Title: Hospital-based interventions to contain antibiotic resistance in low-resource settings (Acronym AIM)
Keywords: Microbial resistance
Health facilities
Disease prevention, control and elimination
Country: Belgium
Institution: Belgium - Antwerp Institute of Tropical Medicine
Course coordinator: Prof. dr. Jan Jacobs
Date start: 2023-04-24
Date end: 2023-05-12
About duration and dates: 3 weeks
Classification: advanced optional
Mode of delivery: Face to face
Course location:
Institute of Tropical Medicine (ITM), Nationalestraat 155, 2000 Antwerp, Belgium
ECTS credit points: 5 ECTS credits
SIT: 105 contact hours and 40 self-study hours
Language: English
Overall learning objective:
At the end of the course participants should be able to develop and articulate action plans for containment of antibiotic resistance (ABR) in hospitals in low-resource settings (LRS), in one of the three following themes: Antibiotic Stewardship, Infection Control or Microbiological Surveillance (AIM) as acting in a “Hospital Committee”.

Specific learning objectives:

Participants to the Antibiotic Stewardship theme should be able to:
- Identify and demonstrate principles of rational use of antibiotics at patient and hospital level
- collect and interpret quantitative and qualitative data on antibiotic use and antibiotic susceptibility results
- translate antibiotic resistance data into antibiotic treatment recommendations and a local antibiotic policy
- Design and evaluate an antibiotic policy at hospital level

Participants to the Infection Control theme should be able to:

- Develop a strategy to improve hand hygiene, cleaning / disinfection of the environment and equipment.
- Select, demonstrate and teach principles of transmission-based precautions.
- Propose possible solutions regarding organizational aspects and core components of IPC.
- Outline care bundles for invasive devices and apply basics of good nursing practices.
- Analyse the evidence-based measures with regards to the prevention of surgical site infections.
- Organize surveillance of healthcare associated infections and outbreak investigation.

Participants to the Microbiological Surveillance theme should be able to:
- Perform quality assured clinical bacteriology (from indications over laboratory work-up to reporting)
- Collect, interpret, and report antibiotic resistance data for individual patients
- Sample, work-up and report selected specimens as support for infection control
- Aggregate laboratory-based data into a meaningful surveillance report ready to use for local antibiotic guideline preparation
- Communicate and interact correctly and efficiently with clinicians and infection prevention & control staff to maximise valorisation (patient-based and cumulative) of microbiology testing and results
- Represent the diagnostic microbiology laboratory in the antibiotic stewardship and infection prevention & control committees in the hospital i.e. with input from environmental microbiology, hospital infection outbreak research and alert reporting.
- Identify and explain drivers to bridge current barriers in rolling-out of clinical microbiology, such as local production of in-vitro diagnostics, market mechanisms, professional associations and business models
Assessment Procedures:
- Pre-test (formative): consists of a set of multiple-choice questions made available through Moodle, before the start of the course (first day of course). The pre-test will evaluate the knowledge of the participants about the basic concepts of ABR and serve as an evaluation of the course content itself.

- To obtain the credit certificate, participants will be assessed as follows (summative):

Multiple choice & short answer questions Assessment of acquired knowledge (written) 50%
Personal project / assignment “My Hospital”: each participant has to develop, present and defend in front of an expert committee an ABR-containment plan for his/her health care facility (written and oral) 30%
Group work presentation Assessment of a hospital outbreak investigation by database analysis, skills lab site-visit and reporting/recommendations (written and oral) 10%
Self-study assignments Assignments available on the learning platform, to develop/enhance student acquaintance with international guidelines (written) 10%
An overall passing score of 50% is required for each component mentioned above.

- Re-sit:
For the group work (10%) and daily online exercises (10%) no re-sit is possible. For the multiple choice test at the end of the course (50%) and the personal project (30%) a re-sit is possible with the same requirements, within 4 weeks after the end of the course (if necessary through Skype/Zoom).
The AIM course focuses on the three main themes of ABR-containment in the low-resource setting hospital as well as on their interactions:

1. Antibiotic Stewardship (ABS)
2. Infection Prevention and Control (IPC)
3. Microbiological Surveillance (MS)

The AIM course consists of a:

A common track addressing topics common to the three themes and providing essential building blocks to address ABR in the local setting:
● Key aspects of pathogens and antibiotics
● Key aspects in Infection Prevention and Control (IPC), including hand hygiene, cleaning and disinfection of environment and equipment
● Interventions to contain ABR including the functioning of a Hospital Committee
● Antiseptics/disinfectants
● Transmission based precautions
● Surveillance on healthcare associated infections and outbreak investigation
● Practical sessions on blood sampling, hand hygiene and preparation of hand rub
● Blood & other cultures: indications, sampling, and transport
● How to turn laboratory data into report
● How to communicate individual laboratory results
● Introduction to Global Antimicrobial Resistance and Use Surveillance System (GLASS) and the National Action Plan to contain ABR
● How to handle commercial promotion of antibiotics
● How to organize, conduct and report a hospital-acquired outbreak
● Diagnostic stewardship
● Efficient communication in the professional situation

Specific modules on themes of relevance for each of the three disciplines:

Antibiotic Stewardship track:
● (Ir)rational use of antibiotics
● Gathering/understanding antibiotic use data
● From antibiotic susceptibility testing to surveillance report
● Translation antibiotic susceptibility testing into guideline
● Prescriber and patient perspective
● Clinical case studies
● Surgical site infections

Infection Prevention & Control track:
● Framework Hospital IPC
● Cleaning / disinfection of the environment and equipment
● Transmission based precautions
● Hand hygiene
● Microbiological sampling and processing of the hospital environment
● Invasive devices and care bundles
● Surgical site infections
● Monitoring IPC

Microbiological Surveillance track:
● The role of the microbiology laboratory as a backbone and support for ABS and IPC
● Diagnostic stewardship – laboratory-confined topics
● Cost-efficient working-up cultures in the laboratory
● Reading and interpreting antimicrobial susceptibility testing results
● Use of European Committee for Antimicrobial Susceptibility Testing (EUCAST)/Clinical and Laboratory Standards Institute (CLSI)guidelines
● Aggregate laboratory data to surveillance report
● Microbiological sampling and processing of the hospital environment
● Closing the gaps: local availability of diagnostics, training and professional profile, business model
The AIM course consists of plenary lectures, hands-on sessions (including bench- and practical exercises and a carrousel ), case discussions, data analysis, group work.

