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00:01What can rocks from the past tell us about the world today?
00:05Why are we so resistant to change?
00:08And what can we do to challenge the status quo?
00:11And how do invasive species threaten nature and our way of life?
00:15We'll be looking into all this and more on 10 Things to Know About.
00:19This week we're exploring the hidden world of bacteria and the urgent fight against antimicrobial resistance.
00:34Antimicrobial resistance or AMR is often known as a silent pandemic and is one of the greatest global health threats today.
00:55We are literally running out of antibiotics and risk returning to a time when even minor infections cannot be treated
01:02and life-saving operations cannot take place.
01:06Thankfully scientists are working hard to find ways to keep us safe when the drugs don't work.
01:13Rachel McLaughlin is an expert in how bacteria interact with our immune system.
01:19Antimicrobial resistance is one of the biggest global challenges we currently face.
01:24Recent estimates are that a million people die every year from a bacterial infection
01:30that is no longer treatable with antibiotics.
01:33That is a huge number of people.
01:35It is a huge number of people and this is why it's so important that we shine a light on this topic.
01:40What can we do to tackle this?
01:41Yes, so we're in a race against the bacteria.
01:44Now one thing we can do is try to make new antibiotics.
01:47But the problem with that is that even if we make new antibiotics, which by the way is a big, big challenge,
01:54bacteria will eventually become resistant to those antibiotics.
01:58So one alternative approach that we have is try to prevent these infections happening in the first place.
02:04And to do that we can use vaccines.
02:07A vaccine works by teaching your immune system how to recognize a threat like a virus or a bacteria
02:14and helps your immune system better respond to those threats.
02:17You know, using a vaccine I guess you could look at it like using sun cream.
02:21It protects you against an invisible threat.
02:24We can't see the UV rays but we know they're very damaging.
02:27So as a parent I do my best to keep my children safe.
02:32I make sure they wear their sun cream.
02:34I make sure they wear their helmet when they're on their bikes.
02:36I've also vaccinated my children.
02:39Ireland's National Immunisation Programme offers free vaccines for all children born in the country.
02:45These vaccines help protect against 14 infectious diseases and support efforts to curb bacterial resistance.
02:53Unfortunately last year we saw rates of the measles virus increase in Ireland.
03:12And measles is a vaccine preventable disease.
03:15But for the vaccines to protect the entire population we need 95% of the population to be vaccinated.
03:23Now in Ireland the rates of uptake of that MMR vaccine have dropped below 90%.
03:29So measles is a virus but what's the difference between a bacteria and a virus?
03:33They're actually very very different.
03:35So antibiotics don't work against viruses.
03:37The problem is a lot of the symptoms that a bacterial and a viral infection can cause are quite similar.
03:44And this is one of the reasons why in the past people have been treated with antibiotics when actually they were infected with the virus.
03:52Falling vaccination rates combined with the overuse and misuse of antibiotics are contributing to the problem of increasing bacterial resistance.
04:01Yet vaccines remain the most powerful tool we have to prevent infections.
04:06Rachel is working to develop new vaccines that directly target antimicrobial resistant bacteria.
04:15My research is focused on understanding the immune response to the bacterium Staphylococcus aureus.
04:21And it's actually the bacterium that causes MRSA.
04:25So MRSA is the antibiotic resistant form of Staphylococcus aureus.
04:30And where does Staphylococcus aureus occur?
04:33Staphylococcus aureus lives in your nose.
04:35In my nose?
04:36Yes.
04:37It's part of the normal human microbiome.
04:39And when it lives in people's noses it doesn't cause any problems.
04:42Issues arise when it leaves the nose and it gets somewhere it shouldn't.
04:46Like into your bloodstream or into a joint.
04:48So for example when people go to hospital and have surgery sometimes they get Staphylococcus infections at the surgical site.
04:55So it really can cause devastating infections.
04:59If Staphylococcus aureus gets into your bloodstream and has a very high mortality rate it causes a huge burden of disease across the globe.
05:08And that's the reason why we really need a vaccine to prevent against Staphylococcus infections if we can.
05:13How do you design a vaccine against something that's already in our body?
05:16Well this is the critical challenge.
05:18Our immune system is very complicated.
05:20There's lots of signaling molecules and cells that control the response.
05:24And we have in the immune system these molecules that act as breaks.
05:28And these breaks in the immune system are really important because we don't want our immune response to be too great.
05:34Or we don't want our immune response to be activated when it shouldn't.
05:37So it's important that we have these breaks.
05:39And what we've discovered here in our research is that Staphylococcus aureus manipulates those breaks.
05:45And it uses the breaks to tell the immune system, I'm not a threat, you don't need to respond.
05:50That's pretty sneaky.
05:51It is very sneaky bacterium.
