In the winter of 2007-08 a new public-facing antimicrobial campaign was agreed by the Advisory Committee on Antimicrobial Resistance and Healthcare-Associated Infection (ARHAI) Education sub-Group (later divided into subgroups for professional and public education): it comprised posters with a positive message on how the public could help themselves when they had a cold. However, the poster campaign, used in isolation in England, did not improve antibiotic use; therefore, the Public Education sub-Group took forward educational approaches to change the behaviour of the public and health professionals. Professionals have been encouraged to give patients clear information about the likely duration of symptoms, self-care, and benefits and harms of antibiotics, reinforcing the public poster campaigns in surgeries, hospitals and pharmacies. Since 2008, campaigns have been launched in England to coincide with European Antibiotic Awareness Day (EAAD) on 18 November, using Department of Health and EAAD materials. Professional education has been facilitated by the 2008 National Institute for Health and Clinical Excellence respiratory tract infection delayed prescribing guidance for general practitioners. A toolkit of materials for medicines management teams, to facilitate good antimicrobial stewardship in primary care (ASPIC), is being taken forward by the Public Education sub-Group and professional societies. After advice from ARHAI, in 2009 the General Medical Council requested that all postgraduate deans and Royal Colleges ensure infection prevention and control and antimicrobial prescribing become standard practice implemented in all clinical settings, and that they are emphasized strongly in undergraduate and postgraduate medical training. ARHAI has also taken a keen interest in reviewing, advising and leading on a number of European Union initiatives dealing with professional education.
Bibliographical noteFunding Information:
This article forms part of a Supplement sponsored by the BSAC and the British Infection Association.
In 2010 the ASPIC group was formed. The initiative has the support of ARHAI and the DH (who funded the workshop), the HPA, the BSAC, the Royal College of General Practitioners (RCGP), the Care Quality Commission (CQC), the British Infection Association (BIA), the National Prescribing Centre (NPC), the British Paediatric Allergy Immunity Infection Group (BPAIIG), Health Protection Scotland and Public Health Wales. Other members of ARHAI, the NHS Information Centre for Health and Social Care, GPs, pharmacists and microbiologists have contributed. The ASPIC group has agreed that the most important indicator of good antimicrobial stewardship is total antimicrobial use measured in items (specific therapeutic group age-sex related prescribing unit; STAR PU), with a target initially set at below the national 25th percentile on a set date. Indicators of good practice can be a real driving force behind modifying behaviour and these have been used very effectively in reducing methicillin-resistant Staphylococcus aureus (MRSA) and Clostridium difficile rates in the hospital setting.40,41The group agreed that antimicrobial use data can also be analysed by age group and seasonal variation. These indicators are in complete agreement with European indicators agreed by the European Surveillance of Antimicrobial Consumption (ESAC) Project Group.42 The ESAC group has also suggested disease-specific indicators for antimicrobial use43 covering the most common infections seen in primary care. Compliance with disease-specific indicators will need to be measured via locally driven audits measuring compliance with local antimicrobial guidance (usually HPA) or ESAC indicators.43 Other indicators of good antimicrobial stewardship were suggested, including high vaccine uptake rates that can reduce infection rates and therefore antimicrobial use,44,45 appropriate use of diagnostic tests by prescribers in line with national guidance and restrictive reporting of antimicrobial susceptibility by laboratories.46 A highly effective way to encourage clinicians to improve prescribing and attempt to reach indicators of excellence is likely to be if the indicators are part of the Quality Outcomes Framework (QOF), advice from the NHS Commissioning Board or CQC indicators;47 The relative value of these approaches will be evaluated.
- Antimicrobial resistance
- Antimicrobial stewardship
- Health campaigns
- Infection prevention and control