Studying Hygiene Interventions to reduce Nosocomial Infections in southeast Asian Intensive Care Units (SHINIA-ICU )

It has  recently been estimated that 1.7 million AMR-associated deaths in low-income and middle-income countries (LMICs) are due to health-care associated infections. A substantial proportion of these deaths could be prevented through improving infection prevention and control programmes through low-cost multimodal interventions, but achieving these reductions requires overcoming chronic under-investment in such interventions in LMICs. Such underinvestment stems from the limited evidence base regarding the effectiveness and cost-effectiveness of such multimodal interventions in LMIC settings, lack of knowledge about the potential health gains achievable, and uncertainty about the best way to spend limited budgets to achieve these gains.
Our proposal aims to address these evidence gaps by generating robust and generalisable evidence about multimodal hygiene interventions in hospitals in LMICs in southeast Asia and to equip regional decision-makers with the knowledge and tools needed to enable appropriate investments in hospital infection prevention and control programmes.
The role of hospital environment-mediated pathogen transmission is well-recognized in healthcare-associated infections, which are often caused by micro-organisms which are resistant to multiple drugs. Contaminated surfaces harbouring these pathogens sustain the spread of drug-resistant bacterial clones and mobile genetic elements (which can spread drug-resistance between bacterial  species) in outbreak and non-outbreak settings. Despite an emphasis on environmental hygiene and the availability of international guidelines, there is insufficient evidence in the current literature to identify the most effective (and cost-effective) setting-specific cleaning strategies to reduce transmission of multidrug-resistant organisms, especially in LMICs. This contributes to the low awareness and prioritisation of environmental cleaning in these resource-limited settings and potentially to...