EDITORIAL
Editor in Chief Ian Peate Editor/Associate Publisher Julie Smith [email protected] Chief Subeditor Sarah Kahn [email protected] Subeditors Daniel Davies [email protected] Vicqui Stuart-Jones [email protected] Commissioning Editor Sue Woodward Group Classified Director Rachel McElhinney [email protected] Circulation Director Sally Boettcher [email protected] Associate Publisher Andrew Iafrati [email protected] MedEd Manager Tracy Cowan [email protected] Classified Sales Executive Harry Nolan Production Manager Jon Redmayne Production Assistant Larry Oakes Editorial Make-up Kyri Apostolou Publishing Director Anthony Kerr Managing Director Jon Benson Chief Executive Officer Ben Allen UK PERSONAL SUBSCRIPTION RATES
Quarterly Direct Debit Annual Direct Debit Annual Credit Card 2yr Annual Credit Card 3yr Annual Credit Card
£43 £169 £178 £303 £427
Subscribe online: www.magsubscriptions.com, Subscribe by phone: +44 (0) 1722 716997 Contact [email protected] for institutional pricing MA Healthcare Ltd is part of the Mark Allen Group
www.markallengroup.com The British Journal of Nursing is published by MA Healthcare Ltd, St Jude’s Church, Dulwich Road, London SE24 0PB Tel: 020 7738 5454 Editorial: 020 7501 6716 Sales: 020 7501 6726 Email: [email protected] Websites: www.britishjournalofnursing.com
© MA Healthcare Ltd, 2015. All rights reserved. No part of the British Journal of Nursing may be reproduced, stored in a retrieval system, or transmitted in any form or by any means electronic, mechanical, photocopying, recording, or otherwise without prior written permission of the Publishing Director. The British Journal of Nursing is a double-blind, peerreviewed journal. It is indexed on the main databases, including the International Nursing Index, Medline and the Cumulative Index of Nursing and Allied Health Literature (CINAHL) ISSN 0966 – 0461 Print: Pensord Press Ltd, Blackwood, NP12 2YA Distribution: Comag Distribution, West Drayton, UB7 7QE Cover picture: iStockphoto.com
The paper used within this publication has been sourced from Chain-of-Custody certified manufacturers, operating within international environmental standards, to ensure sustainable sourcing of the raw materials, sustainable production and to minimise our carbon footprint.
British Journal of Nursing, 2015, Vol 24, No 1
BJON_2015_24_01_005_Editorial.indd 5
Antimicrobial resistance: the nurse’s essential role
T
he discovery of antibiotics in the early 20th century transformed medicine (both human and veterinary).There is no dispute that globally antibiotics are saving millions of lives each year. However, the rise of antibiotic-resistant bacteria now represents a grave threat to public health as well as to the economy. According to the Department of Health (DH) (2013) there are few public health issues of greater importance than antimicrobial resistance. Contemporary medical practice depends on the widespread availability of effective antimicrobials to prevent and treat infections. There is an increased resistance to all antimicrobials, including antivirals and antifungals, but it is the rapid development of bacterial resistance to antibiotics that brings greatest alarm. It is likely that the number of hard-to-treat infections will continue to grow and if this is the case it will become increasingly difficult to control infection in a variety of routine care settings. The National Institute for Health and Care Excellence (2014) has issued a quality standard that addresses the prevention and control of infection for those who are receiving health care in primary, community and secondary care settings. A strategic, coordinated, and sustained effort is required to detect, prevent and control antibiotic resistance but this has to be led by the DH. The approach depends on the engagement of health and social care providers, inter-government agencies, the academic community, industry and the general public. The key aims should be to minimise the emergence of antibiotic-resistant bacteria; maintain the efficacy of new and existing antibacterial drugs; develop improved methods for combating antibiotic resistance and conducting antibiotic stewardship (monitoring prescribing, resistance and infections and supporting prescribers in choice and use of antibiotics); strengthen surveillance efforts in public health; develop and promote the use of new, rapid diagnostic technologies; hasten scientific research and enable the development of new antibacterial drugs, vaccines and diagnostics. Effective, clear communication of the most up-to-date information on the appropriate and correct use of antibiotics to the general public and health and social care providers is essential. Further work with the pharmaceutical industry is required to improve international collaboration and capabilities in all these areas. Such aspirations are mammoth but essential, and nurses are central to this—locally, nationally and internationally. Policy makers and task-force leaders must ensure that nurses are fully involved and engaged at all levels with any initiatives being
