NHS England » World AMR Awareness Week (WAAW) 18 to 24 November 2023 – preventing antimicrobial resistance together

Classification: Official
Publication reference: PRN00920

To:

Integrated care boards (ICBs):
- chair
- chief executives
- medical directors
- chief nurses
- pharmacy leads
- lead healthcare scientists
- primary care leads
Trusts:
- chair
- chief executives
- medical directors
- chief nurses
- chief pharmacists
- lead healthcare scientists
- IPC leads
All primary care networks (PCNs), GP practices, dental practices and pharmacies in England
PCN clinical directors

cc.

Regional:
- directors
- directors of primary care and public health
- lead healthcare scientists

Dear colleague,

World AMR Awareness Week (WAAW) 18-24 November 2023 – preventing antimicrobial resistance together

Thank you for your ongoing personal commitment to tackling antimicrobial resistance (AMR). We are writing to you with an invitation to join us in taking urgent action to prevent AMR together, across all sectors of the healthcare system.

The UK national action plan for AMR sets out ambitions and measures of success to ensure progress towards the UK 20-year vision for addressing AMR. A new resource to support leaders and teams to understand performance and improve AMR prevention has been developed within the policy priorities section of the NHS model health system.

Sepsis is the third most common cause of death in the United Kingdom, associated with over 110,000 deaths each year, and around 80% of sepsis deaths were caused by bacterial infection (GRAM). In the UK in 2019, between 7,576 and 35,162 people died because of bacterial AMR. Globally, more people died due to reasons related to AMR than HIV/AIDS or malaria. The added burden of AMR to the NHS includes extra primary care appointments, more hospital admissions, higher bed occupancy and longer lengths-of-stay (Organisation for Economic Co-operation and Development).

After a 15-year period of declining incidence, the spectre of C. difficile infection is rising again. The Health and Social Care Act 2008: code of practice for infection prevention and control, was refreshed in December 2022 and outlines what registered providers in England should do to ensure compliance with the registration requirement at Regulation 12(2)(h) of the regulations. This includes ‘assessing the risk of, and preventing, detecting and controlling the spread of, infections, including those that are healthcare associated’ as well as optimising antimicrobial use and reducing antimicrobial resistance.

Please share this letter with your teams and consider, together with your AMR lead, the following three immediate actions:

Action 1 – Check if your organisation’s antimicrobial prescribing is optimised to prevent harm from AMR, now, and in the future:

Optimise duration of antibiotics – prescribers should be supported to prescribe the shortest effective course of antibiotics, following NICE guidelines. Patients should be advised to take antibiotics as directed, not to save for later or share with others, and to return any unused antibiotics to community pharmacies for safe disposal. Prescribing the shortest effective course of antibiotics is one of 16 national medicines optimisation opportunities for integrated care boards (ICBs) recommended in the NHS England national medicines optimisation opportunities 2023/24. ICB performance reports for course length are available from the AMR policy priority area of NHS model health system.
Improve appropriate antibiotic prescribing in dentistry – general dental practitioners should be alerted to the updated 2020 evidence-based good practice guidelines from the Faculty of General Dental Practice (UK) and the Faculty of Dental Surgery and the national dental antimicrobial stewardship toolkit.
Timely intravenous-to-oral switch of antibiotics – research suggests timely switching could reduce length-of-stay and release up to 5 million bed days per year in England, free up 20 minutes of nursing time per dose avoided, as well as reducing the carbon footprint of the NHS. Timely intravenous to oral switch of antibiotics is recommended in the NHS England national medicines optimisation opportunities 2023/24. National criteria for IV-to-oral switch are available on the gov.uk website. Your local acute trust performance data is also available.
Reduce inpatient exposure to “watch” and “reserve” antibiotics – for hospitals, the UK AMR national action plan includes an ambition to reduce inpatient exposure to the highest priority critically important antibiotics from the “watch” and “reserve” categories of the World Health Organisation’s AWaRe. This ambition is reflected in the NHS standard Ccntract for 2023/24. Your local acute trust performance data are available on the gov.uk website.

The Start smart then focus (SSTF) antimicrobial stewardship toolkit from the UK Health Security Agency was refreshed in September 2023, providing evidence-based guidance for secondary care clinicians and leaders, designed to reduce the risk of AMR while safeguarding the quality of care for patients with infection.

Action 2 – Check if the measures detailed within the National infection prevention and control manual’ (NIPCM) have been implemented:

Strong infection prevent and control (IPC) is the most effective approach to controlling the spread of AMR. Robust IPC measures are cost-saving because AMR can thrive in healthcare facilities. The most effective intervention is to improve hygiene in healthcare facilities, including promotion of hand hygiene and better hospital hygiene. Safer hospitals mean fewer infections and every infection prevented is an antibiotic avoided (World Health Organization).

Implementation of the infection prevention and control measures detailed within the evidence based NIPCM can reduce the need for unnecessary antibiotics by preventing infection and decreasing the risk of transmission from infectious agents. Reducing the spread of infection and any subsequent treatment will ultimately improve patient outcomes and help to reduce variation and optimise practice across care settings in England. The Board assurance framework (BAF) is available for use by organisations to provide assurance with IPC standards.

