Research and analysis

HPR volume 11 issue 7: news (17 February)

Updated 15 December 2017

1. Updated Cochrane review on antimicrobial stewardship focuses on behaviour change interventions

Antimicrobial stewardship (AMS) promotes the prudent use of antibiotics in order to optimise patient outcomes while at the same time minimizing the risk of adverse effects, including the emergence of, and spread of, antibiotic resistance. Systematic reviews have demonstrated that certain AMS practices improve clinical outcome and reduce adverse events, treatment costs and antibiotic resistance rates. These are: empirical treatment, according to local or national guidelines; de-escalation of treatment; parenteral-to-oral switch; therapeutic drug monitoring; and restricted antimicrobial lists [1].

However, effective and sustained improvement in antibiotic prescribing requires quality improvement approaches using behaviour change techniques and methodologies, with AMS focusing on a specific target audience using specific behavioural intervention functions.

An updated Cochrane review has demonstrated that “enabling” and “restrictive” interventions were associated with a 15% increase in compliance with desired practice, an almost two-day decrease in duration of antibiotic treatment and a more than one-day decrease in inpatient length of stay – without compromising patient safety [2]. The authors suggest that further improvement could be achieved with additional behaviour change intervention functions, particularly explicit goal setting and action planning.

All NHS acute hospitals have an antimicrobial stewardship team. The updated evidence review adds to the extensive literature and resources now available to guide local actions to improve prescribing practices [3].

1.1 References

1. Schuts EC, Hulscher ME, Mouton JW, Verduin CM, Stuart JW, Overdiek HW, et al (2016). Current evidence on hospital antimicrobial stewardship objectives: a systematic review and meta-analysis. Lancet Infect Dis. 16: 847-856.
2. Davey P, Marwick CA, Scott CL, Charani E, McNeil K, Brown et al (February 2017). Interventions to improve antibiotic prescribing practices for hospital inpatients. Cochrane Database of Systematic Reviews 2: CD003543.
3. PHE (2016). Antimicrobial Resistance: resource handbook.

2. WHO guidelines for hepatitis B and C testing

The World Health Organization has published new guidelines on testing for chronic HBV and HCV infection, supporting its Global Health Sector Strategy on Viral Hepatitis 2016-2021 and complementing guidance on prevention, care and treatment of chronic HCV and HBV infection published in 2016 and 2015, respectively [1]. They represent full documentation to underpin a related Policy Brief published last November [2].

The guidelines lay down a public health approach to strengthening and expanding current testing practices for these infections and are intended primarily for public health agencies in low- and middle-income countries (LMICs), particularly in Asia and Africa, where the national burden of infection is disproportionately high and where hepatitis testing programmes are not yet well developed or where quality systems are lacking.

The introduction to the guidelines states, “Despite the high global burden of disease due to chronic hepatitis B and C infection, and the advances and opportunities for treatment, most people infected with HBV and/or HCV remain unaware of their infection and therefore frequently present with advanced disease. The extent of this hidden burden is poorly documented, and largely based on limited data from higher-income settings. However, in low-income settings, it is estimated that less than 5% are aware of their diagnosis. This contrasts with the considerable recent progress in HIV testing coverage, whereby now more than half of all people living with HIV globally are aware of their status.”

The new guidelines include sections covering recommended components of national strategy for LMICs, including:

• testing approaches – who to test for chronic hepatitis B and C infection
• testing strategy – how to test for chronic hepatitis B and C infection
• interventions to promote uptake of hepatitis testing and linkage to care
• implementation issues with regard to product selection and procurement, validation of test kits, and quality assurance.

In high-prevalence countries, the guidelines strongly recommend that testing be offered both to individuals within high-seroprevalence groups and those who have a history of exposure or high-risk behaviours for HBV or HCV infection. Thus for chronic HBV, the guidelines strongly recommend testing for pregnant women, some other specified risk groups, and blood donors. For chronic HCV, they recommend focused testing for adults and adolescents who are members of a high-prevalence group, and for adults and children “with a clinical suspicion of chronic viral hepatitis”.

2.1 References

1. WHO (February 2017). Guidelines for hepatitis B and C testing.
2. WHO (November 2016). Guidelines for hepatitis B and C testing: policy brief.

3. Vaccine-preventable disease report in this issue of HPR

The following infection report is published in this issue of HPR.

• Laboratory reports of hepatitis A and C (England): July-September 2016

4. Health-related risk assessments training course, 9 March 2017

The HSE’s Health and Safety Laboratory is running a one-day course for health and safety practitioners on health-risk assessments relating to substances hazardous to health, noise and vibration. The course is designed to help practitioners better understand the ‘invisible’ risks associated with hazardous substances, noise and vibration, explaining how risk assessments need to be conducted to meet legal requirements and how they should fit into overall risk management programmes.

4.1 Enquiries

training@hsl.gsi.gov.uk.

4.2 Programme and online booking

Improving Your Health Related Risk Assessments, HSL Training Unit, Harpur Hill, Buxton (near Sheffield), Derbyshire SK17 9JN.