Investigator(s)
| WHO Technical Officer |
Nora Nindi Arista WHO CO Indonesia Nora Nindi Arista 
|
| Principal Investigator |
Zahra Zahra Research center of Public Health and Nutrition, Research Organization of Health, National Agency of Research and Innovation, Indonesia Zahra Zahra
|
Title(s) and abstract
| Scientific title | ASSESSMENT OF ANTIMICROBIAL RESISTANCE AT WASTEWATER IN PRIMARY AND TERTIARY HEALTHCARE FACILITIES IN INDONESIA |
| Public title | ASSESSMENT OF ANTIMICROBIAL RESISTANCE AT WASTEWATER IN PRIMARY AND TERTIARY HEALTHCARE FACILITIES IN INDONESIA |
| Background | Antimicrobial Resistance (AMR) is a global health problem, causing millions of deaths and impacting the economy, food security, and livestock production. In 2019, there were 1.27 million global deaths caused by antimicrobial resistance and 4.95 million global deaths related to bacterial resistance. The environment was critical to the development, transmission, and spread of AMR to humans, animals, and plants. The Wastewater Treatment Plant (WWTP) in health care facilities is one of the primary sources for developing resistant microbial contamination, which can pollute the environment. The condition of WASH (water, sanitation, and hygiene) facilities in health facilities and sanitation hygiene behavior and infection prevention and control (IPC) activities influence the quality of waste that enters the WWTP. Even though WWTP management is the key to the quality of waste disposal in the environment, data and information on the situation and condition of AMR in wastewater at health facilities are still limited. Therefore, this study will be carried out with a focus on aspects of waste management and the role of WASH and IPC practices in health facilities. |
| Objectives | This research aims to identify the situation of antimicrobial resistance in healthcare facilities in Indonesia. In particular, this research aims to 1) determine the proportion of antimicrobial resistance in wastewater at health facilities; 2) identify access to drinking water, sanitation, and hygiene services in health facilities; 3) identify the characteristics of the waste and wastewater management in health facilities; and 4) identify the implementation of the AMR control program in health facilities. |
| Study Methods | This research will be conducted in four provinces: South Sumatra Province, DI Yogyakarta Province, East Java Province, and South Sulawesi Province. Each province will be represented by one city and one district, including hospitals and public health centers. The number of samples for health facilities for each province was set at 8 hospitals and 8 health centers, with a total sample size was 32 hospitals and 32 health centers. The data to be collected are wastewater samples from the point before processing (influent) and the end processing (effluent) WWTP and clean water samples. An interview using a questionnaire regarding WASH conditions and management of liquid waste management in health facilities, as well as in-depth discussions about the implementation of the AMR control program, will be conducted in the health care facility. Laboratory tests on wastewater and clean water samples include antibiotic sensitivity testing (AST or antibiotic susceptibility test), ARGs (antibiotic resistance genes), and wastewater quality testing. Laboratory testing will be conducted to detect and identify targeted bacteria, namely Escherichia coli, Staphylococcus aureus, Klebsiella pneumonia, and Pseudomonas aeruginosa from the wastewater using the culture method, determine the character of the antimicrobial resistance profile and identify the bacterial community profiles of the target bacteria using EUCAST guidelines. The method will be 165rRNA gene sequencing (metagenomics) to analyze the wastewater quality from physical, chemical, and biological parameters. The antibiotics to be tested are ESBL (extended-spectrum beta-lactamase) and other types of antibiotics available on the methods and tools used. |
| Expected outcomes and use of results | The results of this research are expected to produce baseline data on AMR conditions in health facilities and provide recommendations for implementing AMR control programs in health facilities for WASH, wastewater management, and PPI aspects. They can be input in developing a surveillance system for controlling antimicrobial resistance in health facilities. This research is also expected to increase the level of awareness of health agencies at the central and regional levels regarding the importance of increasing investment in the WASH sector and wastewater management at health facilities to combat AMR. |
| Keywords | antimicrobial resistance, wastewater management, Wastewater Treatment Plant |
Research Details
| Student research | No |
| Start Date | 13-Feb-2023 |
| End Date | 31-Oct-2023 |
| Key Implementing Institution | National Research Agency and Innovation, Indonesia |
| Multi-country research | No |
| Nationwide research | No |
| Indonesia, Indonesia, Indonesia, Indonesia | |
| Research Domain(s) | Health Systems Research |
| Research field(s) | |
| Involves human subjects | Yes |
| Intervention Evaluation Research | |
| Data Collection | Primary data |
| Proposal reviewed by other Committee | Final decision available |