● Participants will spend about 70% of the direct contact hours of the course in the truncus communis sessions, and 30% of the direct contact hours in one of the track specific sessions. At application, candidates are asked to list their preference(s) for a track. If a track is “fully booked”, the next-in-line eligible candidates will be asked to switch track.

● Multidisciplinary group works (“Hospital outbreak investigation” and “Clinical cases”): using a Problem Based Learning methodology, participants from the Antibiotic Stewardship, Microbiological Surveillance and Infection Control groups are organised in a Hospital Infection Control or Antibiotic Stewardship Committee. Group work includes “Clinical case management”, and “Outbreak investigation”. Role-plays are included within the multidisciplinary team of participants for both a Hospital Committee and Clinical cases group works. A tutor is assigned to each group.

● A personal assignment (“My Hospital”): participants will elaborate an action plan to contain ABR in their facility through self-study, a portfolio and literature study. A personal coach is assigned to each participant (part of the self-study SIT).

● An online course platform for preparatory work (included in the 145 SIT) offers pre-assessments, pre-reads, course exercises and relevant course material (on Moodle).
The course aims at health care workers (medical doctors, nursing staff, clinical officers, pharmacists, biomedical scientists and laboratory staff) with professional experience in hospital facilities in Low Resource Settings and involved in Antibiotic Stewardship, Infection Prevention & Control and/or Microbiological Surveillance activities (AIM).

Participants should be holders of a (para)medical university degree of minimum 240 ECTS credits or equivalent and have two years of relevant professional experience. Exceptions to the degree requirement are possible based on level and relevance of professional experience.

Proficiency in the course language is required. Candidates who are non-native speakers of the course language or whose language of previous instruction is not the same as the course language, must be able to prove their language proficiency with a TOEFL paper-based 580, computer-based 230, Internet-based 88 or IELTS 6.5. or equivalent.
Minimum of 12 and a maximum of 21 participants
A selection committee will select course participants, based on following criteria:
● Health care workers (medical working in hospital facilities in LRS and involved in Antibiotic Stewardship, Infection Prevention & Control and/or Microbiological Surveillance activities
● (Para)medical university degree, min 240 ECTS credits and min. 2 years of relevant professional experience in AMR
● Personal motivation
● Commitment from the “home” institution or organization to engage in ABR
● Personal project: participants are asked to apply with a draft outline presenting the key problems related to ABR in their care facility
● Application of participants collaborating in the same health care facility is encouraged
● Enrolment in tropEd MIH/GH programme
● Gender balance of the participants will be considered
Fees: 730€ (EEA) / 1900€ (non-EEA)
A limited number of full or partial scholarships are available for applicants from LMIC’s through the Belgian Directorate General for Development (DGD) (see list on ITM website, www.itg.be).
Major changes since initial accreditation: Changes student assessment:
In agreement with all teachers, the score on the personal project changed from 40 to 30 %, and the Groupwork from 20 to 10%. More weight (50% instead of 40%) was given to the summative assessment (MCQ), and one assessment was added (10%, online exercises).

Changes course content:
The course focus did not change since its first edition; lectures were updated according to new material or resources available (example EUCAST/CLSI guidelines). Another groupwork ‘clinical cases’ was introduced in the last edition, where students were presented cases to resolve in a multidisciplinary team, including laboratory staff.

Changes course modality:
Due to international COVID-19 restrictions on travel, the course was cancelled in 2020 and switched to an online modality in 2021. The latter provided opportunities to include additional online material in the lectures, which will prove useful in the future, also for face-to-face courses.
Student evaluation: This short course receives excellent reviews from the students each year: most of them would recommend the course to their colleagues. The course interactions between the tracks stimulating peer learning, the practical approach and the connection between theory and real-life practice is highly appreciated.
Each course edition, a course evaluation report, including the student feedback, is prepared, and discussed within the teaching team.
Lessons learned: 1. Change to online course modality provided additional means to prepare students for lectures (for example, watch a video before the lecture, or submit a short survey or quiz).
2. Each course track has one responsible teacher, for whom the tasks are sometimes difficult to combine with other professional duties. In 2021, an additional teacher joined the ABS track, supporting participant selection, lectures, and assessment. In the next years, similar support for the IPC and the MS track will be considered.
tropEd accreditation:
First submission: Amsterdam GA, October 2016
Re-accreditation: submitted February 2022 accepted EC Telco 12 July 2022
This course can switch to an online modality in this way that participants can join from their home country: key lectures are organized as synchronous online sessions whereas practical hands-on sessions are replaced by self-standing online exercises and groupwork. Note that however, a face-to-face attendance is preferable for this course, as inter-disciplinary interactions between clinicians, nurses, and laboratory staff as well as hands-on training are key course outcomes.
Email Address: gvheusden@itg.be
Date Of Record Creation: 2016-11-03 17:23:30 (W3C-DTF)
Date Of Record Release: 2016-11-03 21:40:36 (W3C-DTF)
Date Record Checked: 2017-07-20 (W3C-DTF)
Date Last Modified: 2022-07-19 21:18:07 (W3C-DTF)