AMRSim: A Microbial Reality Simulator

Lead Research Organisation: Glasgow School of Art
Department Name: School of Design


Antimicrobial-resistant bacteria are an established and growing issue in small animal veterinary practice in the developed world. The problem is, people can't see the bacteria on them, on animals, or on the surfaces and objects they touch. This makes it difficult to prevent and control infection in the most effective manner, as habits and standard practice are hard to change if you don't know what you are dealing with. While data exist to inform best practise in infection control, they are usually published in academic journals, thus having limited impact on what is done in practise.

Our solution is to make the 'invisible, visible' by building a three-dimensional graphical simulator of the interior of a veterinary practice in which humans, animals, and bacteria interact, according to rules observed from real-life. We are calling this simulator, AMRSim - A Microbial Reality Simulator.

The indoor environment of the vet practice can be viewed as a complex 'ecosystem' in which animals and humans interact with one another and their physical environment. Within this ecosystem there is a third, unseen group of actors - microbial agents - some of which have the capability to cause infectious disease in animals and/or humans. In the case of bacteria, they often persist in the environment on surfaces as a community. It is within these bacterial communities that they are more resistant to physical or chemical removal and are able to exchange mobile genetic elements that confer resistance to antibiotics. For this reason, activities such as disinfecting surfaces, sterilising instruments and treating patients with antibiotics, are a fundamental part of the working life of health professionals.

AMRSim will take data from the real world and make them 'come alive' in a visual way. Actual video footage will be used of the movements of humans and animals within a busy vet practice and the procedures undertaken, including those intended to reduce infection. The bacteria within the simulation will be introduced according to what is known of bacterial infection (types, location, antibiotic resistance) within vet practices from data already avaliable. Importantly, AMRSim will allow these normally invisible bacteria to be 'seen' as they multiply and spread through the indoor environment on people, animals and surfaces. By 'seeing' the interactions of animals, humans, and bacteria within space and time it will be possible to improve efforts to prevent bacteria entering and spreading through the physical environment, and improve their removal when they do.

AMRSim will be brought, at progressive stages of its development, to a series of co-design workshops with end-users to ensure it is made meaningful, appropriate and usable, and addresses key learning outcomes with respect to preventing and controlling infection.

The theory we shall test is that as practitioners interact with AMRSim, both in its development and then in its application, they will gain a greater appreciation for: 1) the impact their behaviours and activities can have on infection; 2) where weaknesses lie in current practise; and 3) where changes made to the way people and animals interact with each other and their environment can disrupt the status quo. These will lead to a reduced risk of bacterial contamination and infection, and ultimately reduced reliance on antibiotics.

Our previous work in the human health environment has shown the power of 'making the invisible, visible' by simulating infection control on a hospital ward using a visual simulator. We shall build on this experience with a new, multidisciplinary team with expertise in digital design, spatial design, co-design, environmental psychology, veterinary practice, and microbiology. It is our intention that the experience we gain in developing and using AMRSim will be applied more widely, such as for teaching students and to simulate other indoor environments where biosecurity is paramount.

Planned Impact

This research has the potential to reduce infection in veterinary practice, thereby reducing reliance of antibiotics and creating an environment where AMR is disfavoured. As well as this direct application, this proposal will also be relevant to other stakeholders. Specifically, we expect it will provide benefit to the following stakeholders in the following respects.

With respect to all communities that use quantitative data, the project will be an example of how data that are traditionally published in academic formats can be made to come alive and have demonstrable impact in the real world, thereby improving the accessibility and reach of data and their potential to be understood, adopted and to change behaviour. Our approach to realising this is described in the Pathways to Impact document.

To the scientific community:
>Providing an example of how the inclusion of Design that incorporates stakeholder engagement, e.g., via co-design, visualisation and iterative prototyping expertise, can add significant value to multi-disciplinary teams and provide benefit to the more traditional scientific disciplines usually linked with AMR research.
>Furthering our understanding of how to measure and incorporate drivers of behaviour into interventions for the behavioural sciences. Specifically, habits are recognised as a key barrier for behaviour change. However, as they are difficult to measure due to their nature of being an automatic process, this project will produce methodological and theoretical developments of important to the psychology community.
>Promoting a 'One Health' approach to tackling AMR, by directly showing the importance to infection of how humans, animals, and the environment interact with one another in ways that can be manipulated, disrupted, and visualised.

