antibiotic guardian london workshop 2016

Welcome to the Antibiotic Guardian London Workshop

#antibioticguardian

National actions to tackle antimicrobial

resistance (AMR)

Antibiotic Guardian Roadshow

23 November 2016

Dr Diane Ashiru-Oredope

Pharmacist Lead;

Antimicrobial Resistance Programme

Public Health England

Twitter - @DrDianeAshiru

#AntibioticGuardian

The future if we do not act now

3

By 2050: more deaths from

resistant infections compared to

e.g. cancer

http://amr-review.org/

Antimicrobial Resistance and Stewardship Dr Diane Ashiru-Oredope

http://amr-review.org/

AMR and Antibiotic Use

4 Antimicrobial Resistance and Stewardship Dr Diane Ashiru-Oredope

Tackling AMR:

• The government

• Professional bodies/organisations/Public health agencies and leads

• Healthcare professionals – human and animal health

• The public

• Pharmaceutical companies

Antimicrobial Resistance

Dr Diane Ashiru-Oredope5 AMR; WLMHT Physical Health Conference Dr Diane Ashiru-Oredope

EVERYONE HAS A ROLE:


Global action on AMR

• WHA 2014 resolution

• WHO Global AMR Action Plan 2015 – framework for

action

• Global Health Security Agenda: AMR action package

- mechanism and collaboration to accelerate

implementation

• United Nations Declaration – September 2016 (193

countries)

http://www.un.org/pga/71/2016/09/21/press-release-hl-meeting-on-antimicrobial-resistance/


UK 5-year AMR Strategy 2013-18:

Seven key areas for action

PHEHuman health

DH – High Level Steering Group (cross government)

DefraAnimal health

DH

1. Improving infection prevention and control

2. Optimising prescribing practice

3. Improving professional education, training

and public engagement

4. Better access to and use of surveillance

data

• Improving the evidence

base through research

• Developing new drugs,

vaccines and other

diagnostics and treatments

• Strengthening UK and

international collaboration

Impact of EAAD and Antibiotic Guardian Dr Diane Ashiru-Oredope & Ms Katerina (Aikaterini) ChaintarliEAAD and Antibiotic Guardian Dr Diane Ashiru-OredopeAntimicrobial Resistance Dr Diane Ashiru-Oredope7 Antimicrobial Resistance and Stewardship Dr Diane Ashiru-Oredope

Non-susceptibility (%) among (a) E. coli, (b) Klebsiella spp. and (c) Enterobacter spp. from

bacteraemias in England, Wales and Northern Ireland, as reported to PHE-LabBase.

Livermore D M et al. J. Antimicrob. Chemother.

2013;jac.dkt212

© The Author 2013. Published by Oxford University Press on behalf of the British Society for

Antimicrobial Chemotherapy. All rights reserved. For Permissions, please e-mail:

[email protected]

Cephalosporins, diamonds;

ciprofloxacin, squares;

gentamicin, triangles Antimicrobial Use

is a driver for

resistance

AMR: individual riskRisk of resistance persists for at least 12 months in

individuals after each intake of an antibiotic

Increased risk of

resistant organism

Antibiotic in past

2 months

Antibiotic in past

12 months

UTI

5 studies: n = 14,348 2.5 times 1.33 times

RTI

7 studies: n = 2,605 2.4 times 2.4 times

A meta analysis of English Primary Care

Costello et al. BMJ. (2010) 340:c2096.

9 Antimicrobial Resistance Dr Diane Ashiru-Oredope9 Antimicrobial Resistance and Stewardship Dr Diane Ashiru-Oredope

10 Antimicrobial Resistance Dr Diane Ashiru-Oredope

CPEs: 2013 vs 2015

2013 vs 2015

11Antimicrobial Resistance Dr Diane Ashiru-Oredope

England: AMR and AMU surveillance



National Surveillance: Antibiotic use and

resistance in England 2015

Better access to and use of dataIn April 2015 PHE launched a series of AMR local indicators for England on the

Fingertips data portal.2 Data for more than 70 indicators are now available

across three NHS geographies: acute trusts, clinical commisioning groups

(CCGs) and GP practices.


Other clinical syndromes: E. coli UTI

ESPAUR 2010-2014: Year 2 Report

Improved AMR surveillance and drug-bug

outputs

Secular trends: Bloodstream E. coli AMR

Increased coverage from NHS

laboratories from 30% to 98%

Increased daily reporting from

10% to 82%

Increased automated reporting

from 0% to 78%


Developed Enhanced Surveillance for

Emerging Critical Resistance

CPE* in the UK, 2000-2014 Developed Enhanced

Surveillance

Develop

toolkits for

healthcare

settings*Carbapenemase Producing

Enterobacteriaceae

17Antimicrobial Resistance and Stewardship Dr Diane Ashiru-Oredope

Improved AMU surveillanceESPAUR can now track antibiotic prescribing from each healthcare sector.

PHE has worked with NHS England and NHS Improvement to implement the

Antibiotic Prescribing Quality Measures advised by the Department of

Health (DH) expert advisory committee on Antimicrobial Resistance and

Healthcare-Associated Infections (ARHAI) into incentives for CCGs and

acute trusts.


2015


Improved antimicrobial stewardship


Improved antimicrobial stewardship2014 to 2015: assessment of AMS activities and implementation of national AMS

toolkits in primary and secondary care – TARGET and Start Smart then Focus

(SSTF) respectively – Published in JAC

2015: Assessing the implementation of recommended antimicrobial stewardship

interventions in community healthcare trusts (77% response rate)


Improved antimicrobial stewardshipdeveloped an antimicrobial stewardship surveillance system including tools to

support stewardship audits in acute trusts and these are being used as part

of the CQUIN (Commissioning for Quality and Innovation) in 2016/17.


Antimicrobial Stewardship Surveillance:

CQUIN - data collection and submission

tools

ESPAUR and AMS Tools PHE CSPHDG Professional meeting Dr Diane Ashiru-Oredope24 Antimicrobial Resistance and Stewardship Dr Diane Ashiru-Oredope

Improved antimicrobial stewardshipDental antimicrobial stewardship toolkit has been developed and rolled out by

the dental subgroup of ESPAUR in collaboration with Faculty of General

Dental Practice and British Dental Association

https://www.gov.uk/guidance/dental-antimicrobial-stewardship-toolkit:

• Resources

• Guidance

• Education and training tools

• Audit tool and action planning


https://www.gov.uk/guidance/dental-antimicrobial-stewardship-toolkit

Improved public and professional

engagementAntibiotic Guardian’ (AG) campaign from awareness to engagement and

changes in public and professional behaviour around antibiotic use.