05:53What we believe we're going to have to do is to have a vaccine that is able to turn off those breaks temporarily.
06:00You know, we've spent years trying to develop a vaccine.
06:03Not just me, many labs around the world have worked on this and we have failed to do so yet.
06:08And that's why the research that we're doing here is so important.
06:11Because fundamental understanding of the immunology surrounding an infection is really the first step for successful vaccine development.
06:20And in the future, how would you see a vaccine like this being rolled out?
06:25It wouldn't be a vaccine that we would be giving to everybody.
06:28So for example, if you're going to hospital, you're having surgery, perhaps it might be useful to have a vaccine that would protect you during that window where you're susceptible to an invasive infection.
06:40But there's a lot of work to be done yet before we can definitively say how it's going to be rolled out.
06:47It's still early days in the development of a vaccine against antimicrobial resistant bacteria.
06:52But this research is crucial in the fight against this growing threat to our wellbeing.
07:10Hospitals are the frontline of saving lives, but they also pose a distinct challenge to combating antimicrobial resistance.
07:20The constant influx of patients, a variety of pathogens and the necessary but widespread use of antibiotics and disinfectants can create an environment that can lead to the development of drug resistant microbes.
07:35Quiva Fin works with healthcare staff to keep patients safe and reduce the risk of infection in hospitals.
07:42Why are hospitals a particular place of concern in relation to these AMRs?
07:49Obviously patients have extra vulnerabilities when they come into hospital.
07:53It might be that they've had surgery for a particular condition and therefore they might have a wound.
07:58They might have a device inserted, such as the urinary catheter, and all of these can increase infections.
08:03Our patients are older as well, you have to remember, and they may have had multiple episodes of healthcare before, which slightly increases your risk.
08:09And we know then patients are together, these big wards, with a lot of healthcare workers, everybody trying to do the best they can.
08:16But just the risk is inherent to healthcare, unfortunately.
08:20When it comes to preventing infection, the thing that I think about the most is washing my hands.
08:25But I presume in a healthcare setting there are a lot of different things that are being done.
08:29There is a huge amount of different things, like vaccination programs, the hygiene of the area.
08:35For every different infection that we have, we sit down and say, right, what might have caused it?
08:38Is there any commonalities? How can we stop more patients getting it?
08:42And what is the research telling us?
08:44And the more we're doing this, we're actually able to stop outbreaks in their tracks.
08:48And we do know that outbreaks cause bed closures.
08:51People don't need any beds to be closed in this country, because everyone needs access and quick access to the healthcare that they need.
08:56Infection control around patients is essential, but research shows that sinks and wastewater can also harbour antimicrobial resistant bacteria.
09:16Quiva is working with Deirdre Fitzgerald Hughes to create technology to disinfect healthcare wastewater more effectively and target AMR bugs.
09:26When somebody washes their hands, they're doing it to get rid of any potential bugs that might end up at ward level.
09:32But I suppose the bugs will just go and live somewhere else.
09:36And I suppose very convenient for bugs in that situation, when they're being washed down the sink, to end up in these bottle traps that are just below the sink.
09:43They have about two to three inches of water in them.
09:46And that's really important for preventing kind of malodours from coming up from the drain.
09:50But bugs just love it down in the water down there.
09:53They're very good at sticking to the inner surfaces of the pipework.
09:57They build what we call biofilms.
09:59And these are kind of like an architecture that's really, really difficult for disinfectants to penetrate.
10:05Normally how we clean these kind of drains is by pouring disinfectant down them.
10:09Yeah.
10:10But that creates problems down the line potentially.
10:12Down the line.
10:13Many of them are chlorine based.
10:15Chlorine is actually quite bad for the environment.
10:17It produces toxic by-products.
10:19Something that's actually quite concerning is that the antimicrobial resistant genes that are contained in bacteria.
10:26So these are the parts of the bacteria that make them resistant to antibiotics.
10:30They're very stable in the environment.
10:32And so disinfectants tend not to focus on that aspect.
10:35They tend to just want to kill the bugs.
10:37But the DNA can survive in the natural environment.
10:40And so what's the alternative?
10:42One of the alternatives that we're working on is called photodynamic disinfection.
10:47And so this is a completely different way to think about disinfecting.
10:53The team has designed an LED based insert for sink traps.
10:57The device contains a special light activated material that energizes the oxygen in the wastewater and kills the bacteria.
11:05The beauty of this I suppose that makes it stand out from other disinfection is that if you remember I was talking about this architecture that bacteria build around themselves called biofilms.
11:16Photodynamic disinfection has the potential to be able to deal with that much better than liquid disinfectants.
11:22One of the key things as well is it doesn't generate toxic by-products the way chlorine-containing disinfectants do.
11:30So it's very good for the environment.