To veterinary practitioners across their various roles - consultant, nurse and auxiliary:
>Helping untangle, and making visible and more understandable, the complex mechanisms of infection spread, control and prevention in a demanding service environment, the potential threats and risks of certain practices, and to explore improved practices aimed at minimising infection and reliance on antibiotics.

To veterinary bodies and associations:
>Such as the Veterinary Medicines Directorate, Royal College of Veterinary Surgeons, Royal College of Pathologists, Society of Practicing Veterinary Surgeons, British Veterinary Association and Defra, by providing evidence-based recommendations for safer practise.

To digital design and 3D software practitioners:
>Providing an example of how their skills can contribute, in a very practical way, to the global AMR challenge. Poyade is an executive member of EuroVR, an association whose aim is gather VR/AR actors in the EU. Although the visualisation and interaction in the digital tool are not developed as Virtual Reality, the EuroVR conference can be a useful means for dissemination.

To the designers and architects of healthcare environments:
> Providing evidence-based rationales for particular spatial layouts which inform building notes, design guidelines and risk assessment.

To healthcare communities - those involving both people and animals:
>Providing proof of concept that our novel approach might be applied usefully in other human and animal settings.

To the public at large:
>By making research on infection control and AMR accessible and engaging; making it possible to 'see' the conditions for how AMR might occur, contextualised in a largely familiar everyday setting, particularly for those who are pet owners.

To the media:
>We can foresee that an ability to communicate visually to lay audiences will be helpful for media purposes.
Description Our aim was to develop a software tool to support training in infection prevention and control (IPC) for veterinary practitioners and students. The intention of this work is to motivate the changes in behaviour needed to reduce infection risk. Antimicrobial-resistance (AMR) is a growing issue in human and animal health. Increasing numbers of resistant infections are leading to many existing antibiotics becoming less effective. AMR is a continuing challenge in veterinary medicine and AMR bacteria are more likely to emerge and transmit AMR genes where there are higher microbial densities. We developed and evaluated an innovative training intervention, supported by a new type of digital tool, for training veterinary practice staff in IPC. This comprised an interactive mode of presentation and delivery supported by a 3D graphical simulation tool recreating the interior of a vet practice and the interactions of humans, animals, and microbes (such as bacteria), according to rules observed from real-life. Additional visual layers, able to be switched on/off, enabled normally invisible bacteria to be easily 'seen' as they spread via contact between animals, people, equipment and the indoor environment, and the effect of various IPC measures.. By 'making visible the invisible' our objective is to reduce microbial contamination in small animal vet practices, hence to reduce reliance on antibiotics, and to contribute to decreasing the risk of AMR developing. The current tool is a laptop-hosted digital animation designed to support a trainer delivering a short in-house workshop session. In 2019, our intervention was delivered to 51 vet staff during a trial within a large referral vet practice. Participants found the novel approach taken to discussing IPC increased their awareness and appreciation of the issues: comments such as 'very clear', 'informative' and 'showed easy steps on how to prevent infection' were typical of the feedback received. After experiencing the intervention, 92% of the 51 participants agreed to change their behaviour and stated an intention to implement an infection control behaviour that aligned with training objectives. The 3D graphics enhanced the delivery of training content by making difficult and abstract contamination concepts easy to understand. Our trial demonstrated that our prototype intervention was able to meet its training objectives within a 30-minute trainer-led session.
Exploitation Route We were successful in receiving funding for our AHRC follow-on proposal (Grant Ref: AH/V001795/1) VIPVis (Veterinary Infection Prevention through Visualisation) to develop our proof-of-concept prototype into fit-for-deployment software for platforms which permit stand-alone, self-paced and flexible modes of learning, and which can be evaluated in a variety of training situations and environments: for veterinary students during their education to embed a life-long awareness of infection control that has lasting positive impact on the way they approach antimicrobial stewardship once qualified and in practice: for vet practitioners across their various roles - surgeon, nurse and auxiliary; and for veterinary bodies and associations such as the BVA and the Royal College of Veterinary Surgeons (RCVS) through a standalone Massive Open Online Course (MOOC) e-learning programme, with the intention to positively influence behaviours to minimise the risk of infection and ultimately the reliance on antimicrobials. This 9-month project is due to commence in April 2021.