Process and outcome evaluations:

• showed the wide reach of the campaign success in increasing commitment

to tackling AMR in both healthcare professionals and members of the public

• increased self-reported knowledge and changed self-reported behaviour,

particularly among people with prior AMR awareness


http://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-016-3057-2

http://jpubhealth.oxfordjournals.org/content/early/2016/07/22/pubmed.fdw059.abstract

Improved public and professional

engagementWorked with Health Education England to scope and develop implementation

options related to education and training of healthcare professionals for

antimicrobial prescribing and stewardship competencies in undergraduate

and postgraduate education and for continuing professional development.


August 2016

4. Improved public and professional

engagement


The PHE Primary Care Unit has continued to work with schools to provide

education about the spread, prevention and treatment of infection through

the ongoing development and delivery e-Bug, a free educational resource

for use in the classroom and at home.

New work on fungal resistance,

surveillance and stewardship

ESPAUR have also increased outputs to look at fungal resistance, antifungal

consumption and stewardship as this is an area of emerging concern


Improved Antimicrobial Stewardship: Antifungal

StewardshipThere was a 30% response rate to the antifungal survey from acute trusts.

Although only a minority of trusts conducts AFS programmes, nearly half

include AFS as part of routine antimicrobial stewardship activities. Cost and

clinical need are the main drivers for AFS..


Launch of the national point prevalence

survey on healthcare-associated infections

and antimicrobial use in acute hospitals



• National actions to tackle AMR

• Local Implementation to tackle AMR in the North/Local AMR Action plans/STP

• One Health Initiative - uniting human and veterinary medicine

• Strengthening infection prevention and control practices

• Real world experience of a targeted, narrow spectrum antibiotic for the treatment of

CDI

• Evaluation of the feasibility of using point-of-care C-reactive protein to optimise

primary care prescribing for respiratory tract infections in Scotland

• Antimicrobial Stewardship - national update on CQUIN and QP

• Local – how are we doing towards achieving our AMR CQUIN part a and b

objectives

• Tackling AMR: Engaging with Patients and the Public

• Local examples of engagement with public/patient

• Engaging with students

• BANES – engaging with schools and combining flu campaign and Antibiotic

Awareness

• Engaging with community pharmacies

Antimicrobial Resistance Dr Diane Ashiru-Oredope

You are invited to become an Antibiotic

Guardian today (available via mobiles)


Addressing

AMR, IPC & HCAI

in London

Dr Tania Misra

AMR / IPC/ HCAI lead for PHE London

Consultant in Communicable Disease ControlNE & NC London Health Protection Team

Overview

• Role of PHE in AMR & HCAI

• London AMR & HCAI work – timeline

• AMR work done in London by FES,

Microbiology services and HPTs

• London AMR work plan 2016-2017

• London CRO Action Group

• Future plans

AMR, IPC & HCAI - The PHE role

at the frontline

• Working with partners to assist in the prevention of avoidable

HCAIs through proactive encouragement and promotion

of best practice in IP&C and AMR by providers and

commissioners

• Surveillance and timely feedback of AMR and HCAI-

related risk assessments and information to support actions

to reduce preventable HCAIs, including those due to

resistant organisms, and their consequences

• Support, coordination and expert advice in relation to

preservation of antibiotic effectiveness, HCAI and AMR-

related outbreaks and other situations

AMR Targets

Two new government ambitions

following the publication of the

O’Neill review

• Halving inappropriate

antimicrobial prescribing by 2020

• Halving healthcare acquired

Gram negative bloodstream

infections by 2020.

CQUIN for secondary care

• Reduction in antibiotic consumption per 1,000 admissions

• Empiric review of antibiotic prescriptions

Quality premium for primary care

• reduction in the number of antibiotics prescribed in primary care.

• number of co-amoxiclav, cephalosporins and quinolones as a proportion of the total number of selected antibiotics prescribed in primary care

London centre

AMR activity and timeline

Field Epidemiology

Services

Microbiology

Health Protection

Teams

Engagement with NHS

London since 2006

London DIPC Forum set

up in ~ 2010

Engagement with NHSE since 2012-13

Specialist Advice to Acute and Community Trusts

Building links with private providers

since 2014

Workshops, Study Days,

Training

Research projects

London CRO Action

Group - May 2016

London DIPC forum

Dissemination of key

messages

Collaborative Research /

Projects

Data requests

Communication between trusts,

PHE, NHSE, NHSI

Work done by PHL London for

AMR, IPC & HCAI

PHLL

Microbiology

Services in

London

Post Infection Reviews

– monthlyC difficile PII support Support NHS Trusts to

manage HCAI/ AMR

outbreaks / incidents

Education & Training

On going support to HPTs and NHS

providers on AMR and HCAI related topics

Work done by Field Epidemiology

Services for AMR, IPC & HCAI

Monthly Teleconference held at the centre – organised by FES (provide data, chair the meeting)

Quarterly report on mandatory surveillance data (MRSA, Cdiff, MSSA, E.coli) and other useful HCAI related data – e.g. CRO reports

AMR workbooks

Flagging outliers to relevant HPT

Expert epidemiological advice and support to large / complex outbreaks in hospitals, where requested or necessary

Supporting labs to adopt the Electronic Reporting System (ERS) for CRO samples through training and awareness

Training provided to HPT HCAI leads on data tools

- Fingertips

- HCAI DCS

- DET for Norovirus outbreaks

Work done by Health Protection

Teams for AMR, IPC & HCAI

Developing Positive Working

Relationships

Advice on IPC and AMR issues to linked

trusts / providers proactively through

IPCCs, Health Protection Committees

Useful link between IPC and AMR work in acute and community/ primary care – have an overview of the “patch”

Ensuring Surveillance

Information is Used for Action

Examination and dissemination of HCAI

and AMR data on a monthly basis

Raise concerns about outliers with relevant

provider/s

Support and Advice to Providers

Support and advice for transmission incidents

and outbreak management

Be the link for access to national experts

within PHE and the NIS for complex incidents

Workshops and Study Days

held in London over the last 5 years

• HCAI Study Day – July 2012

• IPC workshops with NHSE – July & Dec 2013

• CPE Workshop, March 2013

• CPE Toolkit Launch event – July 2014

• AMR Study Day – July 2016

Various research projects related to

AMR done in London

• The VIM Pseudomonas pilot study in London, 2012

• The Mupirocin Resistance - data analysis, 2012

• The E coli bacteraemia analysis, 2012

• Retrospective CRO review of London Hospitals, 2013

• The C.difficile in the community analysis, 2014

• The CPE toolkit audit study, 2015

• MSSA data analysis, 2015

• CPE toolkit audit of SL HPT

The London AMR plan for 2016-17

• AMR Study day

• HPT Geo leads to ensure in the acute

and community trusts they cover:

