Real-time Infection Control and Antimicrobial Stewardship Through Wastewater-Based Surveillance

Wastewater (WW)-based epidemiology is an emerging science that seeks to understand the health of a population through sewage analysis. Our group proposes to focus this technology on hospitals. Hospitals are where those most susceptible to infections and their consequences are cared for. Accordingly, new methods to determine the day-to-day health of hospital populations are of extreme importance, and hospitals' sewer pipes contain invaluable information. WW will be collected from a range of points in hospitals in order to capture entire facilities and units of specific interest (i.e. intensive care). Samples will be concentrated and purified to enable molecular diagnostic testing for; 1. Viral Outbreaks. Hospital-associated outbreaks of viruses such as SARS-CoV-2, influenza and norovirus can easily occur when unrecognized cases enter from the community. We will identify and quantify target-viruses in WW and compare these with clinically identified cases and outbreaks in patients and healthcare workers in order to develop predictive modelling tools to establish a WW "early-warning" system. 2. Antimicrobial resistant organisms (ARO). ARO are prevalent in hospitals as a consequence of pervasive antibiotic use. ARO colonized individuals are at increased risk of harm and death. Current ARO monitoring strategies focus on only active infections, and rare surveillance screens - and as such miss most cases. By tracking and comparing ARO in WW with hospital-wide infection and antibiotic usage data we will develop real-time actionable tools that provide a day-to-day "snap-shot" of AROs in hospital - informing practice - and saving lives. Our transdisciplinary team, comprised of individuals with diverse backgrounds in engineering, chemistry, infectious diseases and microbiology, have the experience, track-record and tenacity to develop and implement a pilot hospital-WW infection surveillance system providing meaningful and actionable data to inform patient care.