3 Conclusion and Recommendations

Healthcare facilities play a significant role in the development and spread of drug-resistant bacteria. Antimicrobial resistance (AMR) is an emerging global problem which will have significant impact on healthcare systems. It is estimated that many antimicrobials currently in use will be ineffective within the next decade, and it is widely acknowledged that the development pipeline for new antimicrobials will not be able to keep up with this need.

Healthcare associated infections (HAI) such as wound infections, urinary tract infections, pneumonias are frequently due to multi-drug resistant bacteria and are a major driver of antimicrobial use. Some of these infections will be difficult or even impossible to treat due to increasing resistance. Because of this, compliance with systems to prevent and monitor healthcare associated infections is now of paramount importance.

The global threat of AMR calls for the collaborative action for developing effective strategies in combating AMR. Increased collaboration between governments, non-governmental organizations, professional groups and international agencies appears to be very critical.

There are many recommendations made by professionals, researchers and academicians to prevent antimicrobial resistance in a healthcare setting. Most of these recommendations appears to be related to antibiotics use, surveillance, Incentives for the research and development of new drugs and vaccines. However, there are also recommendations which falls under the work scope of the engineers and facility management professionals. Examples of these recommendations are listed in Table 1 and Table 2. Table 1 details the actions that could be taken before the start of the construction phase and Table 2 details the actions that could be taken before or during the Operation phase.

Including AMR related requirements in the technical specification before the start of the construction of a hospital such as having hand wash basins in patient rooms, and in easily accessible locations at wards that make it easy for staff to wash their hands before moving between patients. Design measure which can enhance infection control such as adequate separation of patients (e.g. in single rooms), automatic doors to prevent contamination of handles, automatic or foot/elbow operated sinks, having adequate storage space for cleaning equipment could be included in the Technical Specification.

In general, the hospital management teams would be obliged to satisfy the official regulation requirements in relation to infection control. The FM company, responsible of support services, would generally be also required to satisfy the official procedures, regulations and requirements.

The FM Company would carry its work according to the scope of work outlined in the service agreement they have signed with the Hospital management. Therefore, consideration should be given to include AMR related KPI’s in the service agreement as well as the requirement to comply with the Clinical Infection Control policies. It appears to be difficult to amend any project agreement clause after the inception of a project for various reasons. Therefore, it is recommended that the performance parameters of an agreement should be reviewed before the signing and introduce appropriate KPI’s to the scope of service at an early stage. Ideally these KPI’s should be written in such way that it is clear, specific, frequencies defined, monitorable and linked to the service payments. We do however need to acknowledge that AMR is currently an evolving area were guidance and practices are liable to change and adapt over time.

In some projects, ESAP and ESMS documentation would be prepared and these documentations would be approved by the Lenders, Administration and therefore it would be part of the Facility Management Companies scope of work to monitor the activities against the requirements. Therefore, having AMR specific incentives in the ESAP and ESMS documents could make a significant difference.