Resistant E.coli, S. aureus Community Unit Emergency (R.E.S.C.U.E.)

R.E.S.C.U.E. utilizes data and analytics, surveys, Kirby-Bauer disk diffusion susceptibility testing (i.e., standard methods used), AI-machine learning algorithms, AMR distribution to identify gaps, digitize data, regulatory compliance, enhance security of data, improve healthcare access, and create a bacterial AMR  virtual library for further analysis and research development.

Rozan Attilli, (PhD): expert in microbiology & clinical chemistry, conducting research at Laval University & Hannover Medical School. Member of PMTA, RNA society, Organization of women in developing countries (OWSD)

• AMR is acknowledged as the biggest obstacle facing humanity in the fight against infectious illnesses. deKraker et al state in the absence of immediate action, the annual death toll from antibiotic-resistant bacteria by 2050 is expected to surpass 10 million (13).

• With a population of at least 5 million, in Palestine, AMR deaths are significantly higher than other non-communicable diseases, respiratory infections, tuberculosis, digestive diseases, self-harm and interpersonal violence (12). Low & middle income countries (LMIC) face  higher burden for AMR than other nations (14, 15).

• In Palestine, there are an estimated 735 private medical & governmental labs, still  lacking reliable AMR data acquisition, processing, storage and dissemination, impacted by lack of knowledge, skills of medical technologists specifically and health professionals as a whole. Insufficient training, monitoring led to inadequate AMR control.

• Poor reporting compounded by unavailability of applications to support laboratory technologists.  

• Mapping: lack of available data on multi-sectoral facilities providing testing while mapping ‘problem areas’ , i.e. high rates of AMR infections. 

• Swabbing:  AMR barcoded swabs & data  are  missing.

• Library establishment: absence of a library for AMR genes, that helps in research and development

• AMR disease impacts all aspects of life, especially of the marginalized and underserved.     

• The solution serves the Palestinian population; to address their needs of improved antibiotics effectiveness by improving detection, reporting and management of patients. To eventually be implemented for other  AMR bacteria in Palestine. 

• The primary beneficiaries are health professionals, medical technicians, to address their needs for faster, more accurate reporting of AMR by empowering them with training and  a digital mobile application and support from the research team. 

• Raise awareness among those physicians, lab technicians, and public about AMR through identifying the gaps in knowledge and practice

• Mapping the facilities in the Palestinian cities, to assist health care professionals, researchers, and academics in their need to identify centers affected by AMR, monitor resistance, and serve the population.

• Establish a system and promote the usage of  barcoded swabs and establish a bacterial AMR virtual library to improve  AMR bacterial  identification and monitoring.

• Enhances patient quality of life, decreases antibiotic overuse, and lessens financial burdens on patients and the state in order to improve public health by using simple and accessible methods to detect AMR data.

• We will work with the governmental,  non governmental/private labs & hospitals to:

1. Lower and reduce antimicrobial resistance using data analytics.

2. Minimize laboratory technician errors in Kirby bauer susceptibility disk diffusion method.

3. Rapid analysis/ detection of resistant bacteria via easily available mobile application in Arabic. Digital images will be collected in one database and accessible to the digital mobile application, prediction tool, and block chain technology solution team members.

4. A map will enhance access to services which will help Palestinian or Jordanian citizens and health professionals to gain a better knowledge about AMR in different cities in Palestine. This map will be open access. 

5. Barcoded transport swabs used for bacteria collection can benefit the public by keeping better records about this resistant bacteria identified. Moreover, it helps to generate a library of bacterial resistant genes after further analysis. 

6. A resistant bacterial library will be built in which it will be the first library in Palestine based on WGS, which will also help for better and faster solutions.

Direct impact:

• To increase the knowledge of the health professionals, laboratory technicians about AMR in which according to Institute of Health Metrics and Evaluation (http://www.healthdata.org/ ),  E.coli is resistant to aminoglycosides, beta lactamase inhibitors, carbapenems, fluoroquinolones, third-generation cephalosporins, aminopenicillin, antipseudomonal penicillin, fourth-generation cephalosporins, macrolides, and methicillin, while S.aureus is resistant to fluoroquinolones, macrolides, and methicillin. To educate the public about the use of antibiotics and the dangers of antibiotic resistance.

