World Antimicrobial Awareness Week (WAAW) 2022

Integrated care boards (ICBs):
– chief executives
– medical directors
– chief nurses
– pharmacy leads
– diagnostic leads
– primary care leads

– chief executives
– medical directors
– chief nurses   
– chief pharmacists 
– diagnostic leads    
– IPC leads

All PCNs, GP practices, dental practices and pharmacies in England:
– practices and pharmacies in England

PCN clinical directors

Regional directors
Regional directors of primary care and public health
Regional AMS leads

Dear colleagues,

World Antimicrobial Awareness Week (WAAW) 2022

Thank you for your ongoing commitment to tackle antimicrobial resistance (AMR). We are writing to ask you to consider taking specific actions to further tackle this issue, including supporting this year’s WAAW.

The global burden of bacterial AMR has recently been estimated at almost 5 million deaths associated with, and 1.27 million deaths directly attributable to AMR each year. This puts the magnitude of the problem at a level globally which is at least as large as major diseases such as HIV and malaria, and potentially much larger.

Inappropriate use of antibiotics impacts the NHS today. Infections caused by antibiotic-resistant pathogens are associated with repeat primary care consultations, more hospital admissions, longer lengths-of-stay and increased mortality. The UK national action plan on AMR sets out measures of success to ensure progress towards the UK 20-year vision. These include, among others, targets to halve healthcare associated Gram-negative bloodstream infections (GNBSIs), reduce the number of specific drug-resistant infections in people by 10% by 2025, and to reduce UK antimicrobial use in humans by 15% by 2024.

The establishment of integrated care boards (ICBs) creates an opportunity to adopt an integrated approach to improving infection prevention, diagnosis and treatment across primary, community and secondary care pathways, to address the threat of AMR across healthcare systems.

This needs to be supported by strong executive and clinical leadership. The NHS Operating Framework sets out that ICBs should, ‘Work with partners to set system-level strategy and plans, and to ensure effective arrangements for joint working to deliver plans, performance, outcomes and transformation’.

This approach enables strategic, pathway-based approaches to the management of AMR. Alongside ICBs having governance arrangements and strategic plans for AMR in place, and identifying an AMR lead, please take time this week to consider the following actions which partners can take to support improvement across care pathways:

1. Implement the National Infection Prevention and Control Manual for England

Implementation of the infection prevention and control measures detailed within this evidence-based manual can reduce the need for unnecessary antibiotics by decreasing the risk of transmission from infections 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.

2. Review the findings of the recent Improving the blood culture pathway report

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 FutureNHS Workspace.

3. Review prescribing

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.

For primary care, the NHS Oversight Framework for 2022/23 includes metrics aligned to the UK AMR National Action Plan for appropriate prescribing of antibiotics and broad spectrum antibiotics. All ICBs should review their current performance from data published on the NHS England AMR Programme’s FutureNHS Workspace

For primary care teams, resources such as the TARGET toolkit may be helpful.

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.

4. Ensure timely intravenous to oral antibiotic switch as soon as appropriate

Studies suggest timely switching could release up to 5 million bed days, per year and a substantial amount of nursing time, as well as significantly reducing the carbon footprint of the NHS. The NHS England 2022/23 Priorities and Operational Planning Guidance calls upon healthcare systems to support reduced lengths of hospital stays by ensuring intravenous antibiotics are only used for as long as clinically necessary, with a switch to oral antibiotics as soon as appropriate.  Read the recommended criteria for IV-to-oral switch.

5. 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 list. This ambition is reflected in the NHS Standard Contract for 2022/23. Acute hospital Trust Boards are actively encouraged to be appraised of their current performance using the UKHSA Fingertips website.

6. Adopt the Academy of Medical Royal College’s (AoMRC) statement on the initial antimicrobial treatment of sepsis in hospital

The AoMRC’s statement on the initial antimicrobial treatment of sepsis will support appropriate use of antibiotics and improve patient outcomes.

Appendix 1 and 2 detail a range of useful resources for tackling AMR during WAAW 2022 and beyond. Please share and promote these within your organisation.

If you have any queries relating to the above actions, please contact

For broader WAAW queries, please contact the WAAW and Antibiotic Guardian national lead, Prof Diane Ashiru-Oredope via

Yours sincerely,

Professor Stephen Powis
National Medical Director, NHS England

Sara Hurley
Chief Dental Officer, England

David Webb
Chief Pharmaceutical Officer, NHS England

Professor Dame Sue Hill
Chief Scientific Officer, England

Dame Ruth May, DBE
Chief Nursing Officer, England

Dr Kiren Collison
GP and Interim Medical Director for Primary Care, NHS England

Professor Susan Hopkins
Chief Medical Advisor, UK Health Security Agency

Appendix 1: Suggested actions for WAAW 2022

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. 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 posts.

    • 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 in 2020 and 2021, 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.

Appendix 2: Key AMR resources that can support your actions to tackle AMR

AMR Resources

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, Health Education England, NICE and 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 CCG 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.

IV-to-oral switch criteria and tool.

The TARGET Antibiotics Toolkit for primary care led by UKHSA and RCGP are available from the RCGP 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.