Antimicrobial resistance (AMR) arises when the micro-organisms which cause infection survive exposure to a medicine that would normally kill them or stop their growth. This means that the treatments usually used to treat infections caused by a resistant organism will not be effective.
Antimicrobial resistant organisms (AROs) are common place and examples such as Meticillin resistant Staphylococcus aureus (MRSA) or Multi drug resistant Tuberculosis (MDR-TB) are well publicised.
The drive to reduce public expectation for prescriptions of antibiotics has been evident for several years.
What has begun to emerge more recently is an appreciation of the potentially disastrous impact of increased resistance and reduced treatment options. Many of the medical advances in recent years, for example organ transplantation and cancer chemotherapy, need antibiotics to prevent and treat the bacterial infections that can be caused by the treatment. Without effective antibiotics, even minor surgery and routine operations could become high risk procedures if serious infections can’t be treated.
Professor Dame Sally Davies raised awareness in her first in depth report 'Infections and the rise of antimicrobial resistance in 2011'.
The response to the national strategy is co-ordinated by the Cornwall Antimicrobial Resistance Group (CARG). The UK five year antimicrobial strategy states:
“Success will require a wide range of public and private sector bodies to take co-ordinated action to deliver an integrated programme, which will safeguard human and animal health.”
“…providing clinical leadership and improved collaborative working …”
Starting membership of CARG
- NHS England: Medical director DCIOS (Chair)
- Royal Cornwall Hospitals NHS Trust: Chief pharmacist (Deputy chair), antimicrobial pharmacist, microbiologists, DIPC nurse consultant
- NHS Kernow: GP clinical lead, pharmaceutical advisor, DIPC nurse consultant
- Cornwall Partnership NHS Trust (includes community hospitals and nurses): Medical lead
- Public Health England: Consultant
- Academic: European Centre for Environment and Human Health
- Community pharmacist: LPC chief officer
- Veterinary sector: Small animal veterinary surgeon
Purpose of CARG
- Responsible for ensuring implementation of UK five year AMR national action plan, specifically supporting delivery of three main strategic aims
- Reports to health and wellbeing boards via health protection committee
- Also reports into various committees within each stakeholder organisation e.g. medicines optimisation programme board
CARG works treams
- Education and engagement with the public
- Education and engagement with healthcare workers and vets
- Comprehensive stewardship programme for all sectors
GP practices in Cornwall and the Isles of Scilly have been implementing the TARGET Antibiotics toolkit:
The toolkit aims to help influence prescribers’ and patients’ personal attitudes, social norms and perceived barriers to optimal antibiotic prescribing. It includes a range of resources that can each be used to support prescribers’ and patients’ responsible antibiotic use, helping to fulfil CPD and revalidation requirements.
In 2014/15, GP practices completed a self-assessment checklist and implemented strategies to help to reduce the inappropriate prescribing of antibiotics, e.g. delayed prescribing, patient leaflets. Doctors may consider issuing a ‘delayed or back-up prescription’ so that the patient can obtain antibiotics after a certain period of time if their symptoms continue.
When antibiotics are not prescribed patients can be given information on how long their symptoms may last, how to treat them and what to do if they do not ease. For the last two years NHS Kernow has provided all GP practices with printed A5 pads of the patient leaflets to use during consultations.
Quarterly antibiotic prescribing data is sent out to GP practices, including data for individual prescribers, so that they can monitor their total antibiotic items and numbers of broad spectrum antibiotics that should be kept to a minimum because of antimicrobial resistance (cephalosporins, quinolones and co-amoxiclav).
The current ‘Management of infection guidelines for primary and community services’ can be found here.
An e-learning for Healthcare module on Reducing Antimicrobial Resistance was launched in November 2015.
This module has been designed to support all health and social care staff – both clinical and non-clinical - in a variety of settings to understand the threats posed by antimicrobial resistance, and ways they can help to tackle this major health issue. This programme has been developed by Health Education England in collaboration with Public Health England and NHS England.
Antimicrobial prescribing and stewardship (APS) competencies
The APS competencies can be used by any independent prescriber to help develop their prescribing practice at any point in their professional development in relation to prescribing antimicrobials. There are five competencies:
- Infection prevention and control
- Antimicrobial resistance and antimicrobials
- Prescribing antimicrobials
- Antimicrobial stewardship
- Monitoring and learning
Drug and bug project
The drug and bug project is a joint Royal Cornwall Hospital NHS Trust and Health Education England project, raising awareness of antimicrobial resistance among health care providers and other community groups throughout out Cornwall.
The two BUDDIE nurse educators deliver a multi-tiered programme designed to educate those from both clinical and non-clinical backgrounds in the issues surrounding AMR and how we can all adopt collaborative approach to the way we use antimicrobials - now and in the future.
The first year of the project included visits to nursing homes, schools and engagement with numerous public awareness campaigns in Cornwall.