11:32What's the timeline for getting or trialing this kind of technology in a hospital setting?
11:37We're at the moment working towards getting the chemistry right, getting the lighting right, just figuring out the optimal parameters for the bugs that are the most important to kill.
11:46But our timeline is that within the next nine months we're going to trial some of these in sinks in the hospital.
11:54If we can show that this works in a hospital setting, well then we have a vision to be able to develop it for other sectors.
12:04And really it comes to that One Health kind of focus of how we respond to the AMR crisis.
12:10Any area where there are bugs that need to be killed in large numbers and where there's DNA that's in the environment, that's where this technology could make a real difference and make a real impact.
12:20One Health kind of focus of how we respond to the AMR crisis and how we respond to the AMR crisis and how we respond to the AMR crisis and how we respond to the AMR crisis.
12:27It's not just the overprescribing of antibiotics to humans that is the problem.
12:53The livestock sector uses huge amounts of antibiotics and the residues end up in the environment.
12:59So what is the farming community doing to tackle the problem?
13:02Edgar GarcÃa ManthanÃa is driving agricultural research that promotes the responsible use of antibiotics.
13:09Edgar, we're on a dairy farm. What does agriculture and livestock have to do with antimicrobial resistance?
13:16Well, first we have to think that the animals get sick as people. So for their own welfare and health, we have to treat them.
13:23And then it's a natural consequence that when you put antibiotics somewhere, there's bacteria that become resistant.
13:30And that's what happens everywhere in your kitchen, in here, in a hospital, everywhere.
13:34Like if you think, for example, these cows, what we do with these cows is to produce milk.
13:38The milk is not a product that is contaminated with antibiotics or antimicrobial resistance.
13:43But cows do poo, then it rains, and it goes to the river, and it goes to a waste treatment plant.
13:49And that's where you actually can find, that's why there is all this surveillance of water programs,
13:53because all that happens there and you can see all the resistance there.
13:56What do we know about levels of antibiotic use in livestock?
14:10We know one thing for sure, that animals use more than humans.
14:15Around 60% of the antibiotics in the whole world are used in animals.
14:1860%?
14:19Wow.
14:2060% of the antibiotics.
14:21The biggest users are pigs, but cows do use antibiotics that are, some of them are critical for humans.
14:27So it's not always the amount, it's the type of antibiotic that they are using.
14:30Irish farmers have been kind of tackling this problem for a long time, haven't they?
14:34Yeah.
14:35For the stars, the amount that Irish farmers use is low.
14:39To give you an example, pigs have been down 30% in the last six, seven years.
14:44Wow.
14:45And the veterinarians that treat pigs voluntarily stop using one antibiotic that is only used now.
14:50for humans.
14:51So there is, there is big steps that are taking place.
14:53It's amazing how interconnected it all is though, isn't it?
14:56That like, you know, as a public health community, you have to interact with the veterinarian community
15:00in order to still have the armory of antibiotics available to you.
15:04Yeah, there is this concept that is getting more and more famous.
15:07The one health concept.
15:09It's very, it's very narrow minded if you only think about the animals or the people or whatever,
15:15because we are stepping here today and we are going to bring the bacteria that is in this field into our kitchens, into our houses.
15:21So tomorrow you can go into a hospital to record something and you're bringing this bacteria there.
15:26You have to think about the world now.
15:28In the fight to curb the rise of antimicrobial resistance, Vesh Niamh Hogan and farmer Mella Briscoe are helping lead the charge.
15:47So how have things changed in terms of antibiotic usage on farms over the last 10 years?
15:53When I was in college, it was really only the start of kind of thinking, you know, how we're using these and to be more targeted, I suppose, in the use of our antimicrobials.
16:02As time has gone on, the evidence has just gathered and gathered of, you know, antibiotic resistance being a bigger and bigger issue.
16:08And how about for you Mella, how have you seen it play out?
16:11It's a complete change of tech, you know, we were used to depending on the antibiotics, you know, as our risk management.
16:19And now we have to stand back and we have to assess which cows will we give it to and which cows don't need it anymore.
16:24It makes the job of drying off the cows more complicated.
16:27Drying off is the process of giving a cow a break from milking to prepare for her next calf.
16:33Farmers do this by changing the cow's diet, sealing her udder and sometimes using antibiotics if she's had a previous infection.
16:45If you're not doing preventative antibiotics when you're drying off your cows, what do you do?
16:49We'll split the cows into two groups.
16:51So one group has demonstrated that they have had issues with disease in their mammary during the year
16:57and those animals will all still get antibiotics.
16:59But then there will also be a portion of animals who have no evidence of any disease whatsoever
17:03and those animals don't get any antibiotics.
17:05They just get a sealer up into their quarter.
