Tackling Antimicrobial Resistance: An Interdisciplinary Approach

The proposal aims to facilitate and encourage multidisciplinary research at Loughborough University (LU) into the healthcare environment (air, water and surfaces) and in community settings (e.g. nursing and care homes, low income countries with high population densities) as potential reservoirs for the transmission of antimicrobial resistant infectious agents. Hospital surfaces are a reservoir for transmission of antimicrobial resistant infectious agents, typically via contamination of the hands of healthcare workers. Staphylococci, C. difficile and Acinetobacter species have been shown to survive many months on high touch near-patient surfaces in healthcare environments. Recent epidemiological evidence suggests that patients admitted to rooms previously occupied by colonised patients have a higher probability of acquiring (i.e. is a risk factor for colonisation or infection) the same pathogen. Other studies have shown aerial dissemination of infectious agents, e.g. C. difficile spores, making it particularly difficult to eradicate infectious agents in hospitals. Despite a recent focus on performance management to improve the efficacy of cleaning and disinfection processes, published studies have demonstrated the presence of culturable indicator organisms (e.g. Methicillin-resistant Staphylococcus aureus and Vancomycin-resistant enterococci) post conventional "terminal disinfection" (i.e. upon patient discharge). Bacterial endospores (e.g. Clostridium difficile) are particularly resilient to routine disinfection treatments due to a variety of factors including use of insufficient, low concentration disinfectant, inadequate contact times etc .The Chief Medical Officer's report highlights issues such as poor design that limits cleaning, poor ventilation and poor water-supply management (risk of Legionella species and Pseudomonas aeruginosa). One of the problems of AMR is the length of time taken to identify pathogens (1-3 days) resulting in (i) potential spread of infectious agents; (ii) antibiotics given to patients unnecessarily 'just in case'. Rapid diagnostics would aid early detection and isolation of patients that would otherwise spread contamination. Photocatalytic self-cleaning surfaces could inactivate infectious agents landing on surfaces thereby breaking the link between contaminated surfaces and transmission through contact. Barriers and levers could be identified to improve hand-hygiene compliance whilst monitoring compliance in real-time using teletracking technology. Novel surface, air and water disinfection systems could be developed e.g. using atmospheric plasma technology. Natural ventilation systems could be designed to improve air quality and reduce dispersal of infectious agents in multi-bed wards. The proposal aims to focus on the following three AMR research themes: (i) Accelerating therapeutic and diagnostics development - Alternative approaches to treat resistant bacteria; New technologies for identifying resistant bacteria to underpin diagnostics development; Scale-up and manufacture of biotherapeutics; The effective delivery of existing antimicrobial agents (ii) Understanding the real world interactions - Understanding the role of the environment as a reservoir for AMR microorganisms and the transmission of infections in community and healthcare environments; Ways to manipulate the environment to prevent transmission (iii) Behaviour within and beyond the healthcare setting - Elucidate underpinning motivations for human behaviours relating to the spread of AMR infectious microorganisms in the healthcare environment and the community; Evaluate interventions to control/prevent the spread of resistant bacteria.

The proposed Bridging the Gaps bid aims to bring together highly relevant broad academic expertise in the identified AMR research themes : the focus of the project will be on the environment in healthcare and the community, as a reservoir for the transmission of infections. Through cross-sector engagement multidisciplinary research teams will focus on solving clinically-relevant problems. Strong involvement of clinical partners will ensure critical oversight of problem definition so that the ideas that receive funding have the potential to address real-world problems. Problem-led research will be fed through to clinical partners to work jointly on implementation and behaviour change within healthcare organisations. The potential for policy change within public health will be addressed through collaboration with national organisations (e.g. Public Health England). The programme will have strong clinical and industrial steer using its advisory board chaired by Peter Ellingworth (CEO, ABHI) with high level representatives drawn from the NHS (e.g. The Royal Wolverhampton NHS Trust, University Hospitals of Leicester NHS Trust), Charities (e.g. Infection Prevention Society), regional bodies (e.g. East Midlands Infectious Diseases Research Network, EMIDRN) and Industry (e.g. Smith & Nephew, Hygiene Solutions etc). Industrial partners supporting the project will bring a commercial edge to the activities to ensure opportunities for commercialisation are not overlooked. There will be considerable potential for development of new Intellectual Property around innovative technologies, equipment and techniques, and the added benefit of developing these innovations from a multidisciplinary perspective focusing on AMR. The LU Enterprise Office will be engaged at an early stage in the AMR BtG activities to help facilitate knowledge transfer e.g. through 'Innovate UK' funded 'knowledge transfer partnerships', and with intellectual property protection (e.g. early exploration of intellectual property potential of new research ideas through patent applications). The Advisory/Management Group will ensure continued benefit and impact by representing the voices of all stakeholders and guiding the research, as well as providing a path to addressing problems facing healthcare providers in particular. The network will be further developed using the already established network of contacts of the collaborating organisations and their members e.g. leveraging Medilink (EMIDRN), Infection Prevention Society (IPS), ABHI and targeting other related networks e.g. Hospital Infection Society (HIS).