• To prevent or minimize incidence of AMR among UTI in the Palestinian or Jordanian community.

• To strengthen health practitioners and lab technician skills with an easily feasible digital mobile application. 

• To increase the ability to recognize early warning signs about the appearance of an AMR species or strain using a map which shows the AMR facilities among the Palestinian cities.

• To put into practice procedures to stop the spread of AMR bacteria through establishing the virtual library, and encouraging AMR operational research

Indirect impact:

• To alleviate economic burden in Palestine and Jordan, treating MDR bacteria like E.coli and S. aureus can help reduce the economic burden and treat infections resistant to various antibiotics.

• To improve the wellbeing and health of the citizens

Year one- develop and conduct a KAP survey about  AMR in Palestine targeting doctors, nurses,  pharmacists, medical technologists; map all major medical technology centers in the West Bank; analyze data;  app development; design curriculum and  train  technologists in the technology; tender/purchase supplies.

Year two and three  

• Train health professionals 

• Digitize  the data, monitor usage  

• Implement the usage of barcoding swabs of AMR bacteria; archive   s resistant bacteria

• Promote the project through interactive workshops with policy makers, educators, health professionals, etc  as an essential   public health initiative. Continuous monitoring and reporting / data collection

• Assessing the KAP pre and post survey results 

• Measure amount of data submitted via the app and its quality

• Compare data before and after the intervention  of our project (Year 1,2,3). We will benchmark our work against other similar projects 

• Measure satisfaction among professionals about the intervention: evaluating the influence on physicians' practice efficacy and their degree of satisfaction with the suggested program for predicting appropriate antibiotics without the need for testing. 

• Analyze the number of hospitalizations due to UTI infections   before and after RESCUE.

• Establish a ‘library’ of specimens

• Train graduate students, medical technologists  

• Tracking the number of users per month ( mobile app); assess satisfaction: Success for a mobile app integrating blockchain can be measured by user engagement, accuracy of medical data, regulatory compliance, cost-effectiveness, user satisfaction, and long-term health improvements. gather user feedback, and observe long-term health outcomes. Improved disease management, organizations can assess if the app is achieving its goals.

Next year: Access and availability are issues. Scaling in Palestine faces cost and coverage challenges, with a lack of user-friendly digital solutions in laboratories. Alternative protocols are crucial for improvement. The app is free (open source), the team will do onsite education, visits, surveys and data collection. Online surveys will be conducted to facilitate quicker more efficient data collection. 

Next 3 years: Introducing new technologies and techniques is a challenge but through training, team support  and monitoring,  obstacles can be alleviated. Continuous communications are vital between our team and the data providers. Centralizing the data collection and establishing the ‘library’ at HU will ensure standardization and continuity of research, services, etc. We will provide equipment necessary for this research, i.e. mobile apparatus, barcoded swabs, reagents   for DNA extraction and sequencing etc. 

Since the Trinity Challenge fits with our goal of using data and data analytics to address AMR, we know we cannot solve a problem of this magnitude alone, and the Trinity Challenge can provide the resources to integrate and expand our solution. Applying to Trinity challenge will help to provide catalytic and financial support for (R.E.S.C.U.E.), so we can further reduce the  bacterial resistance and use a mobile application digital tool supplemented with a prediction tool. Additionally, Trinity challenge will help us to scale our solution in Palestine (4.923 million). 

• After disseminating our solution our objective is to establish connections with all academic institution members and encourage their public health, veterinary, and epidemiology departments to join the RESCUE  regional network. In principle our solution is multidisciplinary and it collaborates with different academics with different expertise and specialists. For the success of our solution, we would like to partner with the MOH  in which that could help us to better screen and collect  data regarding bacteria (i.e., E.coli, S. aureus) resistant among urinary tract infections. To strengthen our solution, we  are looking forward to partnering with the Global Burden of Disease Team at the Institute of Health Metrics and Evaluation to collaborate with health data and analyze disease case data in Palestine. http://www.healthdata.org/. For the success of the solution and keeping a closer eye on medical laboratories in Palestine we would like to partner with Palestinian Medical laboratory technician Association (PMTA. For google form online surveying it is reasonable to collaborate with google and its platforms. For mapping google maps. For social promotion and marketing with Facebook and for consulting and services regarding block chain technology, artificial intelligence, or other software and programming solutions with IBM.