an online certificate course on AMS in collaboration with Public Health Foundation of India (PHFI). The Society has so far conducted over 200 workshops and trained more than 8,500 health professionals. 

Training on Antimicrobial Consumption (AMC) Tool and Point Prevalence Sampling (PPS) Methodology

Both, the volumes of antimicrobial used and the prescribing practices contribute to the selection of AMR.

It is imperative that before initiation of any AMS activities, the magnitude of antibiotic use is measured and analysed to understand the causes of irrational prescribing practices followed by designing of interventions to rationalise / reduce the antimicrobial use. 

DSPRUD is actively engaged in developing capacity in using AMC tools developed by the World Health Organization for the national surveillance sites (30 sites) under the National Centre for Disease Control (NCDC).

This is so that the AMC data provides the total quantum of antibiotics consumed and its trends for comparison. 

Nurses as champions for IPC & AMS interventions

Nurses being the largest workforce and in position as team leaders, can significantly contribute to the success of the AMSP. But their potential is less recognised and utilised. 

Nurse-led AMS interventions can significantly improve antibiotic use practices by questioning an antimicrobial order, timely switching from IV to oral antibiotics or timely removal of catheter, etc. 

IPC is a universal component of all health systems and integral to AMR containment.

The Society has played a key role in developing and updating standard operating procedures for IPC for Delhi hospitals since 2016 and running training / certificate courses for Infection Control Nurses on IPC, AMS interventions and critical care nursing. They have trained more than 1,300 nurses.

Developing Standard Treatment Guidelines (STGs): A Point-of-Care Clinical Support Tool

Prescribing is a complex, dynamic process, influenced by many determinants. Inadequate training, combined with the lack of a functional antibiotic policy, are the leading causes of unchecked growth of AMR in Indian hospitals.

The availability and easy access to up-to-date guidelines for antimicrobial usage is an important pre-requisite for appropriate antibiotic use and improved patient outcomes.

The Society has been actively engaged in developing and implementing STGs at various levels of healthcare.

Our latest edition (2021), is a comprehensive evidence-based ready-reckoner covering 330 priority diseases developed and reviewed by a large number of experts.

It includes a section on AMS interventions and provides stepwise treatment of infectious diseases along with pearls for AMS. We are also conducting monthly online workshops in collaboration with ECHO India to train clinicians ‘when not to use antibiotics’.

Patient / Public education / Community awareness

Emergence of community-associated resistant organisms in the last decade has also highlighted the need of public awareness programmes as antimicrobials are consumed in a much larger proportion in the community, compared to hospitals.

DSPRUD has been actively working to design and implement community education programmes focusing on various aspects of antibiotic use by addressing misbeliefs / misconceptions about antimicrobial treatment, self-medication and poor adherence. 

This is in pursuance of SAP-CARD Strategic objective 1.

Raising awareness about problems with antimicrobial use / misuse at a young age not only promotes behavioural change but also positively influences parental and community behaviour towards appropriate antimicrobial use.

The Society for the past two consecutive years has been organizing state-wide awareness campaigns among Delhi school students on the occasion of World Antimicrobial Awareness Week (WAAW). 

In 2019, more than 600,000 school children from 1,041 Delhi government schools participated.

In the wake of the ongoing novel coronavirus disease (COVID-19) pandemic, WAAW 2020 campaign was conducted all online, wherein 3,500 teachers and 350,000 students participated. 

Around 45,000 students took part in a quiz competition and more than 5,000 students participated in online ‘IDEAthon’. Entries were independently evaluated and rewarded based on content, creativity / presentation and relatedness to the theme. 

The Society is also committed to the cause of promoting rational antibiotic use, other activities include prescription audit and research into practices & factors in specific regional and local contexts and regular time-to-time assessment of the AMS programme in order to understand the existing structures, processes and outcomes. 

Professor, neuropsychopharmacology and nodal officer AMR containment

Assistant Professor, Microbiology, Institute of Human Behaviour & Allied Sciences (IHBAS)

Views expressed are the author’s own and don’t necessarily reflect those of Down To Earth

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