• AMR Audits

• AMR steering / stewardship group

• Process of disseminating the AMR

workbooks

• Encourage use of AMR data and

Fingertips

• HPT HCAI and Geo leads to

familiarise themselves with the

Fingertips tool

• Encourage providers to use the AMR

data to focus resources and effort

The AMR Fingertips Tool

• Antibiotic prescribing and antibiotic

resistance are inextricably linked

• AMR local indicators are publicly

available

• Intended to raise awareness of

antibiotic prescribing, AMR, HCAI,

IPC and AMS

• To facilitate the development of local

action plans


• Antimicrobial Resistance data is

available by Acute trust (MRSA) and

by CCG

• Antimicrobial Resistance - new data

available by CCG - Rolling quarterly

average proportion of E. coli blood

specimens non-susceptible to the

following antibiotics: 3rd generation

cephalosporins, ciprofloxacin,

gentamicin, piperacillin/ tazobactam


Antibiotic Prescribing data is available

by Acute Trust, CCG and GP practice

The “compare areas” and “area profiles” functions

enable a picture of antibiotic prescribing at CCG level

London CRO Action Group

• Established July 2016

• Chaired by DDHP

• Representatives from

acute trusts with an interest in CRO

• Quarterly meetings

• Troubleshooting

• Sharing good practice and data

Looking ahead

• Working with community partners on the Gram-

negative bacteraemia target

• Opportunities to engage with new local NHS

planning arrangements in the Sustainability and

Transformation Plans (STPs)

Acknowledgements

– the fab London Team

Microbiology

• Dr Bharat Patel

Field Epidemiology Services

• Shamma Mumtaz

• Geraldine Leong

• Dr James Sedgwick

Health Protection

• Dr Rachel Heathcock

• Dr Anita Bell

• Dr Deborah Turbitt, DDHP

One Health Initiative -

uniting human and

veterinary medicine

Presented by: Professor Peter Borriello

Date: 23rd November 2016 #1086086

ESBLs and food:

disinformation for mass consumption


2. Optimising prescribing

3. Improving professional education, training, public engagement.

4. Developing new drugs, treatments, diagnostics.

5. Increased access to/use of surveillance data.

6. Identification and prioritisation of AMR research needs.

7. Strengthened international collaboration

UK 5 year AMR strategy:

63

The working Hypothesis

Antibiotic useSelection for

resistance

Commensal R genes PathogenComplicates

treatment

Human

Antibiotic useSelection for

resistance

Commensal R genes PathogenComplicates

treatment

Human

The working Hypothesis

Alternatives

Improve

Infection control

• Food Hygiene

• Zonoses control

Prevent

65

AMRAssumptions which areMostlyReasonable

Superbugs in the Supply Chain: How pollution from antibiotics factories in India and China is fuelling the global rise of drug-resistant infections

Antibiotic-resistant ‘superbug’ bacteria found at NHS-funded factories. Drug resistant bacteria have been found at several pharmaceutical manufacturing sites in India…Out of 34 sites tested, 16 were found to be harbouring bacteria resistant to antibiotics, according to the study. At 4 of the sites, resistance to 3 major classes of antibiotics was detected, including antibiotics of 'last resort'

Environmental contamination

“Beaucoup de

germes nous voient

nous et les animaux

comme part du

même

environnement dans

lequel on vit.

Commes ces germes

nous voient comme

part d’un monde

unifié, nous devont

avoir une réponse

unifiée”.

S.P. Borriello, launch of Med Vet Net Association

October 2009

Article 2

70

The Three Key Pillars of National and

International Strategies

1.Optimal Stewardship to prolong

active life of what we have

2.Prevention of spread of resistance

3.Develop alternatives

Antibiotic WHO

(human)

EAGAR

(human)

OIE (animal

health)

Narrow spectrum penicillins Critical (1) Low (3) critical (1)

piperacillin Critical (1) High (2)

Anti-staphylococcal penicillins High (2) Medium

(2)

critical (1)

Amoxicillin-clavulanate Critical (1) Medium

(2)

critical (1)

Ticarcillin-clavulanate;

piperacillin-tazobactam

Critical (1) High (1)

1st generation cephalosporins High (2) Medium

(2)

critical(1)

3rd generation cephalosporins Critical (1) High (1) critical(1)

4th generation cephalosporins Critical (1) High (1) critical (1)

nitrofurans Important

(3)

Low (3)

Comparison of WHO/EAGAR/OIE antibiotic rankings

Antibiotic WHO

(human)

EAGAR

(human)

OIE (animal health)

Macrolides Critical (1) Low (3) critical (1)

Lincosamides Important

(3)

Medium

(2)

Highly important (2)

Quinolones – nalidixic acid Critical (1) Medium

(2)

critical (1)

Fluoroquinolones Critical (1) High (1) critical (1)

Streptogramins Critical (1) High (1) important (3)

Rifamycins Critical (1) High (1) Highly important(2) –

critical (1) in horses

Amphenicols High (2) Low (3) critical(1)

Polypeptides – bacitracin,

gramicidin

Important

(3)

Low (3) Highly important (2)

colistin High (2) High (1) Highly important (2)


Antibiotic WHO

(human)

EAGAR (human) OIE (animal

health)

Tetracyclines High (2) Low (3) critical (1)

Glycylcylines - tigecycline Critical (1) High (1)

Aminoglycosides – neomycin, High (2) Low (3) critical (1)

streptomycin Critical (1) Low (3) critical (1)

Gentamicin, tobramycin Critical (1) Medium (2) critical (1)

spectinomycin High (2) Medium (2) critical (1)

Netilimycin, amikacin Critical (1) High (1) critical (1)

Sulfadiazine, trimethoprim High (2) Low (3) critical (1)

Trimethoprim-sulphamethoxazole (co-

rimoxazole)

High (2) Medium (2) critical (1)

Fusidanes – fusidic acid Important

(3)

High (1) important (3)


74

High-Level comparison of veterinary

and human use of antibiotics.

