clinical pharmacology , a bridge discipline between basic sciences and clinical disciplines , was started in india in the 1960s1 . the development of pharmaceutical industry , clinical trials , accreditation issues in hospitals , and the commitment of the government to provide essential medicines have necessitated a sea change in the role of the clinical pharmacologist . capacity building with training in various skills for roles and responsibilities of the clinical pharmacologist is therefore needed . the indian council of medical research ( icmr ) in its centenary year 2011 - 2012 gave a major boost to development of clinical pharmacology in india and planned workshops in thrust areas2 . one of the major thrust areas was that of antibiotic use , resistance and infection control . this area is unique in that it is truly an integrated area covered by the disciplines of clinical pharmacology , microbiology and infectious diseases . bacterial infections are a major contributing factor to mortality in the world3 , and bacterial resistance to antibiotics has become an all pervading problem throughout the world45 , and in india67 . antibiotic use has been seen to be high in india with one recent surveillance study indicating 40 per cent of patients in the community on antibiotics9 , and an even higher rate of inappropriate use10 . antibiotic stewardship is a multidisciplinary programme with interventions and strategies to encourage appropriate use of antibiotics . stewardship programmes aim to restrict inappropriate use of antibiotics , optimize selection , dose , route and duration of treatment for best outcomes , minimizing detrimental adverse events , excessive costs and emergence of resistance . the team involved in antibiotic stewardship is multidisciplinary and consists of an infectious disease physician , clinical pharmacologist / pharmacist , clinical microbiologist , infection control nurse and hospital administrator . strategies such as development and implementation of treatment guidelines , audit and feedback , and parenteral to oral conversion have been shown to be effective . there have however , been barriers also such as lack of awareness and support from physicians , lack of trained manpower and sometimes administrative shortsightedness . in india , while infection control guidelines and training programme had started relatively early13 , antimicrobial stewardship programme , guidelines and training have lagged behind . publications from india on prevention of infection and control are only a few and on antibiotic stewardship are even fewer ( table ) . number of publications on aspic it was , therefore , deemed important by the icmr that the discipline of clinical pharmacology takes on this void through a training programme not just to build capacity in antibiotic stewardship and infection control and impact hospitals , but also to initiate research projects in different hospital centres which would help in baseline studies and improve the situation with interventional strategies . the aspic programme was initiated through the collaboration of the office of the national chair of clinical pharmacology , icmr , and the christian medical college , vellore . this report outlines the content of the antibiotic stewardship , prevention of infection and control ( aspic ) programme , the primary workshop conducted in 2012 in vellore , tamil nadu , india , the issues in capacity building in antibiotic stewardship ( as ) and the way forward . the overall programme was of one year with two contact sessions ( workshops ) and a project . the workshop was planned to provide training to participants to equip them with ( i ) skills and understanding required for infection prevention and control practice ; ( ii ) knowledge and skills required for development and implementation of antimicrobial policy guidelines for rational use of antibiotics to curb antibiotic resistance ; and ( iii ) ability to plan and conduct research projects in antibiotic policy , infection prevention and control practice . selection of participants : twenty participants were selected on the basis of their qualification , past experience and quality of the concept research paper on antimicrobial stewardship and infection control . among the participants selected , 15 were microbiologists , four were pharmacologists and one was a physician ( figure ) . description of the workshop : the first contact session of five days ( april 16 - 20 , 2012 ) consisted of 40 hours of lectures , site visits , hands on practical training , demonstrations , and project discussion . the main topics covered and types of training assignments given during the workshop were : ( i ) patient safety - lectures , practical demonstration and site visits ; ( ii ) health care associated infections - definitions , preventions , demonstration and visits ; ( iii ) health care workers health and audits in infection control- lectures and case discussions ; ( iv ) antimicrobial stewardship- lectures and case discussions ; and ( v ) project discussion . resource persons for the workshop were faculty from various specialties ( infectious disease , clinical microbiology , clinical pharmacology , nursing , intensive care , surgical specialties , and hospital infection control ) . session outcomes : by the end of the session on patient safety the participants were able to describe the standard precautions to be used to provide patient safety , principles and methods of , hand hygiene , biomedical waste management and its ultimate disposal , and sterilization of instruments . after the session on health care associated infections ( hcai ) , the participants were able to describe the definitions , surveillance and prevention of the following hcai : ( i ) catheter related blood stream infection ( cr - bsi ) ; ( ii ) ventilator associated pneumonia ( vap ) ; ( iii ) skin and soft tissue infection ( ssi ) ; and ( iv ) catheter associated urinary tract infection ( ca - uti ) . by the end of the session on health care workers ( hcw ) health and infection control related audits the participants were able to describe the dos and do nt 's of needle stick injury prevention , protection of hcw by immunization and post exposure prophylaxis , main steps of outbreak investigation , different audit on various