Guidance

Antimicrobial resistance (AMR): applying All Our Health

Updated 25 April 2022

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This publication is available at https://www.gov.uk/government/publications/antimicrobial-resistance-amr-applying-all-our-health/antimicrobial-resistance-amr-applying-all-our-health

The Public Health England team leading this policy transitioned into the Office for Health Improvement and Disparities (OHID) on 1 October 2021.

This guide is part of All Our Health, a resource which helps health professionals prevent ill health and promote wellbeing as part of their everyday practice. The information below will help front-line health and care staff use their trusted relationships with patients, families and communities to promote the benefits of preventing antimicrobial resistance (AMR).

We also recommend important actions that managers and staff holding strategic roles can take.

View the full range of All Our Health topics.

Introduction

Infections that cannot be treated continue to develop. The rapid spread of multidrug resistant organisms means that we may not be able to treat everyday infections or diseases with antibiotics in the near future. Many existing antimicrobials are becoming less effective as bacteria, viruses, protozoa and fungi are adapting and becoming resistant to medicines. Inappropriate use of these valuable medicines has also added to the problem.

Without effective antibiotics, even minor surgery and routine operations could become high risk procedures if serious infections can’t be treated.

Access the antimicrobial resistance e-learning session

An interactive e-learning version of this topic is now available to use.

OHID and Health Education England’s ‘e-Learning for Healthcare’ have developed this content to increase the confidence and skills of health and care professionals, to embed prevention in their day-to-day practice.

Promoting the prevention of infections and the reduction of antimicrobial resistance in your professional practice

Advances in technology, treatments and healthcare over the past decades has increased life expectancy, however, people are living longer but with poorer health. Vital organ transplants, implants and prosthetic replacements, caesarian sections and cancer chemotherapy are just a few examples of treatments that need antibiotics to prevent and treat the bacterial infections that can be caused by the treatment. If antibiotics become less or ineffective, even minor surgery and routine operations could become high risk procedures if serious infections can’t be treated.

By using or taking the wrong kind of anti-infective agent or antimicrobial drug, not using them as directed or in inappropriate concentrations, humans as patients, prescribers, carers can drive antimicrobial resistance the world over.

Within the UK and globally we are already seeing the increase and transmission of antimicrobial resistance with new types of ‘superbugs’ that cannot be treated with existing medicines. Many common diseases such as tuberculosis, HIV/AIDS, malaria, sexually transmitted diseases, urinary tract infections, chest infections, bloodstream infections and food poisoning, can resist a wide range of antimicrobials. Some cases of bacteria causing tuberculosis and gonorrhoea are already resistant to last-resort antibiotics.

Antibiotic resistance diagram

The image shows that antibiotic resistance occurs when some bacteria cells in the human body are drug resistant. Antibiotics kill the sensitive bacteria but the resistant strains remain. The antibiotic resistant bacteria multiply and antibiotic resistance spreads.

In the UK, we will see people suffering longer lasting infectious illnesses, increased numbers of deaths attributable to infectious diseases and increased socioeconomic costs associated with our increasingly pressured services. The UK 20-year vision and 5-year action plan set out the actions that are needed across all sectors to respond to and address the challenges of minimising infections and reducing AMR.

The UK government has recognised AMR as a global problem and committed international action to tackle it as a priority issue. The global approach is based on antibiotic stewardship and infection prevention and control (IPC). The global action plan on antimicrobial resistance sets out the World Health Organization’s (WHO) priorities for tackling AMR. Already, antimicrobial resistance is estimated to cause at least 700,000 deaths around the world each year.

