636119
editorial2016
BJI0010.1177/1757177416636119Journal of Infection PreventionEditorial
Journal of
Infection Prevention
Editorial
Antimicrobial stewardship: a personal and professional challenge
Journal of Infection Prevention 2016, Vol. 17(3) 105–106 DOI: 10.1177/1757177416636119 © The Author(s) 2016 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav jip.sagepub.com
Tracey Cooper
When first working in infection prevention I would say very confidently that my role did not include antibiotic prescribing: that was the preserve of Consultant Microbiologists and Antimicrobial Pharmacists and I do not recall even hearing the term antimicrobial stewardship. Fast-forward 20 years and antimicrobial stewardship definitely is part of my role, and has become a critical part of effective infection prevention to protect the health of the population. The threat of antimicrobial resistance has been recognised globally and at a national level in the UK for a number of years. In 1998 The Path of Least Resistance was published (UK Standing Medical Advisory Committee, 1998), and this was closely followed in 2000 by the first UK antimicrobial resistance strategy (Department of Health, 2000). The UK focus on this issue was re-invigorated in 2013, with the publication of the UK 5-year Antimicrobial Resistance Strategy 2013–2018 (Department of Health & Department for Environment, Food and Rural Affairs, 2013). This document sets out clearly seven key areas for action across the UK, including improving infection prevention and control practices in human and animal health. Each country of the UK is now in the process of implementing programmes of work to deliver this strategy by 2018. For my own practice, the ‘Antimicrobial Resistance Delivery Plan’ has been launched in Wales, and that will frame our professional actions in relation to antimicrobial prescribing across the Health Board where I work. There are also powerful and persuasive social media campaigns which add to this work, such as the #Antibioticguardian twitter campaign, and these are easy to get involved in. However, this cannot be the whole story if we are serious as a group of professionals about changing our overuse of antimicrobials. Reflecting on the issue and the statements in the UK strategy, it is clear that responsibility for action cannot end when we leave our jobs for the day. So, as a mother, friend and colleague, what do I do and say when someone close to me is unwell and wants to go to the GP for antibiotics? As a dog and cat lover and owner, what do I say to the vet who wants to give my cat antibiotics for a minor complaint? What do I do if I am unwell and my GP wants to give me antibiotics? Taking a lead in challenging prescribing
decisions and choices becomes much more difficult when it is personal to the individual, but this is a challenge we must embrace as a group of healthcare professionals and encourage in our colleagues if we are to tackle antimicrobial resistance. The converse issue has also recently made national news across the UK – the issue of ensuring patients with sepsis are diagnosed and treated very rapidly with antibiotics. The Sepsis Six bundle is widely promoted to healthcare staff, with evidence that if all six actions are completed rapidly the risk of mortality is reduced by up to 50% (BMJ 2015). This includes administration of broad-spectrum intravenous antibiotics. There is in fact no tension between the sepsis guidelines, and effective antimicrobial stewardship, but given the significant adverse media publicity, there has to be a real concern that the focus on sepsis treatment may result in further over-administration of antibiotics if there is any suggestion that sepsis is present. Tackling these issues requires an educated healthcare workforce; those who administer antibiotics, and therefore have a powerful role in questioning and challenging issues such as long courses of antibiotics, as well as antibiotic prescribers. As leaders in infection prevention and antimicrobial stewardship, we have a duty to develop and deliver innovative educational and awareness raising programmes for staff, patients and the wider population. There is an urgent need for educational programmes for prescribers to be developed based upon the ARHAI ‘Antimicrobial Prescribing and Stewardship Competencies’ published in 2013. Some recently available online programmes are helping to meet this need, such as the Massive Open On-line Learning (MOOC) on antimicrobial stewardship which is open access and free to register (e.g. University of Dundee, 2015). The challenge however remains, to raise awareness of the seriousness of antimicrobial resistance so that healthcare staff recognise they need to take individual and collective action Betsi Cadwaladr University Health Board, North Wales, UK Corresponding author: Tracey Cooper, Assistant Director of Nursing – Infection Prevention, Betsi Cadwaladr University Health Board, North Wales, UK Email: [email protected]
106 on the issue. Journals such as the Journal of Infection Prevention and professional societies such as the Infection Prevention Society continue to support this work by publication of academic papers focused on antimicrobial resistance and antibiotic stewardship, and by continuing to collaborate with each other and with governmental agencies. Undoubtedly the battle against antimicrobial resistance will be a long one, but we each need to play our part, both professionally and as part of our daily life. References BMJ Best Practice (2015) Sepsis in Adults. http://bestpractice.bmj.com/ best-practice/monograph/245/treatment/step-by-step.html (accessed 6th February 2016).
Journal of Infection Prevention 17(3) Department of Health Standing Medical Advisory Committee Sub-Group on Antimicrobial Resistance (1998) The Path of Least Resistance. http://webarchive.nationalarchives.gov.uk/20080905234748/dh.gov .uk/en/publicationsandstatistics/publications/publicationspolicyandguidance/dh_4009357 (accessed 6th February 2016). Department of Health (2000) UK Antimicrobial Resistance Strategy and Action Plan. http://webarchive.nationalarchives.gov.uk/20130107105354/http:/ www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/ documents/digitalasset/dh_4078448.pdf (accessed 6th February 2016). Department of Health & Department for Environment, Food and Rural Affairs (2013) UK 5 Year Antimicrobial Resistance Strategy 2013– 2018. https://www.gov.uk/government/uploads/system/uploads/attach ment_data/file/244058/20130902_UK_5_year_AMR_strategy.pdf (accessed 6th February 2016). University of Dundee (2015) Massive Open Online Course: Antimicrobial Stewardship https://www.futurelearn.com/courses/antimicrobialstewardship/1/register (accessed 6th February 2016).
