Healthcare Facilities as an Emerging Source of Antimicrobial Resistance: A One Health Perspective

Antimicrobial resistance (AMR), mostly resulting from the widespread use of antimicrobials in healthcare, veterinary, and agriculture, poses a significant challenge to global health. Healthcare facilities are hotspots of AMR due to high antibiotic consumption and the presence of highly susceptible populations. Moreover, there may be a dynamic exchange in AMR between healthcare infrastructures, human populations, animals, and the environment. To address these challenges, this review presents a One Health perspective, emphasizing the complex interconnections among many ecosystems. Furthermore, the development and dissemination of AMR in the healthcare environment, via surfaces and hands, have been critically investigated. Some of the neglected aspects that contribute to AMR, such as ventilation and wastewater, have also been addressed. The natural environment plays a crucial role as a reservoir for antimicrobial resistance genes (ARGs). The expected increase in AMR in the coming years will not only pose a challenge to public health but also to food security and environmental health. Hospitals should install advanced systems for treating wastewater to reduce the discharge of antimicrobials. Hospitals should also combine full water, sanitation, and hygiene (WASH) protocols with infection prevention and control (IPC) methods. These efforts are aimed at preventing infections and protecting public health and the environment. Other measures include advancing research to understand transmission pathways, increasing surveillance, reducing contamination in healthcare settings, implementing national plans for stewardship, and globally sharing resources and targets to reduce AMR.