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About me

I am working as Associate Professor at Department of Pharmacology, R. D. Gardi Medical College, Ujjain, India and as Researcher at Global Health- Health Systems and Policy: Medicines, focusing Antibiotics, Global Health (IHCAR), Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden. Presently, I am Coordinator of a research project titled- “Antibiotic stewardship program including infection prevention and control and waste water treatment – Implementation research in hospital and community in India” since 2013.

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

My main area of research is improving prescribing of antibiotics at hospital and antibiotic use at community level. I have collected a baseline data of antibiotic prescribing for over 0.2 million in-patients from two tertiary care hospitals from 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 in community is another research area of my interest. I am working as the main researcher in an interventional study hat focus to improve hand hygiene and introduction of alcohol based hand rub in a health care facility in central India. The long term aim of this study is to minimize health care associated infection (HAI) rate in the hospitals.

I have been regularly involved in teaching to 4 year undergraduate medical students in India and Sweden, and in academic activities held at Karolinska Institutet, Sweden. I have supervised Naional and International students for their Master of Global Sciences degree from the Division of International Health (IHCAR) and Master of Medicine. I have several published research articles in peer reviewed, indexed international journals. My work has been acknowledged and awarded in many International and National conferences.

Education

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

MSc (Drugs and Pharmceuticals)- Gold medalist, 1997

 

 

Research description

Increasing bacterial resistance and increase in incidences of health care associated infections (HAIs) are the topics of global concern. Lack of knowledge, financial constrains and humid and moist climate of low- middle income countries put them at higher risk of antibacterial (antibiotic) use, spread of infectious diseases including healthcare associated infections (HAIs) and thereby development of bacterial resistance. A significant number of mortality 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 base line of antibiotic prescribing patterns and trends at the settings. Based on the results of pre intervention phase (Base line 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 (650 beds) and one non-teaching (350 beds). Both located in 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 of 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, introduction of alcohol-based hand rub (ABHR) and training and educational meetings with the staff. The intervention phase for HH started with 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 the compliance to the guidelines.
In the post intervention phase, the data of antibiotic prescribing will be recorded continuously to analyse compliance to 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 rest of the wards in the settings.

Teaching portfolio

I am teaching under-graduate medical stuudents at R. D. Gardi medical college, Ujjain, India on regular basis and actively participate in various courses held at Karolinska Institutet, Stockholm, Sweden.

I have supervised 11 Medical students for thier degree project in Medicine from Karolinska Institutet and 6 students for Master in Global Health project. Seven of the medical students have recieved various grants to visit and study at the Indian site.

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Presentations

I have presented my research in 17 national and 19 international conferences where some presentations were appreciated as 'Best presentation' and 'Best paper' accompanied with an award.