Tackling antimicrobial resistance and improving antibiotic prescribing 24th June 2016 Tackling antimicrobial resistance and improving antibiotic prescribing Insert name of presentation on Master Slide Dr Marion Lyons

What will be covered Key themes of AMR delivery plan The O’Neill review Taking things forward in Wales – your recommendations Dr Marion Lyons

Seven themes Dr Marion Lyons Delivery Theme1: Improving infection prevention and control practices. Delivery Theme 2: Optimising prescribing practice. Delivery Theme 3: Improving professional education, training and public engagement. Delivery Theme 4: Developing new drugs, treatments and diagnostics. Delivery Theme 5: Better identification and prioritisation of AMR research needs. Delivery Theme 6: Better access to and use of surveillance data. Delivery Theme 7: Strengthened international collaboration Dr Marion Lyons

Delivery Theme 2: Optimising prescribing practice. Antimicrobial stewardship key Antimicrobial management Team Start Smart and then Focus (annual audit) Targeted campaign for surgical prophylaxis Together we will deliver a multifaceted intervention programme to reduce antibiotic prescribing in highest-prescribing 10% of practices Support the introduction of C reactive protein Develop an audit programme of antimicrobial prescribing for patients presenting with specific infections in primary care Annual audit of antimicrobial prescribing for acute respiratory infections in secondary care Dr Marion Lyons

The O’Neill report -recommendations A massive global public awareness campaign Improve hygiene and prevent the spread of infection Reduce unnecessary use of antibiotics in agriculture and their dissemination into the environment Improve global surveillance of drug resistance and antimicrobial consumption in humans and animals Promote new, rapid diagnostics to cut unnecessary use of antibiotics Promote development and use of vaccines and alternatives Improve the numbers, pay and recognition of people working in infectious disease Insert name of presentation on Master Slide

Prime Ministers response Halving the inappropriate prescription of antibiotics in humans by 2020 Halving the number of healthcare associated bloodstream infections that pose the biggest risk – such as E-coli - by 2020 – to help reduce demand for antibiotics; Setting an overall target for antibiotic use in livestock and fish farmed for food, cutting use to the level recommended by Lord O’Neill by 2018. We will also ensure introduce strict oversight of the use in animals of antibiotics which are critical for human health – including supporting restrictions or even bans where necessary; Insert name of presentation on Master Slide

DH Flu vaccination targets 2016/07 season 75% of those aged 65 years and over 75% of healthcare workers with direct patient contact. at least 55% in all of the clinical risk groups For children levels between 40-65% to be attained Insert name of presentation on Master Slide

Uptake of influenza vaccination in Wales 2015/16 Health Board Patients aged 65y and older Patients aged 6m to 64y at risk Immunised (n) Denominator (n) Uptake (%) Abertawe Bro Morgannwg UHB 68,737 106,453 64.6 27,704 63,869 43.4 Aneurin Bevan UHB 79,226 117,042 67.7 35,471 71,781 49.4 Betsi Cadwaladr UHB 105,809 153,952 68.7 39,778 80,605 49.3 Cardiff and Vale UHB 51,478 74,749 68.9 25,691 53,238 48.3 Cwm Taf UHB 37,820 58,217 65.0 16,937 36,871 45.9 Hywel Dda UHB 57,454 89,886 63.9 18,887 43,681 43.2 Powys Teaching HB 22,586 35,114 64.3 6,694 15,043 44.5 Wales Total 423,110 635,413 66.6 171,162 365,088 46.9 Public Health Wales CDSC and VPDP

Uptake of influenza vaccination in patients aged 65y and older Public Health Wales CDSC and VPDP

Uptake of influenza vaccination in NHS staff

In 10 minutes consider: For the under 56’s at risk and for frontline staff: What should be the Welsh target? In what time frame What do we do differently to achieve the target Insert name of presentation on Master Slide

In 2015, there was a 5.1% decrease in the total number of dispensed antibacterial prescriptions in primary care in Wales comprising: 17.3% reduction in cephalosporins (J01D); 16.8% reduction in BL inhibitors e.g. co-amoxiclav (J01CR); 9.1% reduction in fluoroquinolones e.g. ciprofloxacin (J01MA) ; 8.1% reduction in BSP e.g. amoxicillin (J01CA); 3.9% reduction in beta lactamase sensitive pencillins e.g. phenoxymethylpenicillin (J01CE) and a 2.6% reduction in the trimethoprim group (J01E). The only increases were in the tetracyclines (J01AA) and nitrofurans (J01XE) – in line with guidance.

Consider: (This is a very ambitious target!) To achieve a 50% reduction in inappropriate antimicrobial usage by 2020 Consider: (This is a very ambitious target!) What is your definition of inappropriate and how would you gather baseline data? What is required to achieve this reduction? Dr Marion Lyons

Point of Care testing CRP is recommended by NICE: Consider: Do we need point of care test or a rapid test The contribution you think CRP could make to reduction in antimicrobial usage Where in the care pathway is it of most benefit Who should undertake the test How do we measure impact Dr Marion Lyons

The future We need a step change in actions to date Antibiotics are a precious commodity and should only be used to treat infection Dr Marion Lyons

What success will look like excellent infection prevention and control measures are the norm for everyone and zero tolerance to poor practice is a reality in all health and social care settings; all healthcare providers adhere to the Code of Practice for the Prevention of healthcare associated infections for Wales; care in all health care premises is provided in a safe environment; infections are diagnosed quickly and the right treatment used; prudent antimicrobial prescribing is a reality; all surgical patients can expect infection risk to be reduced through adherence to guidelines on prophylaxis; the public are aware of the appropriate use of antimicrobial treatment regimens and adhere to them; surveillance guides good practice and quickly identifies new threats or changing patterns in organism resistance; and the NHS, health professionals and academic centres in Wales are actively contributing to and involving Welsh patients in AMR research agenda and the development of new drugs, treatments and diagnostics Dr Marion Lyons