1. 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

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

3. 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

4. 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

5. 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
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6. 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 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;
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7. 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
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8. 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

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

10. Uptake of influenza vaccination in NHS staff

11. 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
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12. 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.

13. 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

14. 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

15. 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

16. 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