Core principles for healthcare professionals

This All Our Health AMR resource has been created to help all health and care professionals:

  • understand specific activities and interventions that can prevent Infections and reduce AMR
  • think about the resources and services available in your area that can help people prevent infections, reduce the need for antibiotics, yet when needed, use them in the best possible way
  • identify what resources are currently available and how AMR and the prevention of infections impact on everyone’s daily practice

Taking action

If you’re a frontline health professional:

  • speak to your patients about the benefits of good hygiene including handwashing, hydration, vaccination and preventative measures available to reduce risk of acquiring infections, referring them to information or services if necessary, many of which are laid out in the NHS choice guidance
  • familiarise yourself with the keep antibiotics working campaigns, Antibiotic Guardian programmes and Health Matters to help you have an overview of the subject matter to assist in non-judgmental conversations tailored to individual patients
  • find out about the resources and services in your area that can help people minimize infections, such as local referral pathways (for example travel vaccination clinics, screening programmes, sexual health services, antenatal screening programmes) vaccination and immunization programmes including seasonal flu vaccine programmes and other local referral schemes
  • make yourself familiar with local surveillance programmes to understand what is currently circulating or a priority for your area and identify how to access your local UK Health Security Agency (UKHSA) health protection team
  • become an Antibiotic Guardian
  • familiarise yourself with key IPC messages and the requirement for antibiotics, understand where to access trusted advice for your patients – we recommend NHS advice on infections
  • familiarise yourself with key AMR and IPC messages and understand where to access trusted advice for your patients – for this we recommend NHS Choices antibiotics page and getting in contact with your local IPC team
  • promote health and wellbeing as a good immunity will benefit from a healthy lifestyle and links with other chapters in the All Our Health framework
  • understand and identify the signs and symptoms associated with infection and sepsis
  • to help you have an overview of the subject matter to assist in non-judgmental conversations tailored to individual patients, read our blogs, our keep antibiotics working campaigns, our Antibiotic Guardian programmes, and view the YouTube videos about AMR

Youtube video about AMR

To prevent antimicrobial resistance as a healthcare worker, you should:

  • familiarise yourself with your area’s guidance and policies on antimicrobial prescribing
  • be vigilant about how your area (ward/ unit/practice/community) uses antibiotics
  • if there is evidence or suspicion of infection notify the clinician, GP or nurse in charge of the patient immediately to initiate prompt treatment – antibiotics should not be started without clinical evidence of infection
  • always give antibiotics on time and avoid missing doses – timing is important for optimal therapeutic levels
  • check your patients’ drug prescription records / charts for start, stop and review dates, allergies and inform the prescriber when any changes or reviews are needed
  • promote the need for taking patient samples and document what was sent, where and why – check your patients’ microbiology culture and sensitivity reports if available and act as the patient’s advocate by informing the prescriber if the bacteria is resistant to the prescribed antibiotic
  • develop clear individual care plans with documented evidence of antibiotic treatment, changes in route of treatment (IV to oral) microbiology results, onset of signs and symptoms of infection, patient temperature, date of isolation if required, dates and times of insertion and removal of catheters and other invasive devices and any infection prevention and control precautions needed
  • inform and educate the patients, carers, other staff and general public about the importance of preventing antibiotic resistance
  • carry out evidence-based practice to promote infection prevention and control and raise awareness to all that antibiotics do not work on all infections

If you’re a team leader or manager:

  • ensure the teams you manage are aware of AMR and IPC activity services and interventions in your local area and feedback to IPC teams sharing good practice
  • include AMR, antimicrobial stewardship (AMS) (caring for the antibiotics we have) and infection prevention and control in objective setting, work plans and continuous professional development (CPD)
  • share information, promote learning opportunities and promote campaigns, for example, Antibiotic Guardian campaign, HEE online modules, staff vaccination uptake and key annual campaigns (World Antibiotic Awareness and Infection Prevention and Control weeks)
  • promote a team culture where staff know that they should talk to their patients about healthy lifestyles – Making Every Contact Count initiatives should include the promotion of good hygiene practices, including handwashing, vaccination programmes and optimising health and wellbeing
  • create a culture where all staff understand the benefits of measuring their impact and demonstrating the value of their work including sharing lessons learnt and promote a non-blame culture
  • encourage high-level, executive staff to act as role models promoting good health and wellbeing and actively involved in new initiatives for example, flu campaigns
  • raise risks and issues through risk registers and local governance structures and encourage staff to report issues
  • develop relationships with local UKHSA health protection teams and NHS Improvement Hubs and share best practice and case studies

