My work, collaborating with researchers in the AVAPAR (Quality Improvement and Assay Validation of Automated Platforms testing for Antimicrobial Resistance in Blood Culture Isolates), has been a constant source of moving parts, things to do and slight developments/adaptations, which I guess fits in well with the Quality Improvement approach to the study.

Improving quality and efficiency

Largely, the same aim remains, towards improving the quality and efficiency of blood cultures used in the diagnosis of infection, specifically neonatal sepsis in Sally Mugabe Hospital in Harare. There has already been an initial phase of this work undertaken in the last few years, validating and exploring the use of two molecular diagnostic platforms in this low-middle income setting, recognising the common organisms implicated in neonatal infection. So, this next phase builds on this, developing training for clinical and laboratory staff at the point blood cultures are taken (to help in the diagnosis of infection) and processed to improve efficiency and ultimately aim to deliver results back to clinicians in a timely enough manner to impact the antibiotics used in the care of neonates.

What have I learnt so far?

First, as much as writing ethics applications may come with a groan, amending the protocol to include aspects of the work that I will now be leading and involved in gave me time to consider the context, as well as visit and meet many of the teams involved in the blood culture process – from new doctors and nurses on the Neonatal Unit, to the laboratory staff, through to the neonatal consultants and clinical directors, in order to ensure that this is a process embedded in the practice which happens day to day.

Secondly, doing so also gave me the opportunity to review the work done previously in this area and discover areas which I could contribute to. I’ve been working on developing training materials and delivering training for aspects of the blood culture process – Gram staining, sensitivity testing, and also reviewing the current process to ascertain where improvements in turnaround time can be made.

Further training

This week, the new molecular platform we are trialling for blood culture isolates, the COBAS ePlex platform, arrives in Harare, and with it comes further training for lab staff and the study team alike. Then, in the next few weeks, the enhanced blood culture process we have developed will be introduced and practically supported by study team in the coming months, aiming to reduce the turnaround time for blood culture isolates from a likely 72-96h after blood cultures have indicated ‘positivity’ to 24-48h before provisional organism identification and antibiotic susceptibilities may be available.

Ultimately, we hope that this will mean that clinicians can be informed of results which will allow appropriate alteration antibiotics in time to make a difference to neonates.

More to explore

Finally, I’ve had the opportunity to also consider more conceptual aspects of antibiotic practices in this setting and have been developing a workshop along with some of the qualitative researchers here to explore the conceptualisation of antimicrobial stewardship in Zimbabwe. What does it mean for this setting, given that stewardship as a concept has come from settings with far different approaches to management of infection in terms of availability of diagnostics, systems in place and where you can obtain antibiotics from. There is lots to explore and I’m lucky to have had the chance to meet and be coordinating with two Fleming Fund Fellows to look into this further in the next few months.