Surveillance of Healthcare-associated Infections & Antimicrobial Resistance

Study Overview
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Brief Summary
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The aims of this project, called Surveillance of Healthcare-associated infections & Antimicrobial Resistance, or SHARE, are to 1) enhance laboratory capacity to detect emerging AMR patterns; 2) strengthen hospital epidemiology programs to use data to prevent, detect, and contain emerging AMR threats; 3) deploy study teams to answer critical public health surveillance questions, and 4) to build a national network of infection prevention and control (IPC) resources to prevent, detect, and contain emerging infectious disease threats

Detailed Description
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The World Health Organization (WHO) has declared antimicrobial resistance (AMR) one of the top 10 global public health threats facing humanity. AMR burden is higher in low-and-middle-income countries (LMICs) where, in recent decades, incidence and mortality from healthcare-associated infections (HAI) due to multidrug resistant organisms (MDRO) have dramatically increased. For example, neonatal sepsis is the third most common cause of neonatal deaths and multidrug-resistant Gram-negative bacteria are now the leading cause of sepsis among hospitalized neonates in south Asia and sub-Saharan Africa, including Botswana.1,2 One in three newborns with an MDRO bloodstream infection will die.3 In 2021, to respond to the global threat of AMR, U.S. Centers for Disease Control & Prevention (CDC) announced the launch of a global network of networks to tackle the problem of AMR and healthcare-associated infections (HAIs). The network, called Global Antimicrobial Resistance Laboratory and Response Network, solicited funding applications; in December of 2021, Botswana was announced as recipient of a 5-year cooperative agreement following the successful application for funding for a comprehensive AMR surveillance project. The project was developed by investigators from Botswana-UPenn Partnership (BUP) in collaboration with Botswana's Ministry of Health & Wellness (MOHW) and the University of Botswana (UB).

Official Title
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Surveillance of Healthcare-associated Infections & Antimicrobial Resistance

Conditions
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Antimicrobial Resistance

Intervention / Treatment
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* Diagnostic Test: Routine Infection control


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: hospital inpatient admission to participating wards. Exclusion Criteria: diagnosis of a bleeding disorder platelet counts of <50,000 diagnosis of coagulopathy presence of active bleeding inability to have a nares swab collected due to some other condition where nasal swabbing would be contraindicated inability to have a rectal swab collected due to some other condition where rectal swabbing would be contraindicated
Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| inpatients<br>Individuals in inpatient wards | Diagnostic Test: Routine Infection control<br>* routine part of hospital IPC activities<br>* Other names: Surveillance activity;|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Expertise | Ultimately, the goal of the SHARE project is to assemble the expertise and infrastructure needed to build a resilient HAI/AMR surveillance system fully-incorporated into MOHW's surveillance activities. The project aims to build capacity, both material and knowledge, in existing laboratory and IPC teams to face the dynamic challenges posed by HAIs and AMR | 12 months | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Feasibility and Surveillance | SHARE's Colonization Feasibility Study, will seek to assess the feasibility and surveillance potential of routine MDRO screening in hospitals, determining whether MDRO colonization can provide an early warning system for emerging AMR threats | 12 months |