Antimicrobial Stewardship – Working Together to Improve our Health

---

We all have a role to play in conserving one of our most important health resources writes Claire Boardman, Past President of the Australasian College for Infection Prevention and Control (ACIPC).

---

There is worldwide concern from leaders of prominent health bodies such as the Centre for Disease Control (CDC) in America and the World Health Organisation (WHO) that we are running out of options to treat both complex and straightforward infections. But there is still hope if we ration the use of one of the most common medicines available, antibiotics.
Both human and animal health sectors in Australia are grappling with the potential enormity of what would happen if we simply ran out of antibiotics. Since the first European settlement of Australia, infectious diseases have posed a problem for Indigenous and non-Indigenous people, particularly in an era where antibiotics had not yet been discovered. In an excerpt from the History of Microbiology in Australia, Fenner1. noted that diarrhoeal and childhood diseases were endemic in the early days of colonisation and a major cause of death. Microbial disease of livestock and crops also became a real problem with regular outbreaks of anthrax and  ‘blights’.
The Australian Therapeutic Guidelines for Antibiotics 2. remind us that the body’s natural defence mechanisms will eliminate most viral and minor bacterial infections which are often self-limiting and do not require antimicrobials, yet until recently there has been little public awareness about the importance of saying no to antibiotics against the common cold. Antimicrobial drugs are different to other drugs in that the spread of antibacterial resistance can influence the effects on other patients requiring the same type of antibiotic treatment. The biochemical reasons for resistance are complex for non-clinicians. However, the widespread use of antimicrobial agents and the effect of transmission of these resistant pathogens in the healthcare setting are more readily understood.

---

“As antimicrobial stewardship needs to be a team approach, one of the key aspects to improving antimicrobial prescribing is the promotion of antimicrobial stewardship and increased education and training for all healthcare workers (nurses, doctors, pharmacists etc).”

---

One key area of concern in the fight against antimicrobial resistance (AMR) is the small amount of time available to influence the global situation. The antibiotic pipeline or the rate at which new antibiotics can be developed before there is emerging resistance is becoming increasingly narrow in the absence of discovery of new agents. It is therefore even more critical that we use antimicrobials wisely and judiciously3.
[caption id="attachment_5844" align="aligncenter" width="315"] Click Image To Enlarge[/caption]

---

Bringing together key partners
There are a number of Australian institutions which are working together to ensure both clinicians and consumers are aware of the need to conserve antibiotics. The Australian Commission in Safety and Quality in Healthcare (ACSQHC) has been instrumental in bringing the issues around antimicrobial resistance to the forefront. We are fortunate in Australia to have such a resource committed to bringing key stakeholders together in a highly collaborative forum. ACSQHC has partnered with ACIPC and other bodies to support activities around awareness of antimicrobial resistance and prescribing. In order to address antimicrobial resistance in Australia there is strong recognition that a “one health” approach is required.
As antimicrobial stewardship needs to be a team approach, one of the key aspects to improving antimicrobial prescribing is the promotion of antimicrobial stewardship and increased education and training for all healthcare workers (nurses, doctors, pharmacists etc). To improve antimicrobial prescribing, the Commission promotes the mantra of MIND ME.
Antimicrobial Prescribing 3
Antimicrobial prescribing should follow 6 basic principles (referred to as ‘MIND ME’)

---

A key initiative has been for lead organisations to work with the Nation Prescribing Service (NPS) MedicineWise program to promote awareness throughout consumer and community groups and to develop targeted clinician online learning modules.
More information about these important initiatives is available from:

• www.nps.org.au/about-us/what-we-do/campaigns-events/antibiotic-resistance-fighter


• www.nps.org.au/healthprofessionals/professional-development/online-learning

In 2011 the ACSQHC published Antimicrobial Stewardship in Australian Hospitals. This pdf resource is well worth having in your library:

• www.safetyandquality.gov.au/publications/antimicrobialstewardship/

ACSQHC has also developed a suite of resources to educate health professionals that are available from:

• www.safetyandquality.gov.au/our-work/healthcare-associatedinfection/antimicrobial-stewardship/

Internationally, another organisation championing the cause is ReAct. As an independent global network for concerted action on antibiotic resistance, it aims for profound change in awareness and action to manage the interacting social, political, ecological and technical forces that drive the rising rate of resistant human and animal infection, as well as the rapid spread of resistance within and between communities and countries.
ReAct acts as a forum for ideas, debate and collaboration between diverse stakeholders. It believes change will depend on engagement with social movements, civil society, community, consumerorganisations, academia, health policy reformers as well as with those individuals, networks or institutions that generate and analyse health-related knowledge and catalyse interaction between them on the issue.
You can join the ReACT action group to learn more about how they are dealing with this issue in Europe by visiting their website: www.reactgroup.org/#
 
The next steps
In 2012, to support an integrative approach to the national strategy on AMR in Australia, the Australian Health Ministers Advisory
Council (AHMAC) endorsed the establishment of a new subcommittee, the AMR Subcommittee (AMRSC).
The AMRSC reports directly to the Australian Health Protection Principal Committee (AHPPC). AHPPC is attended by Chief Health Officers from each of the jurisdictions, as well as the Chairs of the Public Health Laboratory Network, Communicable Disease Network Australia, Environmental Health Subcommittee, National Health Emergency Management Subcommittee, and Blood Borne Virus and Sexually Transmissible Infections Subcommittee.
The role of the AMRSC is to:

• Advise the AHPPC on matters relating to AMR


• Provide expert advice and assistance on issues relating to AMR, and


• Recommend action on national priorities for AMR. AMRSC brings together agencies that are currently driving national AMR activities and has recently developed a national strategy to minimise AMR in human health which included 4.:


• Enhancement of existing surveillance systems through a coordinated approach


• Education and stewardship programs


• Infection prevention and control guidelines


• Research into AMR and its prevention


• A review of the current regulatory system applying to antimicrobials, and


• Community and consumer campaigns.

Membership of AMRSC includes the following organisations.

• Australian Commission on Safety & Quality in Health Care


• Australian Pesticides & Veterinary Medicines Authority


• Australasian College for Infection Prevention & Control


• Australasian Society for Infectious Disease


• Australian Society for Antimicrobials


• Communicable Disease Network Australia


• Department of Agriculture, Fisheries and Forestry


• Department of Health and Ageing


• National Health and Medical Research Council


• National Prescribing Service


• Pharmaceutical Benefits Advisory Committee


• Public Health Laboratory Network


• Therapeutic Goods Administration

By promoting a one-health collaborative approach, consumers and the health workforce can work together to coordinate efforts to mitigate risk in the evolving threat to human health of antimicrobial resistance in Australia and internationally.

---

References:

1. Fenner, F. History of Microbiology in Australia (1990)


2. Therapeutic Guidelines: Antibiotic Version 14 (2010)


3. Duguid, M & Cruickshank, M. Antimicrobial Stewardship in Australian Hospitals (2011)


4. Shaban R. Antimicrobial Resistance Standing Committee. National surveillance and reporting of antimicrobial resistance and antibiotic usage for human health in Australia (2013)

Acknowledgements:
Dr. Marilyn Cruickshank Chair, Antimicrobial Resistance Standing Committee (AMRSC) & Program Director, Australian Commission on Safety and Quality in Health Care
Prof. Ramon Shaban Deputy Head of School, Nursing & Midwifery Griffith University