Infection Control Nurse Hend Mohamed Afefy prepares to enter one of the six intensive care units at Cairo’s Ain Shams University Hospital with studied precision. Shoes and clothes are securely tucked inside white sterilized scrubs. Surgical mask is tied just so. Perhaps the only unusual thing is what she is carrying. Instead of a clipboard and pen, there’s a smartphone. And it could save her patients’ lives.
The smartphone is one weapon in a worldwide battle against drug-resistant infections inside health care facilities.
As many as 700,000 people die of these infections each year around the world as medicines that once killed off bacteria have become less effective. The World Health Organization reports that low- and middle-income countries account for far higher numbers of infections than wealthy countries, with infections acquired in intensive care units (ICUs) being two to three times higher.
Today, antibiotic resistance has been declared a worldwide threat by the United Nations. In Egypt and every other country on the planet, health officials are alarmed by this urgent prediction: 10 million people per year will die from these infections by 2050 if nothing is done.
USAID is partnering with Egypt’s Ministry of Health and Population to study the problem in 82 hospitals — nearly 3,000 beds — and determine the best ways to monitor and control infections before they can get out of hand.
Since the project began in 2014, USAID in Egypt has helped hospitals establish a national surveillance system to record infections that happen in their facilities as well as cases of antimicrobial resistance — a category that includes resistance of bacteria, parasites, viruses and fungi to commonly used antibiotics.
Using a smartphone app, specially trained infection control nurses like Afefy monitor patients for signs of antibiotic resistance and upload data through a web-based application to a central data bank for analysis. This allows nurses, doctors, and other staffers at participating hospitals to quickly identify a suspected case and take action. As one of the largest hospitals in the country, Ain Shams also operates its own microbiology lab that allows technicians to run routine and more sophisticated DNA testing.
“We should all be concerned to reflect global concern of the increased burden of HAIs and AMR where these problems are becoming a global health security issue,” says Dr. Maha Talaat, principal investigator for the project and the U.S. Centers for Disease Control and Prevention (CDC) deputy director of Public Health at the Global Disease Detection Regional Center in Cairo. HAI is shorthand for hospital-acquired infections and AMR stands for antimicrobial resistance.
Egypt is a goldmine for researchers, explains Dr. Akmal M.K. Elerian, the senior project management specialist at USAID/Egypt. About 40 percent of people in Egypt are resistant to the most commonly used antibiotic medicines, compared with about 10 percent of people in the United States. Antibiotics are also sold over the counter here, making them easy to access without a physician’s direction or advice.
How to Catch a Bug
Antibiotic resistance happens when the bad bacteria overtake a person’s body and makes them sick. It often happens after routine medical procedures like having a baby or undergoing gallbladder surgery. Once properly diagnosed, doctors prescribe an antibiotic to kill the bad bacteria and restore the person to health. The drugs were considered a miracle in the last century when they were discovered, and are still life savers.
But the invention of new antibiotics has not kept pace with the growing number of resistant bacteria. The old antibiotics no longer work as effectively, forcing health care providers to try multiple medicines before they find an antibiotic that will work — if they find one. One report from 2015 warns that “simple injuries could once again be life threatening” if antibiotic resistance continues.
“Patients who acquire infections in health care systems with resistant organisms have minimal chances of recovery due to lack of treatment options with effective antibiotics,” Dr. Talaat explains.
To fight back, health care workers here are marrying their medical skills with technology. A group of nurses preparing to conduct their rounds recently in the ICU at Ain Shams explain the advantages: the smartphones are superior to the old-fashioned pen and clipboard method for capturing basic patient data and monitoring conditions.
“The real game changer is to have real-time data,” says Dr. Gehan Fahmy, Infection Control Team Leader at Ain Shams University Hospital. “They make us more accurate with the statistics.”
Results come back in an hour or two instead of a day or more. Delays in diagnosing infections in one patient can lead to an outbreak, says Warda Abdelmouty Azab, another infection control nurse at the hospital.
“Before that we had many debates,” added Afefy, her colleague. “Is this hospital-acquired? Is it not? Now I have (the information) to take my action.”
Their efforts are having an impact. Since the project’s start, infection rates have decreased 48 percent at hospitals that are participating in the program. The number of labs that now report accurate diagnoses of bacterial infections increased from just 17 percent to 63 percent.
More than 2,300 doctors, nurses and technicians have been trained by this effort, which is supported by USAID and the CDC, as well as the U.S. Naval Medical Research Unit №3 (NAMRU-3).
“The use of technology to support HAI surveillance in this project was a breakthrough,” Dr. Talaat says, “and we are sure that without using information technology for this project, surveillance of HAIs and AMR would not have been real and successful as they are currently.”
“Americans and Egyptians have a legacy of working together to promote the health and well-being of the Egyptian people,” added USAID/Egypt Mission Director Sherry F. Carlin. “Working together to monitor the level of antibiotic-resistant infections in hospitals and build the reporting capacity of health care providers will help to improve health care for Egyptians.”
Big challenges remain, including getting people to pay attention to this issue beyond when an outbreak of MRSA makes news.
“The public, including patients and others, need more awareness of the problem … as they have an important role,” Dr. Talaat says. “They need to be empowered when they enter hospitals to ensure that health care staff apply safe health care measures.”
Why are cases of antibiotic resistance on the rise? Experts say the answer is simple: overuse. People take or are prescribed these medicines unnecessarily up to 50 percent of the time. In addition, many farm-raised animals that people eat receive antibiotics to ensure their health before slaughter. And hard-to-treat strains of bacterial and other types of infections are showing up in people with increased frequency. — Source: U.S. Centers for Disease Control and Prevention
About the Author: Angela Rucker is a Writer and Editor at USAID.
Editor's Note: This entry originally appeared in USAID's 2030: Ending Extreme Poverty in this Generation publication on Medium.com.