1. Global and National Response to AMR Chatham House/Murdoch University AMR Symposium Chris Baggoley 8 December 2014

2. Drivers of AMR Globalisation and international travel Poor infection prevention and control Collapse of antibiotic research and development Antibiotic resistance Poor and unrestrained use of antibiotics Substandard antibiotics

3. International AMR initiatives in 2014

7. Ministerial Conference Antibiotic Resistance “Joining Forces for Future Health” The Hague – 25 to 26 June 2014

8. Antimicrobial resistance: global report on surveillance. ISBN 978 92 4 156474 8 © World Health Organization 2014

9. Global Health Security Agenda Meeting Washington DC 26 September 2014

10. Total Outpatient antibiotic use in 26 European countries in 2002 Source: ESAC WebsiteAUS

12. What is already in place? Strong regulatory systems to ensure safe, effective, high quality medicines Most antibiotics available by prescription only National standards – Infection prevention and control, antimicrobial stewardship in hospitals Some surveillance of AMR, and antibiotic use in hospitals BUT, some critical gaps, and no comprehensive national strategy to guide action and ensure efforts are coordinated

13. Regulatory Controls

14. Standard 7 Blood and Blood Products Standard 10 Preventing Falls and Harm from Falls The NSQHS Standards Standard 1 Governance for Safety and Quality in Health Service Organisations Standard 2 Partnering with Consumers Standard 4 Medication Safety Standard 3 Healthcare Associated Infections Standard 8 Preventing and Managing Pressure Injuries Standard 9 Recognising and Responding to Clinical Deterioration in Acute Health Care Standard 5 Patient Identification and Procedure Matching Standard 6 Clinical Handover

15. www.health.gov.au/amr

16. © Commonwealth of Australia 2013 ISBN: 987-1-921983-47-4 June 2013

17. This publication is available at: agriculture.gov.au/publications

18. Antimicrobial prescribing practice in Australia: results of the 2013 National Antimicrobial Prescribing Survey www.safetyandquality.gov.au

19. National leadership to drive action Importance of strong leadership, commitment to action, and funding to support development and implementation of a national plan Australian AMR Prevention and Containment Steering Group established February 2013 $11.9 million allocated in 2013-14 Federal Budget Supported by an advisory group to provide expert clinical and technical advice on AMR

20. National AMR Strategy Proposed goal : To slow the development and spread of AMR and conserve the effectiveness of antimicrobials Objectives : To achieve this goal, we will focus our efforts on:  improving surveillance  preventing infections and the spread of resistant infections and  improving the appropriate use of antimicrobials

21. Developing a National Antimicrobial Resistance Strategy for Australia – October 2014 ISBN: 978-1-74186-192-1 Online: ISBN: 978-1-74186-193-8 Publications approval number: 10917

22. Key elements 1.Infection prevention and control 2.Surveillance 3.Antimicrobial stewardship 4.Communication and Education 5.International engagement 6.Research and Development 7.Governance

23. Communication & Education NPSMedicineWise ‘Resistance Fighter’ public awareness campaign Training modules for medical students and junior hospital medical staff Some education activities available for GPs, but not compulsory Gaps – very difficult to achieve sustained changes in consumer attitudes and behaviours - continue with efforts to increase public awareness of AMR, drivers, and appropriate use of antibiotics

25. Global Health Security Agenda Meeting Washington DC 26 September 2014

28. Source: Microbiol. Mol. Biol. Rev. 2010, 74(3):417. DOI: Julian Davies and Dorothy Davies Resistance Origins and Evolution of Antibiotic Origin and Evolution of Antibiotic Resistance

30. ACSQHC: Elements of HAI Standard  Systems and governance  Infection prevention policies and protocols  Managing patients with infections  Antimicrobial stewardship  Cleaning, disinfection and sterilisation  Consumer information

31. Infection Prevention & Control National Safety and Quality Health Service (NSQHS) Standards Standard 3: Preventing and Controlling Healthcare Associated Infections Australian Guidelines for the Prevention and Control of Infection in Healthcare National Hand Hygiene Initiative Gaps – general practice, aged care, veterinary practice, animal health

32. Surveillance Resistance AGAR is a collaboration of 30 public and private laboratories around Australia which collects, analyses and reports on trends in the level of AMR in bacteria causing important and life threatening infections in humans. Antibiotic Usage NAUSP collects data on antibiotic utilisation in Australian hospitals - 80% national representation of principal referral hospital beds. DUSC collects and analyses data on medicines dispensed by community pharmacies Appropriateness NAPS – annual point prevalence survey on the appropriateness of antimicrobial prescribing in hospitals

33. Surveillance Gaps - current initiatives not comprehensive/nationally representative. Need data from general practice, aged care, as well as antibiotic use in animals and agriculture New initiative to improve data on AMR and AU in human health, including establishing passive and targeted surveillance systems for AMR and AU across hospital, community and aged care settings and a national alert system to inform clinicians and policy-makers about emerging AMR trends. Agriculture – report on antimicrobial usage monitoring and resistance surveillance activities in the animal and agriculture sector in Australia, and overseas to inform future action

34. Surveillance of antibiotic usage  Community –PBS, Pharmacies – usage data –Medicare – no. of prescriptions  Animal - APVMA – antibiotic volumes  Hospital –National Antibiotic Usage Surveillance Program (NAUSP) -covers 70% of acute referral beds – pharmacy dispensing data  Appropriateness – –National Antibiotic Prescribing Survey  Import and supply data –Therapeutic Goods Administration and the Australian Pesticides and Veterinary Medicines Authority

35. Antimicrobial Stewardship To date, efforts have focussed on hospital settings National Safety and Quality Health Service Standard 3 requires AMS programs to be implemented Therapeutic Guidelines: Antibiotic Gaps: No equivalent approach in general practice, aged care or animal health Most antibiotics for humans are prescribed in community settings, and evidence of increasing AMR in the community Antibiotic use in animal health???

36. Key components of AMR Stewardship Hospitals Leadership AMR team Local formulary Education and training Prescriber feedback Measure performance Clinical microbiology service Community / primary care Leadership Therapeutic guidelines Practice clinical audit Education and training Liaison with local laboratory Patient education Prescriber feedback

37. Antimicrobial Resistance Global Action Plan “Going Forward” Strategic Technical Advisory Group 14 April 2014 - Keiji Fukuda (Geneva)

39. Strategic and Technical Advisory Group for Addressing AMR Dr Marie-Paule Kieny: 14-16 April 2014

42. The Drugs Don’t Work A Global Threat Published 2013 Copyright © Professor Dame Sally C Davies, Dr Jonathan Grant And Professor Mike Catchpole