editorial2016
BJI0010.1177/1757177416636119Journal of Infection PreventionEditorial
Journal of
Infection Prevention
Editorial
Antimicrobial stewardship: a personal and professional challenge
Journal of Infection Prevention 2016, Vol. 17(3) 105–106 DOI: 10.1177/1757177416636119 © The Author(s) 2016 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav jip.sagepub.com
Tracey Cooper
When first working in infection prevention I would say very confidently that my role did not include antibiotic prescribing: that was the preserve of Consultant Microbiologists and Antimicrobial Pharmacists and I do not recall even hearing the term antimicrobial stewardship. Fast-forward 20 years and antimicrobial stewardship definitely is part of my role, and has become a critical part of effective infection prevention to protect the health of the population. The threat of antimicrobial resistance has been recognised globally and at a national level in the UK for a number of years. In 1998 The Path of Least Resistance was published (UK Standing Medical Advisory Committee, 1998), and this was closely followed in 2000 by the first UK antimicrobial resistance strategy (Department of Health, 2000). The UK focus on this issue was re-invigorated in 2013, with the publication of the UK 5-year Antimicrobial Resistance Strategy 2013–2018 (Department of Health & Department for Environment, Food and Rural Affairs, 2013). This document sets out clearly seven key areas for action across the UK, including improving infection prevention and control practices in human and animal health. Each country of the UK is now in the process of implementing programmes of work to deliver this strategy by 2018. For my own practice, the ‘Antimicrobial Resistance Delivery Plan’ has been launched in Wales, and that will frame our professional actions in relation to antimicrobial prescribing across the Health Board where I work. There are also powerful and persuasive social media campaigns which add to this work, such as the #Antibioticguardian twitter campaign, and these are easy to get involved in. However, this cannot be the whole story if we are serious as a group of professionals about changing our overuse of antimicrobials. Reflecting on the issue and the statements in the UK strategy, it is clear that responsibility for action cannot end when we leave our jobs for the day. So, as a mother, friend and colleague, what do I do and say when someone close to me is unwell and wants to go to the GP for antibiotics? As a dog and cat lover and owner, what do I say to the vet who wants to give my cat antibiotics for a minor complaint? What do I do if I am unwell and my GP wants to give me antibiotics? Taking a lead in challenging prescribing
decisions and choices becomes much more difficult when it is personal to the individual, but this is a challenge we must embrace as a group of healthcare professionals and encourage in our colleagues if we are to tackle antimicrobial resistance. The converse issue has also recently made national news across the UK – the issue of ensuring patients with sepsis are diagnosed and treated very rapidly with antibiotics. The Sepsis Six bundle is widely promoted to healthcare staff, with evidence that if all six actions are completed rapidly the risk of mortality is reduced by up to 50% (BMJ 2015). This includes administration of broad-spectrum intravenous antibiotics. There is in fact no tension between the sepsis guidelines, and effective antimicrobial stewardship, but given the significant adverse media publicity, there has to be a real concern that the focus on sepsis treatment may result in further over-administration of antibiotics if there is any suggestion that sepsis is present. Tackling these issues requires an educated healthcare workforce; those who administer antibiotics, and therefore have a powerful role in questioning and challenging issues such as long courses of antibiotics, as well as antibiotic prescribers. As leaders in infection prevention and antimicrobial stewardship, we have a duty to develop and deliver innovative educational and awareness raising programmes for staff, patients and the wider population. There is an urgent need for educational programmes for prescribers to be developed based upon the ARHAI ‘Antimicrobial Prescribing and Stewardship Competencies’ published in 2013. Some recently available online programmes are helping to meet this need, such as the Massive Open On-line Learning (MOOC) on antimicrobial stewardship which is open access and free to register (e.g. University of Dundee, 2015). The challenge however remains, to raise awareness of the seriousness of antimicrobial resistance so that healthcare staff recognise they need to take individual and collective action Betsi Cadwaladr University Health Board, North Wales, UK Corresponding author: Tracey Cooper, Assistant Director of Nursing – Infection Prevention, Betsi Cadwaladr University Health Board, North Wales, UK Email: [email protected]
106 on the issue. Journals such as the Journal of Infection Prevention and professional societies such as the Infection Prevention Society continue to support this work by publication of academic papers focused on antimicrobial resistance and antibiotic stewardship, and by continuing to collaborate with each other and with governmental agencies. Undoubtedly the battle against antimicrobial resistance will be a long one, but we each need to play our part, both professionally and as part of our daily life. References BMJ Best Practice (2015) Sepsis in Adults. http://bestpractice.bmj.com/ best-practice/monograph/245/treatment/step-by-step.html (accessed 6th February 2016).
Journal of Infection Prevention 17(3) Department of Health Standing Medical Advisory Committee Sub-Group on Antimicrobial Resistance (1998) The Path of Least Resistance. http://webarchive.nationalarchives.gov.uk/20080905234748/dh.gov .uk/en/publicationsandstatistics/publications/publicationspolicyandguidance/dh_4009357 (accessed 6th February 2016). Department of Health (2000) UK Antimicrobial Resistance Strategy and Action Plan. http://webarchive.nationalarchives.gov.uk/20130107105354/http:/ www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/ documents/digitalasset/dh_4078448.pdf (accessed 6th February 2016). Department of Health & Department for Environment, Food and Rural Affairs (2013) UK 5 Year Antimicrobial Resistance Strategy 2013– 2018. https://www.gov.uk/government/uploads/system/uploads/attach ment_data/file/244058/20130902_UK_5_year_AMR_strategy.pdf (accessed 6th February 2016). University of Dundee (2015) Massive Open Online Course: Antimicrobial Stewardship https://www.futurelearn.com/courses/antimicrobialstewardship/1/register (accessed 6th February 2016).
