NMC Warns Hospitals, Medical Colleges against Antimicrobial Resistance, Issues Advisory

For this, NMC, the apex medical education regulatory body in India has advised the Heads of all the medical colleges to have Hospital Infection Control Committee (HICC) and Antimicrobial Stewardship (AMS) Committees.

"All hospitals and medical colleges should increase the activity of both the Committees and prepare guidelines for antibiotic use in their hospitals depending on prevalent organisms and antimicrobial sensitivity," stated the advisory issued by Dr Suresh Chandra Sharma, the Chairman of NMC.

Along with such an advisory on the part of the NMC, Dr Sharma has also forwarded a letter from the Union Health Secretary, Rajesh Bhushan, advising all the medical regarding Antimicrobial resistance (AMR), which has been recognized as a serious and growing public health threat globally that threatens the effective prevention and treatment of an ever-increasing range of infections.

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Opining that the problem of AMR assumes critical importance in the context of antibiotic resistance in bacteria, Mr. Bhushan in the letter directed to NMC Chairman has also mentioned, "One of the factors contributing to rapid emergence of AMR even to the newer antibiotics is the misuse and overuse of antimicrobials. In addition, inadequate access to water, sanitation and hygiene, poor infection prevention measures, lack of access to affordable and quality assured antimicrobials, vaccines and diagnostics, all contribute to the spread of drug resistant pathogens."

He also referred to the National action plan on AMR (NAP-AMR) in April 2017 launched by MoHFW and pointed out that "It is important to replace syndromic management of infectious diseases with laboratory evidence-based treatment to prevent overuse or misuse of antimicrobials. Implementing good infection prevention and control (IPC) practices to prevent spread of infections in health care facilities among patients and from patient to health care workers would also reduce antimicrobial use."

"These practices in day to day management of patients would further become a source of practical education for medical students, that is the future doctors, for rational use of antimicrobials. During the present pandemic, many health care workers got infected with COVID-19 due to inadequate IPC practices and many hospitalised patients succumbed to health care associated infections caused by AMR pathogens," further mentioned the letter.

Mentioning that medical colleges are one of the key stakeholders in judicious use of antimicrobials, the Union Health Secretary referred to some actions which are required to be implemented in the medical colleges and associated hospitals in the country for the purpose of AMR containment.

1. Implement AMR containment activities as committed in the National action plan on AMR that is to strengthen and consolidate AMR and related topics as core components of professional education and training,

a. All clinical subjects in nursing and medical education must include practical education and evaluation on AMR, judicious use of antimicrobials, antimicrobial stewardship and infection prevention and control.

b. Review and develop curriculum and resources for in-service training of different health professionals and allied services.

c. Mandate periodic training of health care professionals to optimise antibiotic use and strengthen Infection prevention & control through pre-service and in-service trainings.

2. All medical colleges must have the mandate, minimum infrastructure, manpower and other resources to:

a. Ensure well-functioning hospital Infection control committees (HICC) which meet regularly to develop and monitor the implementation of concrete action plan for Infection Prevention and Control (IPC) practices and surveillance of Healthcare associated infections (HAIs).

b. Ensure well-functioning Antimicrobial Stewardship (AMS) Committees which meet regularly to develop and monitor implementation of AMS practices towards judicious use of antimicrobials in the hospital through formally identified AMS teams.

c. For the above two activities, it is essential that the hospitals have well-functioning, well utilised 24x7 microbiology laboratories actively involved in management of patients with infectious diseases. AMR Surveillance data generated by such well-functioning and well utilised labs is to be used at the facility level to develop antibiotic policy and further can be collated at the state and the National level to assess the magnitude of the problem.