Animal Human

Highest Use

Lowest Use

Livestock

(farm)GP

(Community)

Companion

animals

(Community)

Hospitals

Sales / Use

Human Animal

Sales

Prescription

All ATC Codes

76

Drivers of Enhanced Selection and

Maintenance of Antibiotic Resistance

Poor prescribing

Counterfeits

Globalisation

Inappropriate dosing

Slow diagnostics

Market disincentives

Variable

regulation/guidance/education

77

Key Issues Within and Between

Disciplines

Methodology Degree of Speciation

Break-points Source of Isolates

ECoFFs Drug-bug Combinations

MARAN: Salmonella CipR

2004 0.3%

2005 10.1%

MARAN: Salmonella CipR

2004 0.3% CBp>2µg/ml

2005 10.1% ECV 0.06µg/ml

Article 2

82

One Health Reports

E.coli, salmonella, campylobacters.

Issues:

Sample size Incomplete speciation

Methodology Dose data (human)

Definition of R Sales data (animals)

83

Escherichia coli and Resistance to

Key Antibiotic Classes

Cefotaxime/Ceftazidime 10% -

Cefotaxime - 11%

Ceftazidime - 6%

Fluoroquinolones 18% 6%

Gentamicin 9% 3%

Antibiotic Human Animal

84

Salmonella and Resistance to Key

Antibiotic Classes

Humans 2% 16%

Cattle 0% 0%

Chickens* 0% 1% (0%)

Turkeys* 0% 7% (0%)

Pigs* <1% (2%) 0%

Sheep 0% 0%

Cefotaxime Fluoroquinolones

85

Campylobacter and Resistance to

key Antibiotic Classes

Fluoroquinolones Erythromycin

Humans (c.jejuni) 47% 2.5%

Chickens (c.jejuni) 31% 0%

Humans (c.coli) 47% 8%

Chickens (c.coli) 42% 3%

Pigs (c.coli) 13% 28%

One Health and Susceptibility Testing

Campylobacter

Routine lab (h) : Campylobacter spp; disc

Reference lab (h): C.jejuni / coli ; diln

Animal: C.jejuni / coli ; disc

Large animal MRSA- LA-MRSA

animal MRSA- LA-MRSAanimal

MRSA- LA-MRSA• Generally multi-resistant – tetracycline and macrolide

(erythromycin, tylosin) resistance particularly common

• Note that ST398 less virulent than other MRSA strains

(lacks virulence genes)

• Large animal MRSA no longer just ST398 or ST9 –

also ST541 and ST692 (South Korea), ST5 (Korea,

USA), ST1, ST8 (Switzerland)

• Some of the non-ST398 strains carry PVL (Japan,

Korea)

• Pig ST9 strains ex China – 16/100 – reduced

vancomycin susceptibility (Kwok et al, 2013)

MRSA in companion animals

companion animals• Animal link first suspected late 80s–

Scott et al (J Hosp Infect 12:29-34) –

geriatric ward – nursing staff -

resident cat

• Same hospital strain found in pet

dog as in nurse owners – repeated

colonisation (Cefai et al Lancet,

1994, 344:539-540)

• From then on exponential increase

in reported cases – all hospital

strains

• Carriage in veterinarians and staff

reported

• Many cat and dog isolates from

healthy animals (ie carriage) but

some wound infections

89

Most commonly used Antibiotics

Human Animals

1. Penicillins 64% 1. Tetracylines 43.5%

2. Tetracylines 10% 2. Penicillins 22%

3. Macrolides 9.5% 3. Sulph/Trimeth 14.5%

4. Sulph/Trimeth 3% 4. Macrolides 10%

5. Other 13.5% 5. Other 10%

Lewisham and Greenwich NHS

Trust

NHS Improvements -

Infection Prevention and Control

Improvement Collaborative

Chris Wood – Lead Antimicrobial

Pharmacist (QEH)

Feb 2016Visit from TDA

Invitation to participate:

Infection Prevention and Control Improvement Collaborative


Better patient outcomes by improving IPC practice by September 2016

• Builds on the work many trusts are already undertaking to improve their processes for IPC

• 90 day cycle rapid improvement programme

• Start small in a defined area

• Undertake early testing (PDSA cycles)

• Use the learning gathered in these areas to choose the interventions with the greatest impact

• Scale-up to full implementation across the organisation

PDSA cycles

Project ideas

• Recording of stool charts

• Stool sampling process

• Antimicrobial prescribing

Why focus on 72 hour review of antibiotics?

“Antimicrobial resistance poses a catastrophic threat. If we don’t act now, any one of us could go into hospital in 20 years for minor surgery and die because of an ordinary infection that can’t be treated by antibiotics. And routine operations like hip replacements or organ transplants could be deadly because of the risk of infection.”

Chief Medical Officer - Dame Sally Davies


• Threat of antimicrobial resistance



• Evidence of lapses contributing to C diff cases




• Local antibiotic prescribing audit results





• National initiatives (Start Smart then Focus, Antibiotic Guardian)





• National initiatives (Start Smart then Focus, Antibiotic Guardian)

• CQUINs

Aim Primary Drivers Secondary Drivers

Within 90 days increase the

percentage of patients on

antibiotics with a documented

antibiotic review decision within 72 hours

Medical leadership

Divisional Director and consultant engagement

Junior doctor involvement in change process

Junior doctor involvement in auditing

Empowering staff to challenge prescribing

Co-ordinated education of doctors, nurses and pharmacy team

Communication points between pharmacy and medical team

Communication points between nursing and medical team

Tools in place to support process

Materials in place on ward as reminders

Educational materials in place for new staff

Selecting the area

• Team with existing links to the microbiology team

• Area with below average performance in audits

• Engaged junior doctors

• Engaged senior nursing team

• Pharmacy team involvement

Left to right: Alok Khanna (Orthopaedic SHO), Jeanette Baverstock (ward 17 manager), Chris Wood (antimicrobial pharmacist), Juliet Uwagwu (consultant microbiologist), Debbie Flaxman (Deputy director infection prevention and control), Sheila Howard (Infection prevention and control matron)

PDSA cycles

PDSA cycles

• Doctors education programme

• Promotion of Start Smart then Focus principles


• Promotion of Start Smart then Focus

principles

PDSA cycles



• Nurse ward round prompt sheet

• Nurse ward round prompt

sheet

PDSA cycles



• Nurse ward round prompt sheet

• Ward pharmacist engagement

Challenges

• Small number of patients for auditing

• Time consuming processes

• Maintaining motivation within the team

• Slow speed of generating and testing new ideas

• Roll out not yet completed

Benefits

• Creation of multi-disciplinary team with different approaches

• Trial of different interventions over short period

• Production of new resources which can be used to promote Antimicrobial Stewardship within the Trust

• Learnt new rapid methods of making change

Next steps

• Scaling up

• Working with general surgical team

• Recruit “change champions” - consultant, junior doctor, senior nurse, practice development nurse, pharmacist

• Roll out pack of materials

• Antimicrobial Stewardship introduction video

Antimicrobial Stewardship introduction video

https://www.youtube.com/watch?v=ykvl9ArctvI&t

https://www.youtube.com/watch?v=ykvl9ArctvI&t

[email protected]

mailto:[email protected]

Evaluation of C-reactive protein in

primary care settings to support

reduction of antibiotic prescribing

for self-limiting respiratory infections

Dr Jacqueline Sneddon,

Project Lead for SAPG

• Patient expectations

• Diagnostic uncertainty

• Decision fatigue

• Targets to reduce unnecessary antibiotic

use

ISSUES WITH MANAGING RESPIRATORY TRACT

INFECTIONS IN PRIMARY CARE

For people presenting with symptoms of lower respiratory tract infection in

primary care, consider a point of care C-reactive protein test if after

clinical assessment a diagnosis of pneumonia has not been made and it is

not clear whether antibiotics should be prescribed.

