Megha Sharma in front of Aula Medica, Karolinska Institutet

Megha Sharma

Affiliated to research

About me

I am an Associate Professor at the Department of Pharmacology, R. D. Gardi Medical College, Ujjain, India and an Affiliated Researcher at Global Health- Health Systems and Policy (HSP): Medicines, focusing Antibiotics, Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden. Presently, I am the Coordinator of two multinational collaborative research projects titled- 1) “Antibiotic stewardship program including infection prevention and control and wastewater treatment – Implementation research in hospital and community in India (APRIAM)” between Sweden and India since 2017; and 2) Building equity in digital global health: the case of antimicrobial resistance in low- and lower-middle-income countries (EquityAMR) for R. D. Gardi Medical College, Ujjain (Norway, India and Sweden).

I have worked as Post Doctoral fellow at the Division of International Health (IHCAR), Karolinska Institutet in the HSP research group. In addition, I have coordinated three multinational, multidisciplinary collaborative research projects acronym APRIAM I, II and III” during 2007-2010, 2010 -2013 and 2013-2017 respectively, “Antibiotic pollutants in waters and resistance in rural India-Interventions to improve antibiotic resistance Management”.

My main area of research is improving the situation of judicious antibiotics prescribing at healthcare facilities and rationalizing the use of antibiotics at the community level. I have collected baseline data of antibiotic prescribing for over 200,000 in-patients from two tertiary care, private-sector hospitals from the private sector in Central India. I have established a strong system of manual data collection in the study hospitals, with the help of nursing staff.

Improving hygiene in healthcare facilities and the community is another research area of my interest. I am the team leader for an interventional study that focuses to improve overall hygiene focusing on hand hygiene and the introduction of alcohol-based hand rub in healthcare facilities in Central India. The long term aim of this study is to minimize healthcare-associated infections (HAI) and minimize the spread of infections that will lead to minimizing the overall use of antibiotics.

I have been regularly involved in teaching to 4-year undergraduate medical students in India and Sweden, and actively participate in academic activities at Karolinska Institutet, Sweden. I have supervised National and International students for the degree of Master of Global Health from the Department of Global Public Health, Karolinska Institutet and Master of Medicine at Karolinska Institutet. I have published several research articles in peer-reviewed, indexed, international journals. My work has been acknowledged and awarded in many International and National conferences.

Research description

Increasing bacterial resistance and an increase in incidences of healthcare-associated infections (HAIs) are topics of global concern. Lack of knowledge, financial constraints and humid and moist climate of low- middle-income countries put them at higher risk of antibacterial (antibiotic) use, the spread of infectious diseases including healthcare-associated infections (HAIs) and thereby the development of bacterial resistance. A significant number of mortalities and morbidity, cost of treatment and duration of hospital stay could be minimized by reducing the use of antibiotics, preventing the spread of HAIs and bacterial resistance. A long term study was designed and is being conducted at two tertiary care study hospitals in Central India since 2008. The main aim of the study was to provide a baseline of antibiotic prescribing patterns and trends in the settings. Based on the results of the pre-intervention phase (Baseline data) context-relevant diagnosis-specific prescribing guidelines were developed and implemented at high-risk departments. The impact of the interventions will be evaluated in terms of a) reduction in antibiotic prescribing and rationality in prescribing antibiotics in relation to the diagnosis. Another aspect of the spread of infections is to reduce the spread of hospital-associated infections (HAIs) and b) to decrease antimicrobial resistance These hospitals are private, tertiary care hospitals; one teaching (850 beds) and one non-teaching (350 beds). Both are located in the Ujjain district in Madhya Pradesh, India. The study design includes three phases: pre-intervention (baseline), intervention and post-intervention. As part of the pre-intervention phase, a continuous data collection of antibiotic prescribing in both hospitals has been conducted since April 2008. Monitoring of HAI incidence started in high-risk wards from August 2010. Up to date over 90,000 patients have been enrolled in prescribing study and 843 suspected HAIs samples. High antibiotic prescribing was observed in both hospitals with high rates of HAIs. A recently published qualitative study from our group has shown that several infrastructural constraints hinder hand hygiene (HH) practices in the setting. These results suggest the need for relevant guidelines for rational antibiotic prescribing and to improve the HH practice in the settings. The intervention package consists of feedback meetings, development and implementation of antibiotic prescribing guidelines, the introduction of alcohol-based hand rub (ABHR) and training and educational meetings with the staff. The intervention phase for HH started with the introduction of in-house prepared cost-effective ABHR in high-risk wards (WHO formulation), along with educational meetings in August 2011. Awareness campaigns for HH are also been conducted for the staff. Further, repeated feedback meetings will be done to present antibiotic prescribing patterns and HAI incidence data and will be discussed with the prescribers. This will be in order to develop the context relevant prescribing guidelines with the consensus of the prescribers. Pocket-sized printed guidelines will be distributed to the prescribers and posted in the wards. The mobile technology will be used to send reminders both for improving HH practice and for compliance with the guidelines. In the post-intervention phase, the data of antibiotic prescribing will be recorded continuously to analyse compliance with the local guidelines. HAI incidence rates will be monitored continuously. The compliance to HH practice will be observed, documented and analysed at several points. Economic feasibility will be checked to introduce the ABHR to the rest of the wards in the settings.

Teaching portfolio

I am teaching undergraduate medical students at R. D. Gardi medical college, Ujjain, India on regular basis and regularly contribute to various courses held at Karolinska Institutet, Stockholm, Sweden.

I have supervised 15 Medical students for their degree project in Medicine from Karolinska Institutet and 14 students for their Masters in Global/ Public Health. Nine medical students have received various grants to visit and study at the Indian site. I have co-supervised one Doctoral student who defended her thesis titled: ‘Antibiotic prescribing at hospitals in Central India with limited access to diagnostic methods - what can be improved in order to reduce unnecessary antibiotic use and development of antibiotic resistance’ in 2020.

Education

PhD- Isolation & identification of active constituents of medicinal plants Citrullus colocynthis & Artabotrys odoratissimus, 2001

MSc (Drugs and Pharmceuticals)- Gold Medalist, 1997

 

 

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