Augmenting Approaches to AMR Prevention: A case for environmental sustainability within the WHO Core Components for infection, prevention, control

The growing challenge of antimicrobial resistance (AMR) is increasingly understood to be driven by multiple factors including the misuse of antimicrobial products and environmental pollution. However, targeted AMR action in health facilities primarily focuses on antimicrobial stewardship with limited or no consideration for environmental drivers limiting program impact. We seek to describe how health facilities can expand action against AMR through collaborative One Health approaches, building on the World Health Organization (WHO) Core Components for Infection, Prevention, and Control (IPC). A rapid review on the integration of environmental sustainability, IPC, and antimicrobial stewardship across six databases for articles published globally was conducted along with a review of publicly available contemporary guidance documents linked to IPC and environmental sustainability. Current IPC and sustainability practices were then compared with opportunities for sustainability identified across the WHO Core Components for IPC. Finally, a theorised causal pathway for the implementation of this strategy was developed. Despite increased calls for health facilities to embrace a One Health approach to AMR, there is limited evidence in the literature for how to achieve this. However, significant overlap exists between IPC and sustainability objectives. We therefore propose a 1) theorised causal pathway, and 2) strategy to systematically integrate environmental sustainability across the eight WHO Core Components for IPC. Action against AMR can be accelerated if hospital IPC and sustainability programmes adopt One Health approaches. We propose a framework for this using the WHO Core Components for IPC given their widespread use.