Use the results of the C-reactive protein test to guide antibiotic prescribing in people

without a clinical diagnosis of pneumonia as follows:

• Do not routinely offer antibiotic therapy if the C-reactive protein concentration is less

than 20 mg/litre.

• Consider a delayed antibiotic prescription (a prescription for use at a later date if

symptoms worsen) if the C-reactive protein concentration is between 20 mg/litre and

100 mg/litre.

• Offer antibiotic therapy if the C-reactive protein concentration is greater than

100 mg/litre

PNEUMONIA IN ADULTS: DIAGNOSIS AND

MANAGEMENT – NICE CG191

https://www.nice.org.uk/guidance/cg191?unlid=3826569120162211655

• Biomarker of infection which is part of the acute phase response to acute tissue injury regardless of the aetiology (infection, trauma and inflammation)

Surrogate marker of infection

• Evidence supports the clinical and cost-effectiveness of CRP testing for management of lower respiratory tract infections in primary care

• CRP is standard of care in some European countries

• CRP testing also recommended in Public Health England (PHE) primary care guidance (May 2016) for acute cough bronchitis

• Test takes 3.5 minutes so can be utilised within GP consultations to inform clinical management

C-REACTIVE PROTEIN

• Jensen A R et al, Biomarkers as point-of-care tests to guide prescription of antibiotics in patients with acute respiratory infections in primary care (Review) Cochrane Collaboration 2014

• Cooke J et al, Narrative review of primary care point-of-care testing (POCT) and antibacterial use in respiratory tract infection (RTI). BMJ Open Resp Res 2015;2:e000086

• Cals J W L et al, Point-of-Care C-Reactive Protein Testing and Antibiotic Prescribing for Respiratory Tract Infections: A Randomized Controlled Trial, Ann Fam Med 2010;8:124-133

• Oppong R et al. Cost-effectiveness of point-of-care C-reactive protein testing to inform antibiotic prescribing decisions Br J Gen Pract. 2013 Jul; 63(612): e465–e471

• Hunter R, Cost-Effectiveness of Point-of-Care C-Reactive Protein Tests for Respiratory Tract Infection in Primary Care in England. Adv Ther (2015) 32:69–85

• Andreeva A, Melbye H, Usefulness of C-reactive protein testing in acute cough/respiratory tract infection: an open cluster-randomized clinical trial with C-reactive protein testing in the intervention group, BMC Family Practice 2014, 15:80

• Howick J et al, Current and future use of point-of-care tests in primary care: an international survey in Australia, Belgium, The Netherlands, the UK and the USA, BMJ Open 2014;4:e005611

• Huddy J R et al, Point-of-care C reactive protein for the diagnosis of lower respiratory tract infection in NHS primary care: a qualitative study of barriers and facilitators to adoption, BMJ Open 2016;6:e00995

EVIDENCE FOR CRP TESTING

• Evidence base supports use in LRTI

• Work underway in children presenting to Out-of-hours settings

(mainly with URTI) and in patients with COPD exacerbations

(anticipatory care).

• Procalcitonin also useful biomarker for infection but evidence only

established in hospital practice – mainly in ICU to assess response to

treatment and inform when antibiotics can be stopped.

• Early trials in primary care underway.

• Test takes about 20 minutes for a result so logistics of use in primary

care would need different model to CRP

WHEN IS CRP USEFUL?

WHAT ABOUT USING PROCALCITONIN?

AIM - to evaluate the feasibility of using CRP to support clinical decision-making in lower

respiratory tract infections in GP practices in Scotland.

METHOD

• Study steering group established to advise on methodology and governance issues.

• Ten GP practices recruited across four NHS board areas to take part in study.

• Alere Afinion® instruments provided on loan and training provided within each practice.

• Test strips ordered by practices and funded by SAPG (£3.50 per test).

• CRP testing used with patients presenting with suspected LRTI for at least 4 weeks

during the period November 2015–February 2016. NICE CRP thresholds used.

• Data on patient demographics and decision to prescribed or not collected during

consultations.

• On-line survey used to gather feedback on practical aspects of how the test was used

and its perceived impact on GP decision-making and prescribing of antibiotics.

SAPG STUDY

RESULTS - PATIENTS PRESENTING WITH LRTI

172

59

15

Age of patients presenting with LRTI (n= 246)

16-64 years

65-79 years

80 years and over

18% of patients had COPD

CRP TEST RESULTS

72%

24%

4%

0% 10% 20% 30% 40% 50% 60% 70% 80%

CRP result low (<20)

CRP result intermediate (20-100)

CRP result high (>100)

Percentage of patient tests

CRP results (n= 231)

For 15 patients (6%) there were problems with instrument error message so no result recorded

DID CRP TEST RESULT AFFECT DECISION MAKING?

74%

20%

6%

0% 10% 20% 30% 40% 50% 60% 70% 80%

Yes

No

Unsure

Percentage of patients

Influence of CRP on prescribing decision (n=231)

HOW DID CRP INFLUENCE PRESCRIPTIONS?

64%

14%

22%

0% 10% 20% 30% 40% 50% 60% 70%

No prescription

Delayed prescription

Immediate prescription

Percentage of patients

Prescriptions for antibiotics (n=230)

One patient referred to hospital as high CRP

• Completed by 15 GPs.

• Training provided was sufficient but suggestion for a training DVD to provide a refresh on details of user technique.

• Most respondents found test easy to use.

• Three respondents reported having problems with user technique e.g. not using adequate blood sample, getting air bubble in cartridge.

• A few respondents suggested the need to switch on to warm up for 15 minutes and 3+ minute wait for result were potential barriers although this became easier with use.

• A variety of models were used; 4 GPs carried out tests themselves, 8 had test carried out by a practice nurse and 3 used a combination of both approaches.