aspects of infection control , and disinfection of various areas and equipment in the hospital . by the end of the session on the antimicrobial resistance and stewardship the participants were able to describe the following : ( i ) surveillance of antimicrobial resistance and antibiotic consumption in their hospital ; ( ii ) principles of planning standard treatment guidelines and antimicrobial stewardship for their hospitals ; and ( iii ) principles of epidemiological investigation of antimicrobial resistance in the laboratory . during the first contact session , research projects to be undertaken at the participant 's institution were discussed . two projects were selected based on the common problems of the centres and the need for improvement . these projects were aimed at assessing the knowledge and practices in two areas in the hospital , viz . use of antimicrobials in surgical prophylaxis , and use of carbapenems/3 generation cephalosporins in intensive care units . after assessment , each centre would develop focused learning modules as an intervention strategy which would be pilot tested and then used as part of the stewardship practice of that hospital . after dissemination of these modules their effectiveness would be assessed by determining the practices once again . summary of feedback : all participants found the workshop productive and useful , and they enjoyed the style of teaching , the visits to see various laboratories , processes and facilities . the content of the workshop was felt to be adequate . however , some of the participants were of the opinion that the microbiological aspects could be reduced . overall outcomes and evaluation of programme : at the end of the programme , it was hoped that each participant 's institution would have a comprehensive systematic infection control and antibiotic stewardship programme , an antibiotic guidelines manual based on the local antimicrobial resistance pattern , and completed research projects and papers for publication . the programme will be evaluated using the following parameters : ( i ) participant attendance for workshops ; ( ii ) pre- and post - test workshop scores ; ( iii ) workshop feedback ; ( iv ) training others in participant 's institution and region ; ( v ) implementation of antibiotic stewardship in participant 's institution ; ( vi ) implementation of infection control practices in participant 's institution ; ( vii ) development of antibiotic policy manual in participant 's institution ; ( viii ) research project initiation and completion ; and ( ix ) dissemination of findings through publication . follow up : the project is expected to be completed within 6 - 8 months after initiation . the second contact workshop was held in july 2013 . the improvements made in the area of antimicrobial stewardship and infection control in each site hospital were discussed . the mix of personnel from different disciplines also created the need for a balance of topics between the disciplines in the short span of workshop time . the presence of an infection control team , quality assured microbiology laboratory , and access to various groups of antibiotics , were highly variable across the institutions . this was a challenge when designing projects that would be able to capture the practices and data uniformly from all institutions . the variation in approach of ethics committees in granting permission for projects was time consuming . it was also important to generate projects which were feasible and doable within the short span of time . planning for collaborative projects when there is a great variation between participating centres , is challenging . individual institutional projects may be another approach but the comparison as to which is better between both approaches is debatable . this workshop was the beginning of a programme initiated by the icmr , national chair for clinical pharmacology and christian medical college , vellore , to train pharmacologists and microbiologists to address the need for antibiotic stewardship and infection control in various institutions and hospitals throughout india . the focus was to bring together different disciplines and faculty in working towards a common cause , assessing the ground level realities in antibiotic use and hospital infections as well as developing strategic interventions through a collaborative approach to improve infection control and rational antibiotic use . it is hoped that this programme will raise awareness about these issues and empower the participating centres to train other centres so that antimicrobial resistance and hospital infections can be optimally contained .
antimicrobial resistance and hospital infections have increased alarmingly in india . 
 antibiotic stewardship and hospital infection control are two broad strategies which have been employed globally to contain the problems of resistance and infections . for this to succeed , it is important to bring on board the various stakeholders in hospitals , especially the clinical pharmacologists . 
 the discipline of clinical pharmacology needs to be involved in themes such as antimicrobial resistance and hospital infection which truly impact patient care . 
 clinical pharmacologists need to collaborate with faculty in other disciplines such as microbiology to achieve good outcomes for optimal patient care in the hospital setting . 
 the aspic programme was initiated by the indian council of medical research ( icmr ) in response to the above need and was designed to bring together faculty from clinical pharmacology , microbiology and other disciplines to collaborate on initiating and improving antibiotic stewardship and concurrently curbing hospital infections through feasible infection control practices . 
 this programme involves the participation of 20 centres per year throughout the country which come together for a training workshop . 
 topics pertaining to the above areas are discussed in addition to planning a project which helps to improve antibiotic stewardship and infection control practices in the various centres . 
 it is hoped that this programme would empower hospitals and institutions throughout the country to improve antibiotic stewardship and infection control and ultimately contain antimicrobial resistance .