INFECTION PREVENTION AND CONTROL


Combating AMR requires multi-pronged approach


Dr Simon Pybus, a specialist registrar in medical microbiology and infectious diseases in Glasgow, George McCracken, head of Estates Risk and Environment at Belfast Health and Social Care Trust, and Dr Michael Weinbren, Consultant Medical Microbiologist, and Specialist Advisor Microbiology, New Hospital Programme, discuss the key role of the construction supply chain and manufacturers in the fight against antimicrobial resistance.


Architects, design teams, construction companies, and manufacturers; the skills of you all are required in the fight against antimicrobial resistance (AMR). Surely – such personnel might think – this is a mistake? Is this indeed not the province of pharmaceutical companies, doctors, nurses, pharmacists, and veterinarians? While the latter professionals undoubtedly have an important role, the skills of all the stakeholders involved in the construction and manufacturing industry are required. In this article we seek to explain why and how such professionals’ expertise is required, and the opportunities available, not just in the UK market, but globally, as this is a worldwide issue. For those who embrace the challenge there is the potential to save and improve many more lives than any healthcare professional can achieve in their entire career, and – simultaneously – the size of the financial market for solutions is immense. The healthcare built environment has been placed at the forefront of the 2024 UK 5-year national action plan (NAP) to tackle AMR.1


What is AMR? There are few people alive who remember the pre- antibiotic era, when individuals would go into hospital with trivial complaints and frequently not survive due to a complicating infection. The advent of effective antibiotics revolutionised the management of infectious diseases; the wards housing patients with untreatable infections disappeared, as these diseases could now be simply treated at an early stage with a pill, out in the community. However, the honeymoon period is over. We are now seeing bacteria resistant to last-line antibiotics, and patients with infections that are untreatable. Soon we will find ourselves in the post-antibiotic era.


0 10 10 2 8 6 4 2 0


0 2 4 6 8


4 2019 6 By 2050 8 10 Cancer Heart disease Stroke AMR Diabetes Tuberculosis HIV Malaria


Figure 2: Global deaths from a range of conditions, including deaths associated with AMR, and projections for deaths related to AMR by 2050. Data sources.2,3


October 2024 Health Estate Journal 39


Antibiotics are used not just to treat patients with infections, but also to protect patients when they are made susceptible during many of the interventions required for modern medicine. Without effective antimicrobials, many of the advances in medicine we take for granted will either carry a high mortality, or no longer be an option, since without these agents they no longer offer patients survival advantages. The European Centre for Disease Control is already warning some Western European countries that key medical interventions such as organ transplantation, intensive care medicine, or major surgery, are at risk.


Predictions of an end to the ‘antibiotic era’ The predictions are that the antibiotic era will end by 2050 (if not earlier), having a global economic impact of $100 trillion, and with 10 million extra deaths year-on-year globally. AMR is set to become one of the leading causes of death. The first AMR NAP was released five years ago, with a predominant focus on antimicrobial stewardship and the need to develop new classes of antibiotic. To date no new classes of antibiotic have been developed, and, despite improvements in antimicrobial stewardship, AMR is on the rise. The healthcare built environment has been placed at the forefront of the 2024 UK 5 year NAP to tackle AMR.1 On page 20 it states: ‘Designed-in IPC for healthcare facilities means that designers, architects, engineers, facilities managers, and planners, work with IPC teams, other healthcare staff,


Figure 1: The authors cite the vital role many different parties – including the construction supply chain and manufacturers – can play in the battle against antimicrobial resistance.


Global deaths (millions/year)


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