FEEDBACK SURVEY – USING AFINION INSTRUMENT

• All respondents found it easy to identify patients with LRTI.

• Proportion of consultations where CRP test influenced the decision to not prescribe antibiotics

• Several respondents commented that using the test improved patient engagement and supported them in not prescribing to back up their assessment of clinical symptoms

IMPACT ON CLINICAL PRACTICE

Proportion of patients No. GPs (% GPs)

<25% 3 (20.0%)

25-50% 3 (20.0%)

51 – 75% 5 (33.3%)

>75% 4 (26.7%)

• Most respondents thought their patients found the results of

the CRP test an additional reassurance to their clinical

diagnosis

• Nine (60%) of respondents found the test helpful in dealing

with difficult patients who insisted on an antibiotic

• Other potential benefits identified by some respondents

were:

o increased use of delayed prescriptions for LRTI

o reduced number of patients seeking a second

appointment with the same symptoms

PERCEIVED IMPACT ON PATIENTS

• Overall respondents were positive about the benefits of using CRP testing.

• The main practical concern was the additional time that the test adds to a consultation, 3.5 minutes for the test plus time to explain test to patient is significant within a 10 minute consultation.

• A portable instrument would be of interest for home visits and in care homes, particularly for patients with COPD where exacerbations are often treated with antibiotics despite uncertainty about whether there is an infection.

• Patient experience of the test was positive as it provided reassurance when no antibiotic was required especially for ‘worried well’ patients.

• The majority of respondents would like to see CRP testing used routinely but there were some concerns about cost effectiveness.

SUMMARY OF EVALUATION

• Study results presented to Controlling Antimicrobial

Resistance in Scotland (CARS) group, chaired by CMO

discussions underway within Scottish

Government about further testing/roll out.

• Results shared with colleagues in other UK nations trialling

or implementing CRP testing.

• Results presented as poster at RCGP and FIS conferences

and as presentation at Antibiotic Guardian road show in

London.

WHAT HAPPENS NEXT?

RCGP conference

• Reduced antibiotic prescribing and unscheduled re-attendance by implementation of CRP point of care testing for acute LRTI in a nurse-led clinic - 67 patients (18-65 years)

• Near-patient CRP testing – a game changer antibiotic prescribing?– 3-month study in primary care using 606 tests resulted in 30% reduction in antibiotic prescriptions

Publications

• Should all acutely ill children in primary care be tested with point-of-care CRP: a cluster randomised trial? Restrict to those with high risk of serious infection. Verbakel et al. BMC Medicine (2016) 14:131

• Point-of-care C-reactive protein testing to reduce inappropriate use of antibiotics for non-severe acute respiratory infections in Vietnamese primary health care: a randomised controlled trial - 1028 children and 1009 adults. Lancet Global Health 2016; 4: e633–41

• Evaluating a point-of-care C-reactive protein test to support antibiotic prescribing decisions in a general practice – 94 patients. Clinical Pharmacist, October 2016, 309-318

RECENT STUDIES ON CRP

Point-of-care CRP testing in the diagnosis of pneumonia in adults

DRUG AND THERAPEUTICS BULLETIN OCTOBER 2016

The use of CRP testing may reduce unnecessary antibiotic prescribing while

targeting antibiotic therapy to patients most likely to benefit from it.

Rapid uptake of POC CRP testing in primary care seems unlikely in the absence

of a funded implementation programme.

• Scottish Government HAI Task Force (now SARHAI Strategy

Group) – for funding the study

• Alere Ltd – for supplying Afinion analysers

• Study reference group – for advice on study set up

• SAPG members – for recruiting GP Practices

• GP Practice staff in NHS GGC, Lothian, Tayside and Highland

ACKNOWLEDGEMENTS

THANK YOU

http://www.scottishmedicines.org.uk/files/sapg1/Executive_summary

_Evaluation_of_CRP_testing_in_primary_care_July_2016.pdf

http://www.scottishmedicines.org.uk/files/sapg1/Executive_summary_Evaluation_of_CRP_testing_in_primary_care_July_2016.pdf

Question and answers from the floor

#antibioticguardian

Lunch and networking

#antibioticguardian

Welcome back

Dr Diane Ashiru-Oredope, Pharmacist Lead, Public Health England

#antibioticguardian

Antimicrobial Stewardship - national

update on CQUIN and QPStuart Brown

Project Lead – AMR and HCAI

NHS Improvement

18th November 2016

Plan

• Background

• AMR CQUIN

• Quality Premium

• It is growing and spreading according to WHO

figures

– 5 of 6 regions show >50% resistance to 3rd gen

cephalosporins & fluoroquinolones in E.coli

– ALL SIX regions have >50% resistance in Kleb

pneumonia to 3rd gen cephalosporins & 2/5 show AMR

to carbapenems

• All antibiotics will be become resistant in time

• Antimicrobial resistance is generally irreversible

• AMR is directly linked to use at national level

• The antibiotic pipeline is dripping at best

Global AMR in 2014

UK Five Year AMR Strategy

Commissioning for Quality

and Innovation (CQUIN)

• CQUIN framework supports improvements

in the quality of hospital services and the

creation of new, improved patterns of care.

• National & local indicators

– 4 or 5 national priorities each year. Worth 2.5%

of income

– 2016-7 Clinical: Sepsis (2nd year), AMR,

Physical health of patient with severe mental

health

Commissioning for Quality and

Innovation (CQUIN) 2016-17

The CQUIN scheme is intended to deliver clinical quality

improvements and drive transformational change. These

will impact on reducing inequalities in access to services,

the experiences of using them and the outcomes

achieved

Part A – Reduction in antibiotic consumption per

1,000 admissions

Part B – Empiric review of antibiotic prescriptions

156

AMR CQUIN 2016/17

Part A

• Reduction of 1% or more* in

– total antibiotic usage

– carbapenem usage

– piperacillin-tazobactam usage

• Submission of consumption data to PHE for years

2014/15 and 2015/16

Part B

• Percentage of antibiotics prescriptions reviewed within

72 hours

– Local audit of a minimum of 50 antibiotic prescriptions

* against baseline data 2013/14

Each indicator is worth 0.2% of the CQUIN scheme

AMR-CQUIN – what & why?

Requires 1% (DDD per admission) vs 2013-4

baseline for:

• Total (IP & OP): +6% over 4 years nationally

• Carbapenems: +36% & KPC outbreaks

• Piperacillin-tazo: +55% & K.pneum-R +36%

E.coli +31%

• 90%+ documentation of empiric antibiotics review

by day 3 (Q1 25%, Q2 50%, Q3 75%, Q4 90%): Only 10% of

Trusts could provide data though mandatory

Hospitals AMS Teams to use ££ to improve IT, staffing,

fund more expensive antibiotics or tests.