Action 3 – Check if the nationally recommended audit following the improving blood culture pathway report has been undertaken and there is an action plan in place:

Blood cultures are fundamentally important diagnostic tests to guide effective treatment for patients with sepsis. NHS trusts are strongly encouraged to review the findings of the report and evaluate current performance. An audit tool to assist with this is available on the Office of the Chief Scientific Officer’s Future NHS workspace.

A range of useful resources for tackling AMR during World AMR Awareness Week 2023 and beyond is detailed within appendix 1 and 2. Please share and promote these within your organisation.

If you have any queries relating to the above actions, please contact england.prevention-amr@nhs.net, your ICB AMR lead, or your NHS England regional antimicrobial stewardship lead england.amrprescribingworkstream@nhs.net.

For broader World AMR Awareness Week queries, please contact the World AMR Awareness Week and Antibiotic Guardian National Lead, Professor Diane Ashiru-Oredope diane.ashiru-oredope@ukhsa.gov.uk

We value your feedback on this letter, please help us by completing a brief one minute survey.

Yours sincerely,

Professor Sir Stephen Powis, National Medical Director
Professor Susan Hopkins, Chief Medical Advisor, UK Health Security Agency
David Webb, Chief Pharmaceutical Officer
Professor Dame Sue Hill, Chief Scientific Officer, England
Dame Ruth May, Chief Nursing Officer, England
Dr Claire Fuller MBBS DRCOG MRCGP, National Medical Director for Primary Care
Dr Jason Wong, Interim Chief Dental Officer, England.

Appendix 1: Further actions to consider for World AMR Awareness Week 2023

As part of your activities for the awareness week you are invited to encourage colleagues to take and or lead in supporting others to take the following simple actions:

Choose their antibiotic guardian pledge and encourage colleagues, family members and friends to do the same. The pledges were reviewed, and the website was updated earlier this year. You may wish to share your pledge on social media platforms to encourage others to join you also. Please include #AntibioticGuardian, #KeepAntibioticsWorking and #WAAW in social media.
Register your organisation’s AMR awareness activities by using the online registration form (this will take less than 5 minutes). Following registration, you will receive an email with your certificate for your organisation which can be displayed.
Access digital resources for health care workers that can be used and shared during WAAW. These resources build on those produced for previous campaigns, including digital notes, images, and social media messages.
Visit the FutureNHS AMR Programme website for access to key national guidance, updates and content available relating to infection management and antimicrobial resistance, and as a mechanism to share knowledge and to network with other colleagues across the country.
Use social media and community networks to engage with diverse population groups to promote key messages on AMR throughout the winter season using #AntibioticGuardian and/or #KeepAntibioticsWorking. Ready to use social media images and messages are available via the WAAW digital resources folder.
Encourage staff to engage with available training resources around infections.

Appendix 2: key antimicrobial resistance resources that can support your actions to tackle AMR

UK Government AMR national action plan

English surveillance programme for antimicrobial utilisation and resistance (ESPAUR) annual report

A range of tools and resources are available for healthcare professionals to help you contribute to achieving the national ambitions of halving HA-GNBSI and inappropriate antibiotic prescribing through the collaborative work of NHS England, NHS England Workforce, Training and Education (previously Health Education England), the National Institute for Health and Care Excellence (NICE) and the UK Health Security Agency (UKHSA).

Preventing healthcare associated Gram – negative bloodstream infections (GNBSI) and supporting best practice for:

IPC developing local collaborative actions to reduce these infections

The AMR indicators on UKHSA Fingertips provide a range of trust level data sets on antimicrobial resistance, healthcare-associated infections, antibiotic prescribing, infection prevention and antimicrobial stewardship that can be used.

Other sources of presenting antibiotic prescribing data for primary care are also available:

The number of antibiotic guardians per 100,000 population for each ICB is also available via UKHSA Fingertips and by local authority via Antibiotic Guardian website.

The Royal Pharmaceutical Society AMR campaign and CPPE provide specific resources for pharmacists

The Start smart then focus toolkit for secondary care (updated September 2023)

Antimicrobial intravenous-to-oral switch: criteria for early switch (www.gov.uk)

The TARGET Antibiotics Toolkit for primary care led by UKHSA and RCGP are available from the Royal College of General Practitioners website and include a range of resources specific for general practice and community pharmacy

The dental AMS toolkit provides a set of resources to help primary care practitioners promote the appropriate use of antibiotics in dental care.

The Faculty of General Dental Practice UK (FGDP) and the Faculty of Dental Surgery of the Royal College of Surgeons of England (FDS) Antimicrobial prescribing in dentistry good practice guidelines were updated in 2020 and support the judicious use of antimicrobials in dentistry.

Additional resources are available via the British Dental Association and College of General Dentistry:

Healthcare students are encouraged to learn more about and raise awareness of antimicrobial resistance with peers especially non-healthcare students during World Antibiotics Awareness Week and become antibiotic guardian champions.

Students can also:

Materials for school children and their families are available via e-bug (including resources specific for COVID-19), Antibiotic Guardian Youth Badge, which educate on infection prevention and control as well as microbes, their spread and use of antibiotics with schools.

Healthcare workers, scientists and public health professionals can also sign up to become antibiotic guardian schools ambassadors.