Research and analysis

HPR volume 9 issue 29: news (21 August)

Updated 29 December 2015

1. New NICE guideline on antimicrobial stewardship

The National Institute for Health and Clinical Excellence has published a new guideline on antimicrobial stewardship that includes recommendations for systems, processes and interventions aimed at ensuring effective antimicrobial medicine use across the health and care sector and slowing the emergence of antimicrobial resistance [1].

Recent PHE research illustrates that four in 10 people with a cough or symptoms of a cold, and six in 10 people with a throat infection, had taken antibiotics, despite the fact that these conditions are usually self-limiting and antibiotic prescriptions are not required [2].

Antimicrobial stewardship (AMS) programmes aim to reduce inappropriate prescribing and optimise antibiotic use and are crucial to combatting antimicrobial resistance (AMR), as highlighted in the UK five-year AMR strategy [3]. The NICE guideline highlights the role of toolkits in such programmes, including the “TARGET” and “SSTF” toolkits developed under the auspices of the English Surveillance Programme for Antimicrobial Usage and Resistance (ESPAUR) set up to collate data on antibiotic use in primary and secondary care and investigate possible correlations with antimicrobial resistance trends and infection rates.

The Treat Antibiotics Responsibly, Guidance, Education, Tools toolkit (TARGET) for primary care was developed by PHE and RCGP [4]. TARGET is designed for use by the whole primary care team within general practice or out-of-hours settings. It aims to help to influence prescribers’ and patients’ personal attitudes, social norms and perceived barriers to optimal antibiotic prescribing and use. Its resources can be used to fulfil continuing professional development and appraisal requirements. TARGET has been updated following a recent evaluation, including the development of a clinical e-learning module to support implementation.

The Start Smart Then Focus AMS toolkit (SSTF) is a summary of evidence-based AMS practice for use in secondary care settings [5]. It provides information on strategies to improve antibiotic use within secondary care and suggested audit topics to improve practice. Implementing SSTF can help local organisations to demonstrate compliance with the Department of Health code of practice on infection control [6]. ESPAUR’s first annual report last year established a baseline of 48% of Acute Trusts with SSTF action plans in place [7]. ESPAUR collaborated with experts in the field to update SSTF in March this year, based on user consultation and newly published evidence.

To further support AMS, PHE has developed, piloted and published a protocol by which Acute Trusts may validate their antimicrobial prescribing data [8]. Completion of the validation process forms part of the NHS England Quality Premium for Clinical Commissioning Groups in 2015/16. The Quality Premium aims to reduce total prescribing and broad spectrum prescribing in primary care, and is measured by NHS England and PHE. Antimicrobial prescribing and stewardship competencies have also been developed and published by PHE and ARHAI to inform the development of standards, guidance and training in this area [9].

The NICE AMS guidance highlights the PHE prescribing competencies, and the TARGET and SSTF toolkits, as key interventions for changing prescribing practice [10]. These tools can be used to help organisations fulfil many aspects of the new NICE guidance. In partnership with NHS England and Health Education England, PHE also issued a Patient Safety Alert on AMS to coincide with publication of the NICE guidance [11]. The alert calls on healthcare providers to ensure they have AMS strategies/action plans in place and are completing audits as recommended in the AMS toolkits.

Engaging the public and professionals on the prudent use and prescription of antibiotics is essential. For this purpose, PHE developed the Antibiotic Guardian campaign to which over 13,000 individuals have responded, making a pledge to protect antibiotics; further pledges are invited at antibioticguardian.com [12].

1.1 References

1. NICE (18 August 2015). Antimicrobial stewardship: systems and processes for effective antimicrobial medicine use (guideline NG15).

2. “Entrenched misconceptions about antibiotics revealed in new survey”, PHE press release 18 November 2014.

3. UK five-year antimicrobial resistance strategy 2013 to 2018, DH website, 10 September 2013.

4. TARGET Antibiotics Toolkit, RCGP website.

5. Start Smart - Then Focus Antimicrobial Stewardship Toolkit for English Hospitals (March 2015)

6. DH. The Health and Social Care Act 2008: code of practice on the prevention and control of infections and related guidance (updated July 2015)

7. ESPAUR (October 2014). English surveillance programme antimicrobial utilisation and resistance (ESPAUR) 2014 report.

8. PHE (March 2015). Antimicrobial consumption data: validation protocol for NHS acute trusts.

9. PHE (October 2013). Antimicrobial prescribing and stewardship competencies.

10. NICE antimicrobial stewardship guideline NG15: Implementation: getting started.

11. PHE/NHS (18 August 2015). Patient Safety Alert stage two - resources: addressing antimicrobial resistance through implementation of an antimicrobial stewardship programme.

12. Antibiotic Guardian website: antibioticguardian.com/.

2. Ebola virus disease: international epidemiological summary (at 16 August 2015)

While the outbreak of Ebola virus disease (EVD) continues in West Africa, reports of new confirmed cases have remained below double figures for four consecutive weeks.

As of 16 August 2015, a total of 27,988 clinically compatible cases of EVD (15,220 confirmed), including 11,299 deaths, have been reported associated with the outbreak.

In the last two weeks, a total of six confirmed have been reported in the still-affected countries: five in Guinea and one in Sierra Leone. For the week ending 16 August, Sierra Leone reported no new confirmed cases, the first time this has occurred since the start of the outbreak. No new cases have been reported in Sierra Leone since 7 August and in Liberia since 12 July 2015.

While the decrease in new cases is encouraging, the risk of further transmission and an increase in case numbers in the coming weeks remains.

Number of new confirmed cases reported per week (17 May to 15 August 2015) in affected countries in West Africa. (Data Source: WHO Ebola Situation Report 2 September 2015)

Further information on the epidemiological situation can be found in PHE’s weekly Ebola epidemiological update and from the Ebola outbreak distribution map.