Summary: To meet the AMR and

Sepsis CQUINs

• Design systems to force better prescribing eg day 3 review for de-escalation AND IV to oral switch

• Review guidelines containing piperacillin-tazobactam and meropenem. Ensure they are followed through audit & feedback

• Quality improvement, not annual audit of AMS

• Merge sepsis and AMR CQUIN – start smart then focus

• Protected (restricted) antibiotic systems need to work

• Monitor & benchmark antibiotic usage

• Regular but varied communication on progress

• Local education & training at ward level

• Strong and effective multidisciplinary leadership (champions) at all levels

Start Smart – Then Focus

160

Progress So Far (as of October 2016)

Part A Consumption

2014/15 and 2015/16

Consumption data

Q1 2016/17

Number

Submitted

132 124

% of total 86% 81%

• Part B Empiric review of antibiotic prescriptions• 125 of 154 Trusts have submitted data via the PHE AMS online

submission tool

• Data indicates that 81.3% of prescriptions have evidence of review

within 72 hours (range 22-100%).

All data submitted is available on AMR Fingertips

http://fingertips.phe.org.uk/profile/amr-local-indicators

http://fingertips.phe.org.uk/profile/amr-local-indicators

Quality Premium

2015/16 and 2016/17

Improved antibiotic prescribing in

primary and secondary care

The ‘quality premium’ is intended to reward

clinical commissioning groups (CCGs)

for improvements in the quality of the

services that they commission and for

associated improvements in health

outcomes and reductions in inequalities in

access and in health outcomes

This is a composite Quality Premium consisting

of three parts:

Part a) reduction in the number of antibiotics

prescribed in primary care

Part b) reduction in the proportion of broad

spectrum antibiotics prescribed in primary care

Part c) secondary care providers validating their

total antibiotic prescription data

NHS England Antibiotic Quality

Premium Dashboard

NHS England Antibiotic Quality Premium

Dashboard 2015-16

Antimicrobial resistance (AMR) Improving

antibiotic prescribing in primary care

Quality Premium Guidance for 2016/17

The two parts of the quality premium have specific thresholds as follows:

• Part a) reduction in the number of antibiotics prescribed in primary care. The required performance in 2016/17 must either be:

a 4% (or greater) reduction on 2013/14 performance

OR

equal to (or below) the England 2013/14 mean performance of 1.161 items per STAR-PU

• Part b) number of co-amoxiclav, cephalosporins and quinolones as a proportion of the total number of selected antibiotics prescribed in primary care to either:

to be equal to or lower than 10%, or

to reduce by 20% from each CCG’s 2014/15 value

So how do we continue to improve primary care

antibacterial prescribing in 2016-17?

Respiratory tract infections

• Delayed and No antibiotic prescription resources

• Bristol University NIHR funded research tools for use in

children

• Diagnostics – US Agency for Healthcare Research and Quality

• Vaccination

Urinary Tract Infections

• Link with the Think Kidney AKI programme

• Target nursing home residents

Education and Behavioural change

• Engage schools and universities

• Make every contact count – how can nurses help?

Local AMR Plans

Antimicrobial resistance (AMR)

Improving antibiotic prescribing in

primary care Quality Premium Guidance for 2016/17

Current Performance

173

2017-19 AMR incentives

174

Reducing the impact of serious

infection CQUIN

Reducing Gram Negative

Bloodstream Infections (GNBSIs)

and inappropriate antibiotic

prescribing in at risk groups

Quality Premium for CCGs

a) Timely identification and

treatment for sepsis in

emergency departments and

acute inpatient settings

b) Empiric review of antibiotic

prescriptions between 24-72

hours of patients with sepsis who

are still inpatients at 72 hours

c) Reduction in antibiotic usage

a) Reducing GNBSIs across the

whole health economy

b) Reduction of inappropriate

antibiotic prescribing for urinary

tract infections (UTI) in primary

care

c) Sustained reduction of

inappropriate prescribing in

primary care

Tackling AMR: Engaging with

Patients and the Public

Dr Diane Ashiru-Oredope

Pharmacist Lead;

Antimicrobial Resistance Programme

Public Health England

Twitter - @DrDianeAshiru

#AntibioticGuardian

UK 5-year AMR Strategy 2013-18:

Seven key areas for action

PHEHuman health

DH – High Level Steering Group (cross government)

DefraAnimal health

DH


2. Optimising prescribing practice

3. Improving professional education,

training and public engagement

4. Better access to and use of surveillance

data

• Improving the evidence

base through research

• Developing new drugs,

vaccines and other

diagnostics and treatments

• Strengthening UK and

international collaboration

Impact of EAAD and Antibiotic Guardian Dr Diane Ashiru-Oredope & Ms Katerina (Aikaterini) Chaintarli

Tackling AMR: Engaging with Patients and the Public

Antibiotic resistance is poorly communicated and widely

misunderstood by UK public

“the body becomes resistant to antibiotics”

“If my symptoms have gone, I no longer

need to take antibiotics”

“It’s not my problem”

People have a better understanding when

AMR is presented in a way that is relatable

to them

“By getting antibiotics from the doctor, I

haven’t wasted their time”


Every infection prevented

means less antibiotics

are used

AMR



2016 theme: chain of infection

Timeline of English Antibiotic

Awareness campaigns

1999: Andybiotic –

“Don’t wear me out”

• Press and magazines

• GP surgeries –

leaflets and postcards

• GP non-prescription

pads

• 1999, 2000, 2003,

2006

Educating the public: the value of awareness campaigns Dr Diane Ashiru-OredopeTackling AMR: Engaging with Patients and the Public

Sent to all GP surgeries and

independent pharmacies

Developing plans for EAAD 2014• In previous years EAAD plans included creating educational materials

which healthcare professionals could use as part of local awareness

campaigns.