planned or implemented that might impact on antimicrobial resistance. Nurses form the largest professional group of the healthcare workforce, they bring much to the table and what they offer should be acted on. I would suggest that if the Government ignores the vital contribution that nurses can make, it does so at our collective peril. The Royal College of Nursing (2014) has issued its position on the nursing contribution to antimicrobial resistance. It lists a range of specific recommendations including prescribing, dispensing and administration systems, standard in all secondary care settings, to assist with the electronic gathering of quality and timely data concerning prescribing and administration practices with the aim of driving further improvements. Convincing leadership is required to ensure multiprofessional engagement across all systems and organisational boundaries possibly through the role held by the Inspector of Microbiology (or equivalent). Pre-registration nursing programmes should include antimicrobial resistance and the contribution that the nurse makes to support multidisciplinary engagement of antimicrobial stewardship (I would add that any learning beyond registration must also have a compulsory element on antimicrobial resistance). A nurse should be present at World Health Assembly/World Health Organization summits with delegations from the UK. In the USA combating antibiotic-resistant bacteria is seen as a national security priority. The National Security Council staff are to coordinate (with other relevant agencies) the development and implementation of Federal policies with the overriding intention of combatting antibiotic-resistant bacteria (White House, 2014). Concerns over antimicrobial resistance are very similar to those in the UK. The question must be asked, however: is the UK doing enough to deal with BJN this serious threat to public health?
Ian Peate
Editor in Chief British Journal of Nursing
Department of Health (2013) UK Five Year Antimicrobial Resistance Strategy 2013 to 2018 http:// tinyurl.com/nkhoek2 (accessed 10 December 2014) National Institute for Health and Care Excellence (2014) Infection Prevention and Care. http:// www.nice.org.uk/guidance/qs61 (accessed 10 December 2014 Royal College of Nursing (2014) Antimicrobial Resistance: RCN Position on the Nursing Contribution http://tinyurl.com/n7wwu68 (accessed 10 December 2014) White House (2014) Executive Order - Combating AntibioticResistant Bacteria http://tinyurl. com/ncfk3hw (accessed 10 December 2014)
5 18/12/2014 10:09
British Journal of Nursing. Downloaded from magonlinelibrary.com by 155.198.030.043 on August 9, 2015. For personal use only. No other uses without permission. . All rights reserved.
Editor in Chief Ian Peate Editor/Associate Publisher Julie Smith [email protected] Chief Subeditor Sarah Kahn [email protected] Subeditors Daniel Davies [email protected] Vicqui Stuart-Jones [email protected] Commissioning Editor Sue Woodward Group Classified Director Rachel McElhinney [email protected] Circulation Director Sally Boettcher [email protected] Associate Publisher Andrew Iafrati [email protected] MedEd Manager Tracy Cowan [email protected] Classified Sales Executive Harry Nolan Production Manager Jon Redmayne Production Assistant Larry Oakes Editorial Make-up Kyri Apostolou Publishing Director Anthony Kerr Managing Director Jon Benson Chief Executive Officer Ben Allen UK PERSONAL SUBSCRIPTION RATES
Quarterly Direct Debit Annual Direct Debit Annual Credit Card 2yr Annual Credit Card 3yr Annual Credit Card
£43 £169 £178 £303 £427
Subscribe online: www.magsubscriptions.com, Subscribe by phone: +44 (0) 1722 716997 Contact [email protected] for institutional pricing MA Healthcare Ltd is part of the Mark Allen Group
www.markallengroup.com The British Journal of Nursing is published by MA Healthcare Ltd, St Jude’s Church, Dulwich Road, London SE24 0PB Tel: 020 7738 5454 Editorial: 020 7501 6716 Sales: 020 7501 6726 Email: [email protected] Websites: www.britishjournalofnursing.com
© MA Healthcare Ltd, 2015. All rights reserved. No part of the British Journal of Nursing may be reproduced, stored in a retrieval system, or transmitted in any form or by any means electronic, mechanical, photocopying, recording, or otherwise without prior written permission of the Publishing Director. The British Journal of Nursing is a double-blind, peerreviewed journal. It is indexed on the main databases, including the International Nursing Index, Medline and the Cumulative Index of Nursing and Allied Health Literature (CINAHL) ISSN 0966 – 0461 Print: Pensord Press Ltd, Blackwood, NP12 2YA Distribution: Comag Distribution, West Drayton, UB7 7QE Cover picture: iStockphoto.com
The paper used within this publication has been sourced from Chain-of-Custody certified manufacturers, operating within international environmental standards, to ensure sustainable sourcing of the raw materials, sustainable production and to minimise our carbon footprint.
