FAQ

Important steps to be taken at hospital level to contain AMR are:

• Establish an infection prevention and control committee (IPC).
• Whenever available, use rapid point-of-care diagnostics to support clinical decisions and further develop where inadequacies persist.
• Promote rational antimicrobial use.
• Develop standardised antibiotic surveillance systems for antibiotic resistance and antibiotic use.
• Purchase food raised without routine antimicrobials
• Improve sanitation in hospitals to prevent healthcare associated infections
• Improve waste management to efficiently remove pharmaceuticals and microbes
• Hand hygiene with soap or alcohol-based rub are key to protect patients from avoidable infections contracted in health-care settings and prevent the spread of AMR (WHO, 2017)
• Include environmental criteria in antimicrobial drugs’ procurement decisions to improve transparency along the supply chain.
• Report AMR cases and resistance patterns to the regional and international levels, such as through the EARS-Net EU reporting network

Antibiotics are a common treatment for human infections, however, sometimes bacteria can develop a resistance to antibiotics that renders the treatment ineffective. Resistance is developed through the natural, adaptive reactions of the bacteria which can then spread if a patient carries these antibiotic resistant bacteria. The most common vectors for bacteria spread are dirty hands or contaminated objects; eventually patients will be sent home and can spread resistant bacteria to others outside the hospital as well (ECDC).

Doctors have a leading role in antimicrobial stewardship, educating patients about antimicrobial resistance, and improving prescription practices to save antibiotics for the future generations. The most beneficial actions a doctor can take include:

• Implement appropriate prescription practices to ensure antibiotics are prescribed and dispensed correctly
• Whenever available, use rapid point-of-care diagnostics to support clinical decisions and further develop where inadequacies persist.
• Use preventative measures such as vaccines to protect patients from infections
• Include environmental criteria in antibiotic procurement decisions
• Support administrative policy changes to purchase food raised without routine antimicrobials
• Improve sanitation in hospitals to prevent healthcare associated infections
• Improve waste management to efficiently remove pharmaceuticals and microbes
• Advise patients about the risks associated with antimicrobial therapy and use preventative measures when possible
• Educate patients on the safe, recommended methods for disposing or returning unused antimicrobial drugs
• Hand hygiene with soap or alcohol-based rub are key to protect patients from avoidable infections contracted in health-care settings and prevent the spread of AMR (WHO, 2017)

Unchecked manufacturing discharge into water systems has had a major impact not only on the safety of those water sources, but also on the people and animals that encounter the resistant bacteria. This problem is particularly salient in India and China where most active pharmaceutical ingredients (APIs) are manufactured (Changing Markets, 2016).

Studies from Hyderabad in India have shown that concentrations of pharmaceuticals routinely exceed the maximum regulatory limits or safe exposure levels (Larsson et al., 2007). Point-source pollution occurs when APIs and finished-dose antibiotics are produced in specific areas and cause excessively high concentrations which, in turn, encourages the development of drug resistance. Vulnerable populations living near manufacturing facilities and wastewater treatment plants are the most at risk for the damaging impacts of resistance. (Lübbert et al., 2017) (Al Jazeera, 2016) (Larsson, 2014)

• Confirm antimicrobials are being used appropriately throughout the health system before filling prescriptions
• Learn about the important role of antimicrobial stewardship and infection prevention and control programs in health systems.
• Inform patients about AMR and their role in combating its spread. For example, patients should complete their entire course of antibiotics as prescribed by their doctor
• Ensure that patients are aware antibiotics will not treat viral infections such as the common cold and flu
• Advise patients about the risks associated with antimicrobial therapy and use preventative measures such as vaccines when possible
• Educate patients on the safe, recommended methods for disposing or returning unused antimicrobial drugs

Nurses play one of the most critical roles in combating AMR and although they are often integrated into antimicrobial stewardship initiatives, their role has not been made clear. Nurses should take an active role in these programmes to manage antimicrobial resistance and ensure that all antibiotic prescriptions are prescribed correctly and in compliance with local and national policy. Prescriptions for antibiotics should always be evidence based to guarantee they are being used for the right reasons and will be an effective treatment for the patient.

Nurses should always make sure that their knowledge of AMR is up to date so that they can better educate patients as well as make the right decisions regarding antibiotics. In both primary and secondary care settings nurses are some of the best positioned people to be able to inform patients about the threat of AMR and help them make health decisions that are better for themselves and for society  (Ladenheim, 2018).