• Developed EAAD in 2014

• campaign that would be available all year round

• awareness raising engagement

• commitment from healthcare professionals and the public

• First year that the lead organisation aimed to directly engage the public

• Campaign developed by PHE in collaboration with all the UK devolved

administrations and also professional organisations

• Planning group is a multi-disciplinary group with public and third-sector

representation from human and animal health sector across the UK


Educating the public

Moving from awareness to engagement:

Antibiotic Guardian calls on everyone in UK to become

Antibiotic Guardians – Behaviour change – ‘if-then’ approach

pledge system: http://antibioticguardian.com/

Tackling AMR: Engaging with Patients and the Public Combating AMR (CPC Conference) Dr Diane Ashiru-OredopeAntimicrobial Stewardship Dr Diane Ashiru-OredopeEAAD and Antibiotic Guardian Dr Diane Ashiru-OredopeTackling AMR: Engaging with Patients and the Public

http://antibioticguardian.com/

Video created with TV doctorEducates on antibiotic resistance; suggests three steps that public can

take to help and a call to become an antibiotic guardian. Available for

download

Antimicrobial Stewardship Dr Diane Ashiru-OredopeTackling AMR: Engaging with Patients and the Public

Current website

Public Information should reflect One Health agenda –

VMD, Bella Moss


NEW GROUPS FOR WAAW/EAAD/AG 2016/17

• Increase local implementation and participation – can you help?

• Healthcare Students – seeking Antibiotic Guardian champions in healthcare schools

• Young families for children and families – Developing “Junior Antibiotic Guardian”

through the use of digital badges. This is in collaboration with PHE nursing directorate, eBug and Makewaves(https://www.makewav.es/).

• The Public through Community Pharmacy

Antimicrobial Stewardship in England Dr Diane Ashiru-Oredope 190 Implementing Antimicrobial Stewardship London AMR Study Day Dr Diane Ashiru-Oredope


New resources for 2016

World Antibiotic Awareness Week 2016


#AGCStudents

BBC Doctors: EAAD/AG Replay

AMR Quiz on Playbuzz

Blogs posted duringWAAW 2016


EAAD & Antibiotic Guardian: children

centres; hospitals; community pharmacies

University College London Hospitals

Awareness and engagement in Hospitals, community pharmacies,

universities, organisations in all UK Countries

Engagement via social media – e.g pictures tweeted with

#AntibioticGuardian

World Antibiotic Awareness Week


2016 Registration:

Organisation support: 157

Health School (dentistry, medicine, pharmacy, Vet): 48

Community Pharmacy: 238

#AntibioticGuardian


#EAAD


#AntibioticResistance


Antibiotic Guardian – Russian & Dutch

French currently being developed


Educating children – e-bug led by PHE

Primary Care Unit (Prof Cliodna McNulty)

Europe wide resource, led by Public Health England

e-Bug has

been

translated

into 22

different

languages,

including

most

European

languages,

Turkish

and Arabic

Free educational resource for classroom and home use and makes learning about micro-

organisms, the spread, prevention and treatment of infection fun and accessible for children and

young adults/students

AMR Public Involvement Forum • Engage with the public via strategic partners and other voluntary

organisations, PHE colleagues, lay members

• Representation from

• animal health, respiratory conditions, faith organisation, BME

organisation, home hygiene, various Healthwatch

• Raise awareness of the importance of AMR

• Encourage organisations to engage with the public to raise awareness

of AMR, especially during WAAW, IIPW

• Using resources and expertise to produce a public engagement toolkit

to support local Public Health England centres and Health Protection

teams



AMR Toolkit

Local

engagement


Conclusion• Improving professional education, training and public engagement is

one of the seven key areas of the 5 year UK AMR strategy

• England has participated in EAAD activities since 2008, awareness

was increased but no evidence of increased knowledge and behaviour

change

• For the first time, using behaviour change strategies, the Antibiotic

Guardian campaign has shown evidence of moving from increasing

AWARENESS to ENGAGMENT and commitment from healthcare

professionals and the public

• Evaluation of the Antibiotic Guardian campaign highlighted that it is

an effective for increasing knowledge and changing behaviour (self

reported) particularly among members of public


Antimicrobial Resistance Dr Diane Ashiru-Oredope

You are invited to become an Antibiotic

Guardian Champions today

208 Dr Diane Ashiru-Oredope

The Antibiotic Guardian Campaign

- At the Student End

Osenadia Joseph-Ebare & Lara-Turiya Seitz

Co-leads of the Antibiotic Guardian Health Students Planning Group

AG Health Students Planning Group

- Launched in April till November 2016

- Multidisciplinary team:

- Pharmacy

- Medicine

- Dentistry

- Nursing

- Veterinary medicine

Campaign Goals

Goal: 20 universities

Outcome:

20 universities and health student societies

66 nominated AG representatives

Communication:

- Facebook group

- AGC email account

Materials

How local networks are enabling Antimicrobial Stewardship activity in Bath & North East SomersetSchools & Vaccination

Elizabeth Beech 24th November 2016 Pharmacist - NHS Bath and North East Somerset CCGNational Project Lead Healthcare Acquired Infection and Antimicrobial Resistance - NHS [email protected] @elizbeech

mailto:[email protected]

Maximising flu vaccination to reduce unnecessary antibiotic use

Maximising vaccination

• Every contact counts – childhood immunisation sticker

• Book bagging in Key Stage 1

• 40% uptake vs 33% national

• Men ACWY reminder in A levels results

• Pharmacist at the University Freshers Week stall

• 52% uptake vs 35% national

• Flu Myth Busters for health & social care workforce 2016

• School Nurses flu vaccinating 2016

Bath & North East Somerset (B&NES)

Primary School Poster Competition• Launched in time for European Antibiotic Awareness Day 2016 and World

Antibiotic Awareness Week 2016

• Year 3 in all B&NES Primary Schools (50+)

• 4 key messages & lesson plans – delivered during WAAW

• Poster competition based on 4 key messages

• Judging & display of posters in community settings – GPs, Community

Pharmacies, local Hospital, Council locations

• Communications campaign – Get a conversation going! Collect and share

on twitter #AntibioticGuardian

220 e-Bug www.e-bug.eu

http://www.directorofpublichealthaward.org.uk/

https://www.sirona-cic.org.uk/

http://www.bathandnortheastsomersetccg.nhs.uk/

Bath & North East Somerset (B&NES)

Primary School Poster Competition

The children will design posters around these 4 key messages:

• Hand washing prevents infection

• Many common winter infections such as ear ache, sore throats, coughs and

colds are caused by viruses. Antibiotics do not work for viruses and can

give you side effects like diarrhoea and vomiting

• Vaccination prevents infection, particularly flu vaccination

• Using a tissue when coughing and sneezing can prevent sharing your

infection – Catch it, Bin it, Kill it!


http://www.directorofpublichealthaward.org.uk/

https://www.sirona-cic.org.uk/

http://www.bathandnortheastsomersetccg.nhs.uk/

Bath & North East Somerset 201522% of the whole population26% of children aged up to 10 years

Question and answers from the floor

#antibioticguardian

Concluding comments

Dr Diane Ashiru-Oredope, Pharmacist Lead, Public Health England

#antibioticguardian

antibiotic guardian london workshop 2016

Health & Medicine