17:07That's, for want of a better word, it's like chewing gum that will sit right at the bottom of the teeth
17:12and will stop any dirt or bacteria going up into that teeth during their dry period.
17:17The issue is if you're not meticulously clean when you're putting in that teeth sealer, you run the risk of introducing dirt then.
17:25So we'll say farms just have to have a very high level of hygiene, have to have enough space for the cows afterwards.
17:31Cubicle hygiene is very important.
17:33Which sounds like a lot of work.
17:35Yes, it is a lot of work, absolutely.
17:37And you have to be prepared and you have to decide the night before who's for drying off tomorrow,
17:41who's getting antibiotics, who isn't.
17:43And you have to take your time doing it.
17:45So there's no financial gain from it.
17:47Would that be fair to say?
17:49Oh, I would 100% agree with that.
17:50There's no financial gain.
17:51But I still believe in it.
17:52We're doing it since 2017 and I still believe in it.
17:55But I imagine that, as Yvette, you probably have tricky conversations with people who maybe want to just keep doing things the way things have been done.
18:01Absolutely.
18:02Every farmer is different and what motivates them is different.
18:05And what works for mellow won't work for the next farmer.
18:08In 2022, the EU banned the preventative use of antibiotics on farms, reserving them for when animals are ill.
18:21While Mela had already embraced this approach, the new rules have demanded a major shift in mindset across the farming community.
18:28To support this transition, Alison Burrell is developing behaviour change strategies to help vets and farmers adapt
18:36and reduce antimicrobial use on farms.
18:41Veterinary practitioners are obviously those who prescribe antibiotics.
18:45But they're also a really important source of information for farmers to be able to safely reduce the amount of antibiotics that they're using.
18:52So what we are doing is we're delivering motivational interviewing training to veterinary practitioners.
18:59And really, it's about having a conversation for change that is a collaborative conversation and that is supporting someone's autonomy and acknowledging their own strengths and their own abilities to change.
19:11So a key component, I suppose, is understanding that people do not like being told what to do.
19:17Nobody likes being told what to do.
19:18Nobody likes being told what to do.
19:19Nobody likes being told what to do.
19:20So what does that look like for if you're a vet and you're trying to convince a farmer that actually, no, you don't need antibiotics in this situation?
19:26So I suppose it's key to understand that you can't really convince or persuade someone to make a change.
19:33But you can draw out their own internal motivation to do something using things like open questions.
19:40So using questions like how, what, why, making sure you're opening up that conversation and then really exploring what that person is motivated by and providing advice.
19:52But it's tailored, a chunk of tailored advice that's particularly relevant to that individual that you're speaking to.
19:58OK, OK.
19:59So you're using these communication techniques.
20:01You're not, you know, developing a new antibiotic.
20:03You're not developing a new technology.
20:05It's actually just behavioral science.
20:07Absolutely.
20:08We know a lot about AMR now, but really it's about moving from knowing to actually doing.
20:26Having grown up on a dairy farm with a keen interest in calf health, Niamh was a key participant in the Conversations for Change initiative.
20:34Before my, my mindset was I'm coming in to tell people how to do things right.
20:39Whereas that has changed for me completely now.
20:41And I'm, I'm taking, I won't say a backseat.
20:44I'm still an active participant, but I'm, we'll say an advisor.
20:49I'm guiding rather than telling people what to do.
20:51Do you know, we have those open questions that I'm a big fan of now.
20:55And I'm trying to get the farmer to come up with the solutions themselves.
20:57So what does an open question sound like?
20:59So I would say to Mela, how did your dry off go last year?
21:02Were you happy with how everything went?
21:04And then she elaborates then on that.
21:06I've got a favorite subject, chat, chat, chat.
21:08And then you pull out all the information.
21:09Exactly.
21:10Yeah.
21:11Niamh visited our farm last year and our discussion group were here.
21:14And she was super at talking to all the lads in the group.
21:18Because, you know, for a long time I was the only one, we were the only ones in the group doing the selective dry cow.
21:23And the rest of them were very much on the fence and very wary of it because they had bad experience in the past.
21:27But Niamh really brought the conversation out of them and got a lot of them thinking twice.
21:32Tackling antimicrobial resistance and preserving antibiotics for future generations is a complex problem to solve.
21:41It's so encouraging to see collaboration and communication between researchers, vets, farmers and clinicians,
21:48and people like you and me can help turn the tide on this growing threat.
22:02That's our 10 things to know about bacteria.
22:06And that's it for another series.
22:08Across Ireland and beyond, we've seen how change takes shape through the commitment of our dedicated researchers
22:14and the determination of our communities.
22:16From the sea, to rocks, to the air, these stories show how connected we all are.
22:22And as we understand more about our world, we're learning how to build a better future together.
22:32See you in the next episode.
22:51Take care.
22:55Take care.
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