May 28, 2021 - When they call you to the hospital too late to save patients who have already embarked on the journey of recovery from an illness or surgery, you feel helpless; This feeling is what prompted the concerned Dr. Amal Bint Saif and her colleagues to lead the race against antimicrobial resistance in its early stages. Since 2015 and for more than 10 years now, Dr. Amal and her colleagues have advocated for the adoption of a national strategy to combat antimicrobial resistance, and have contributed to the development and implementation of this strategy.
“If you are a specialist in infectious diseases, and with your experience in this field, there is not much you can do for the patient,” says Dr. Amal, Director of the Department of Prevention and Infection Control at the Omani Ministry of Health.
And we need to do something earlier, to tackle AMR at a multisectoral level, in a more holistic way so that we tackle the problem in all its facets. At the national level, yes, but it won't work without reaching out internationally to all the teams working globally to combat antimicrobial resistance.”
Antimicrobial resistance occurs when bacteria, viruses, fungi, and parasites change over time and no longer respond to medication, which makes it more difficult to treat infections and increases the risk of disease spread, severe illness, and death.
The cause of antimicrobial resistance is the unnecessarily overuse of antimicrobial drugs, such as antibiotics; This reduces the effect of these drugs over time on the bacteria, viruses, fungi and parasites they target - after which these resistant microbes spread more easily, with inadequate water, sanitation and hygiene services, both in clinical and everyday settings.
In 2016, Dr. Amal embarked on two fronts: raising awareness of antimicrobial resistance and the importance of hand hygiene in combating AMR, and advocating for the rational use of antimicrobials.
Launching Hand Washing and Awareness Campaigns
Dr. Amal, along with her colleagues at the Directorate General of Disease Control and Control at the Ministry of Health, led one of the largest campaigns on antimicrobial resistance in the Sultanate of Oman. The campaign paid special attention to community involvement. Amal and her colleagues also set up a national antimicrobial resistance surveillance system (Oman Antibiotic Resistance Surveillance System) that feeds data into the global antimicrobial resistance surveillance system.
Dr. Amal demonstrates the role of infection prevention and control in combating the spread of antimicrobial resistance: The 2016 High-Level National Ministerial Meeting in Oman, the launch ceremony of the national campaign “Oman Fights Antimicrobial Resistance”. Source: Dr. Amal Al-Mu’anna
The campaign was launched in May 2016 with a high-level national conference at which the National Antimicrobial Resistance Strategic Plan, National Antimicrobial Guidelines and National Multidrug-Resistant Organism Surveillance Policy were signed and released. The team working with Dr. Amal supervised, for two full months, activities and exhibitions that targeted the local community, academic institutions, the agricultural and fishing sectors, and other sectors, private and governmental, in all governorates of Oman.
As part of the campaign, a hand hygiene demonstration project was implemented, which featured Omani political leaders publicly advocating hand hygiene as a key strategy for preventing transmission. In parallel, hospital executives and leaders, and the nursing department, spoke to all staff to educate them about hand hygiene, and put in place support plans.
Dr. Amal participates in the national project “Example by Hand Hygiene” as part of her ongoing work in advocating hand hygiene in the community and health care settings. Source: Dr. Amal Al-Mu’anna
The national hand hygiene project, which awarded the Department of Disease Prevention and Control headed by Dr. Amal the golden award on the occasion of World Patient Safety Day 2020, was launched in specialized hospitals, after which her team began implementing the project in secondary hospitals and primary care units in outpatient clinics. Efforts to involve the local community in infection prevention included activities in schools and for pilgrims traveling to Mecca. Involving the students also had a positive side effect in reducing diarrheal diseases and respiratory infections, especially in the flu season.
People don't think about antimicrobial resistance and their role in preventing it, unless they or their loved ones get sick. In contrast, infection control professionals move much earlier than that.
Eliminating antimicrobials in the bud: tackling antimicrobial overuse
Oman's antibiotic resistance surveillance system collects data from the national laboratory, pharmaceutical sector and electronic medical records, enabling the healthcare system to target use Overuse of antibiotics with immediate and long-term health costs. An ongoing surveillance system helps chart progress and the effectiveness of interventions.
With this system, for example, the team has seen significant increases in the use of powerful antibiotics in some hospitals. This increase is due to some doctors believing that they should give these powerful antibiotics to patients whose conditions have not yet been determined, before choosing a less powerful antibiotic, if the problem is eventually discovered.
However, the delay in diagnosing the condition, or the difficulty in diagnosing it, means that the patient continues to take stronger antibiotics for a longer period, with no one having enough courage to partially reduce antibiotics, for fear of possible legal repercussions, which creates an environment conducive to the growth of most resistant pathogens.
For this reason, Dr. Amal believes that tackling AMR requires much better diagnostic tools, as well as new preventive and treatment approaches, processes and practices that outperform the human factor in infection prevention and control.
The Essentials of Eradication of Antimicrobial Resistance: Better, Faster Diagnosis and Empowered Health Workers
“I know, from my experience as a prescribing clinician at times, that it is difficult to make a decision to give a patient Antibiotics or not, when you don't have a tool to know if a patient needs them or not.So we need to empower the end users - clinicians and nurses - and provide them with better diagnostic tools to know every patient's condition much earlier, very quickly ".
Dr. Amal Al Maana is a member of the Omani delegation, headed by His Excellency Dr. Ahmed bin Mohammed Al Saidi, Minister of Health, participating in the Second Ministerial Conference on Antimicrobial Resistance hosted by the Netherlands (19-20 June 2019 in Noordwijk). Source: Dr. Amal Al-Mu’anna
The pandemic reveals a new urgency for the issue of antimicrobial resistance, but it sets the record straight
“Antimicrobial resistance, if not addressed, could cost the world much more than what the pandemic did,” says Dr. Amal. So far, the COVID-19 pandemic has exacerbated the problem of antimicrobial resistance in two ways: firstly, the unprecedented influx of patients into hospitals adds to the challenges of adhering to hygiene practices, especially with full protective equipment. "The clinical trial sees COVID-19 patients being given broad-spectrum antibiotics, in case the fever is caused by a secondary bacterial infection. As a result, we are starting to see outbreaks of resistant pathogens in COVID-19 units around the world."
"There is global concern that COVID-19 has accelerated the spread of antimicrobial resistance and the emergence of new resistant pathogens," she added.
However, the response to the COVID-19 pandemic has also renewed its belief in the world's ability to combat AMR, if preventive measures are given the attention they deserve.
“We have all invested in responding to the pandemic in big ways and at breakneck speed like never before. And I think it's not hard for the world to come together and invest in ending antimicrobial resistance. And I'm not exaggerating when I say: prevention is the cornerstone.” safety of any health care system.
In her speech to the World Health Assembly upon receiving the award, Dr. Amal said: “I take this opportunity to call for giving priority to investment and innovation in infection prevention tools, so that we can reduce the impact of human factors to a minimum, and prevent health crises in the future.” ".
The World Health Organization has also called for placing antimicrobial resistance at the top of its priorities, as an essential step towards achieving the Sustainable Development Goals, and preventing the worst health disaster from a growing pandemic.
“Let's enable global infection control, require all healthcare workers to obtain training and certification in infection prevention and control, invest in innovation that is more accessible, usable and more convenient, and accelerate research and development in Vaccines, diagnostics and treatment.
She added: "Germs and microbes are smart, and are constantly changing in order to survive, so we have to be more alert, prepared, and armed with new advanced tools to confront them."