If you’re a senior or strategic leader:

  • work to ensure AMR, AMS and IPC is an organisational priority
  • AMR, AMS and IPC, (as outlined in the code of practice and Care Quality Commission (CQC) requirements) activity is promoted prominently within commissioned healthcare services
  • include AMR, AMS and IPC as a priority area in health and wellbeing boards’ Joint Strategic Needs Assessment (JSNA) and whole health economy or quality surveillance meetings
  • consider the training and development needs of the local workforce to create a culture change and behavioural change in practice to move towards reducing infections and prescribing practices in the community
  • look at the education and training needs of the workforce, to equip them to deliver high-quality advice and interventions based on surveillance and evidence
  • encourage high-level, executive staff to promote the AMR priority 20-year vision and 5-year action plans
  • be aware of and understand the IPC reports required by the board of the organisation and escalate risk and patient safety issues
  • actively work towards ensuring compliance with organisations’ policies and procedures, regulators, commissioning bodies and patient safety partnerships
  • understand mandatory data and surveillance systems and act on the findings

Understanding local needs

Public health profiles

These profiles are a rich source of indicators across a range of health and wellbeing themes that have been designed to support JSNAs and commissioning to improve health and wellbeing and reduce antimicrobial resistance, infections and inequalities. These profiles have been developed by OHID.

The Fingertips website provides information on what can be found in each data source. The local indicators have been uploaded across 6 domains:

  • supporting NHS England initiatives
  • antimicrobial resistance (AMR)
  • antimicrobial prescribing
  • healthcare associated infections (HCAI)
  • infection prevention and control (IPC)
  • antimicrobial stewardship (AMS)

Antibiotic prescribing and antibiotic resistance are inextricably linked, as overuse and incorrect use of antibiotics are major drivers of resistance. AMR local indicators are publicly available data intended to raise awareness of antibiotic prescribing, AMR, HCAI, IPC and AMS; and to facilitate the development of local action plans. The data published in this tool may be used by healthcare staff, commissioners, directors of public health, academics and the public to compare the situation in their local area to the national picture.

Measuring impact

As a health professional there is a range of reasons why it makes sense to measure your impact and demonstrate the value of your contribution, making every contact count. Many long-term diseases in our population are closely linked to known behavioural risk factors. Around 40% of the UK’s disability adjusted life years lost are attributable to tobacco, hypertension, alcohol, being overweight or being physically inactive. This also increases the risk of acquiring an infection, which in turn results in the need for antibiotics.

Making changes such as stopping smoking, improving diet, increasing physical activity, losing weight and reducing alcohol consumption can help people to reduce their risk of poor health significantly. Making Every Contact Count (MECC) is an approach to behaviour change that utilises the millions of day to day interactions that organisations and people have with other people to encourage changes in behaviour that have a positive effect on the health and wellbeing of individuals, communities and populations.

Linking All Our Health with Making Every Contact Count and optimising health and wellbeing will reduce the risk of acquiring infections and the demand and need for antibiotics, whilst also empowering the population with knowledge and skills to help themselves make healthy lifestyle choices and reduce the risk of acquiring infections. The overall impact will be a reduction in the numbers of people who develop infections requiring antibiotics, reduction in morbidity and mortality as a result of infections and sepsis and the reduction in the need to prescribe antibiotics with an outcome of less people requiring hospital-based care.

This could also be about sharing what has worked well in order to benefit your colleagues and local populations or what has helped with your professional development.

Further reading, resources and good practice

Advice for patients and the public

The following advice can be given to patients and the public:

Professional resources and tools

These resources and tools can be used by professionals:

Good practice examples

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