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Harmonisation of Antibiotic Resistance measurement, Methods of typing Organisms and ways of using these and other tools to increase the effectiveness of Nosocomial Infection control


Harmony (Harmonisation of Antibiotic Resistance measurement, methods of typing organisms and ways of using these and other tools to increase the effectiveness of Nosocomial Infection control) will comprise a resource, facilitating centers, an international network of opinion leaders and centers of excellence, interact with the various networks of hospitals and target four areas as follows: &L- Antibiotic susceptibility testing To introduce or augment existing continuous quality improvement systems of antibiotic susceptibility testing and thus provide a credible basis for describing and monitoring the extent of the problem of antibiotic resistance in participating countries. &L- Microbial Typing <o establish strains and other mechanisms to harmonise and standardise "DNA fingerprinting" to become genuine typing systems, disseminate the improved methodology to all participating countries and design joint experiments to explore the applicability, variability and other matters raised by the group. To assess what new and old antibiotics Infection control teams (ICTs) should test as an extended antibiotic resistotyping tool for the targeted antibiotic resistant organisms (AROs). These will be reported to the center and inform the database (see IV) as well as provide data on the available therapeutic options against important bacterial strains causing hospital infection. We will also examine the cost, effectiveness and feasibility of also using chemical resistotyping as an initial ICT typing system for methicillin-resistant Staphylococcus aureus (MRSA). &L- Infection control, antibiotic therapy policy and audit Facilitate the production of "bottom-up" policies and audit tools: &Li) to increase the power and focus of typing data by agreeing the criteria for submission of isolates for typing, the demographic and epidemiological information accompanying them and audit compliance with these standards and assess how the typing data meets the aims of the ICTs in device related infection and outbreak investigations. &Lii) for device usage, insertion and maintenance &Liii) for methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant enterococci (VRE), antibiotic resistant gram negative rod and Clostridium difficile outbreaks &Liv) of antibiotic therapy and explore the feasibility of using a resistance/use index to examine the effects of antibiotic use and ARO occurrence. &L- Establish a "State of the Art" European interactive database on thc INTERNET of existing and prospectively collected validated antibiotic resistant strains causing HAI together with antibiotic susceptibilities, conventional and computerised DNA typing parameters, agreed parameters of virulence e.g. toxins, lectin spectra, epidemicity, "infection control pedigree" e.g. influence of staff/patient ratios, intensivity of care, case mix so that ICTs can compare their own organisms with these data and prioritise or optimise their infection control strategies. Templates for policies, guidelines and audit tools will also be accessible in this way.&L &L Keywords:&L Typing, Antibiotics, Hospital Infection, Policies, Audit, Quality Assurance, MRSA, VRE, C. difficile

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