AMRSim: A Microbial Reality Simulator

Antimicrobial-resistant bacteria are an established and growing issue in small animal veterinary practice in the developed world. The problem is, people can't see the bacteria on them, on animals, or on the surfaces and objects they touch. This makes it difficult to prevent and control infection in the most effective manner, as habits and standard practice are hard to change if you don't know what you are dealing with. While data exist to inform best practise in infection control, they are usually published in academic journals, thus having limited impact on what is done in practise. Our solution is to make the 'invisible, visible' by building a three-dimensional graphical simulator of the interior of a veterinary practice in which humans, animals, and bacteria interact, according to rules observed from real-life. We are calling this simulator, AMRSim - A Microbial Reality Simulator. The indoor environment of the vet practice can be viewed as a complex 'ecosystem' in which animals and humans interact with one another and their physical environment. Within this ecosystem there is a third, unseen group of actors - microbial agents - some of which have the capability to cause infectious disease in animals and/or humans. In the case of bacteria, they often persist in the environment on surfaces as a community. It is within these bacterial communities that they are more resistant to physical or chemical removal and are able to exchange mobile genetic elements that confer resistance to antibiotics. For this reason, activities such as disinfecting surfaces, sterilising instruments and treating patients with antibiotics, are a fundamental part of the working life of health professionals. AMRSim will take data from the real world and make them 'come alive' in a visual way. Actual video footage will be used of the movements of humans and animals within a busy vet practice and the procedures undertaken, including those intended to reduce infection. The bacteria within the simulation will be introduced according to what is known of bacterial infection (types, location, antibiotic resistance) within vet practices from data already avaliable. Importantly, AMRSim will allow these normally invisible bacteria to be 'seen' as they multiply and spread through the indoor environment on people, animals and surfaces. By 'seeing' the interactions of animals, humans, and bacteria within space and time it will be possible to improve efforts to prevent bacteria entering and spreading through the physical environment, and improve their removal when they do. AMRSim will be brought, at progressive stages of its development, to a series of co-design workshops with end-users to ensure it is made meaningful, appropriate and usable, and addresses key learning outcomes with respect to preventing and controlling infection. The theory we shall test is that as practitioners interact with AMRSim, both in its development and then in its application, they will gain a greater appreciation for: 1) the impact their behaviours and activities can have on infection; 2) where weaknesses lie in current practise; and 3) where changes made to the way people and animals interact with each other and their environment can disrupt the status quo. These will lead to a reduced risk of bacterial contamination and infection, and ultimately reduced reliance on antibiotics. Our previous work in the human health environment has shown the power of 'making the invisible, visible' by simulating infection control on a hospital ward using a visual simulator. We shall build on this experience with a new, multidisciplinary team with expertise in digital design, spatial design, co-design, environmental psychology, veterinary practice, and microbiology. It is our intention that the experience we gain in developing and using AMRSim will be applied more widely, such as for teaching students and to simulate other indoor environments where biosecurity is paramount.