For the first 3-5 years, the University of Surrey (UofS) will wish to explore the commercial potential of the outputs from this project, as well as exploiting them exclusively for its own students through its SurreyLearn virtual learning environment, with their partner practices and also through the MOOC. Thereafter, the use of the data will be made widely available, with attribution, for non-commercial use only, potentially without permission, to create derivative works (along Creative Commons lines). Data will be licensed under CC-BY-NC 4.0 for non-commercial re-use. Any commercial re-use would need to be agreed with, and between, GSA and UofS.
Sectors Education,Healthcare,Other

Description In the trial of our prototype, when asked, 92% of the 51 participants agreed to change their behaviour and stated an intention to implement an infection control behaviour that aligned with the learning objectives of the workshop by increasing hand hygiene (31.37%), wearing gloves (15.69%), wearing protective clothing (15.69%), reducing unnecessary touching of animals (11.76%), being more aware of self-touching face, hair and glasses (19.60%), and intending to clean their equipment, work area or touchpoints more frequently (17.76%). Participants found the 3D graphics enhanced the delivery of the workshop content by making difficult and abstract concepts easy to understand and it was considered overall a 'very good visual representation' of pathogen transfer. Feedback also indicated participants found the trial 'interesting', 'important', 'beneficial to practice' and that they could see the potential for others to similarly benefit. Indeed, suggestions for improving the intervention included making it more widely available, increasing the frequency of workshops and diversifying to include other specific aspects of infection control practice, such as kennel care. These findings will be used now in our AHRC Follow on (Grant Ref: AH/V001795/1) VIPVis (Veterinary Infection Prevention through Visualisation) project to make this available on a variety of platforms for self-paced training.
Sector Education,Healthcare
Impact Types Societal

Description Veterinary Practice
Geographic Reach Multiple continents/international 
Policy Influence Type Influenced training of practitioners or researchers
Description Veterinary Infection Prevention through Visualisation
Amount £99,477 (GBP)
Funding ID V001795 
Organisation Glasgow School of Art 
Sector Academic/University
Country United Kingdom
Start 04/2021 
End 01/2022
Description FPR 
Organisation Fitzpatrick's Referral
Country United Kingdom 
Sector Private 
PI Contribution The team conceived the study which aimed to develop a new training intervention supported by an innovative digital tool 'to make visible invisible' microbes and the spread of contamination to positively influence behaviours to minimise the risk of infection and ultimately the reliance on antimicrobials in veterinary practices.
Collaborator Contribution In summary, the partner provided contributions as follows. 1) They enabled the team to capture video data from within the referral practice for three entire canine patient journeys for the purposes of identifying those stages in the surgical procedures posing the greatest risk, providing data on the flow of humans and animals within the veterinary practice and the interactions between humans, animals and their surroundings (e.g., person-person, person-animal, person-surfaces, and animal-surfaces). These data were used to assist in the development of the digital tool. 2) They made available a practice nurse as a full member of the team for the duration of the project, to support the team, enable access to the referral practice staff and premises, and to provide veterinary nurse practice expertise relevant to the requirements of the project. 3) They made available a large number of staff from its practice for the trial where the prototype training intervention was trialled.
Impact Outputs to date are listed elsewhere in this entry. The multi-disciplinary research team comprised expertise in co-design, software engineering, environmental psychology, veterinary bacteriology, pathology and veterinary infectious disease expertise, microbiology, anti-microbial resistance and veterinary nursing.
Start Year 2017
Description AMR MOOC - Massive Open Online Course in Antibiotic stewardship in Veterinary Practice 
Form Of Engagement Activity Engagement focused website, blog or social media channel
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Professional Practitioners
Results and Impact Better understanding of infection control and antimicrobial resistance (AMR)
Year(s) Of Engagement Activity 2020
Description Talk at 'World One Health Conference' on 'Use of big data and digital transformation in microbiology and pathology'. 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Professional Practitioners
Results and Impact Potential for new collaborations identified.
Year(s) Of Engagement Activity 2020