British Journal of Nursing, 2015, Vol 24, No 1
BJON_2015_24_01_005_Editorial.indd 5
Antimicrobial resistance: the nurse’s essential role
T
he discovery of antibiotics in the early 20th century transformed medicine (both human and veterinary).There is no dispute that globally antibiotics are saving millions of lives each year. However, the rise of antibiotic-resistant bacteria now represents a grave threat to public health as well as to the economy. According to the Department of Health (DH) (2013) there are few public health issues of greater importance than antimicrobial resistance. Contemporary medical practice depends on the widespread availability of effective antimicrobials to prevent and treat infections. There is an increased resistance to all antimicrobials, including antivirals and antifungals, but it is the rapid development of bacterial resistance to antibiotics that brings greatest alarm. It is likely that the number of hard-to-treat infections will continue to grow and if this is the case it will become increasingly difficult to control infection in a variety of routine care settings. The National Institute for Health and Care Excellence (2014) has issued a quality standard that addresses the prevention and control of infection for those who are receiving health care in primary, community and secondary care settings. A strategic, coordinated, and sustained effort is required to detect, prevent and control antibiotic resistance but this has to be led by the DH. The approach depends on the engagement of health and social care providers, inter-government agencies, the academic community, industry and the general public. The key aims should be to minimise the emergence of antibiotic-resistant bacteria; maintain the efficacy of new and existing antibacterial drugs; develop improved methods for combating antibiotic resistance and conducting antibiotic stewardship (monitoring prescribing, resistance and infections and supporting prescribers in choice and use of antibiotics); strengthen surveillance efforts in public health; develop and promote the use of new, rapid diagnostic technologies; hasten scientific research and enable the development of new antibacterial drugs, vaccines and diagnostics. Effective, clear communication of the most up-to-date information on the appropriate and correct use of antibiotics to the general public and health and social care providers is essential. Further work with the pharmaceutical industry is required to improve international collaboration and capabilities in all these areas. Such aspirations are mammoth but essential, and nurses are central to this—locally, nationally and internationally. Policy makers and task-force leaders must ensure that nurses are fully involved and engaged at all levels with any initiatives being
planned or implemented that might impact on antimicrobial resistance. Nurses form the largest professional group of the healthcare workforce, they bring much to the table and what they offer should be acted on. I would suggest that if the Government ignores the vital contribution that nurses can make, it does so at our collective peril. The Royal College of Nursing (2014) has issued its position on the nursing contribution to antimicrobial resistance. It lists a range of specific recommendations including prescribing, dispensing and administration systems, standard in all secondary care settings, to assist with the electronic gathering of quality and timely data concerning prescribing and administration practices with the aim of driving further improvements. Convincing leadership is required to ensure multiprofessional engagement across all systems and organisational boundaries possibly through the role held by the Inspector of Microbiology (or equivalent). Pre-registration nursing programmes should include antimicrobial resistance and the contribution that the nurse makes to support multidisciplinary engagement of antimicrobial stewardship (I would add that any learning beyond registration must also have a compulsory element on antimicrobial resistance). A nurse should be present at World Health Assembly/World Health Organization summits with delegations from the UK. In the USA combating antibiotic-resistant bacteria is seen as a national security priority. The National Security Council staff are to coordinate (with other relevant agencies) the development and implementation of Federal policies with the overriding intention of combatting antibiotic-resistant bacteria (White House, 2014). Concerns over antimicrobial resistance are very similar to those in the UK. The question must be asked, however: is the UK doing enough to deal with BJN this serious threat to public health?
Ian Peate
Editor in Chief British Journal of Nursing
Department of Health (2013) UK Five Year Antimicrobial Resistance Strategy 2013 to 2018 http:// tinyurl.com/nkhoek2 (accessed 10 December 2014) National Institute for Health and Care Excellence (2014) Infection Prevention and Care. http:// www.nice.org.uk/guidance/qs61 (accessed 10 December 2014 Royal College of Nursing (2014) Antimicrobial Resistance: RCN Position on the Nursing Contribution http://tinyurl.com/n7wwu68 (accessed 10 December 2014) White House (2014) Executive Order - Combating AntibioticResistant Bacteria http://tinyurl. com/ncfk3hw (accessed 10 December 2014)
5 18/12/2014 10:09
British Journal of Nursing. Downloaded from magonlinelibrary.com by 155.198.030.043 on August 9, 2015. For personal use only. No other uses without permission. . All rights reserved.
