By Rose Gallagher MBE, Professional Lead Infection Prevention & Control, Royal College of Nursing and EPHA Scientific Advisor on Antimicrobial Resistance
There’s no doubt that awareness of antimicrobial resistance is increasing – within civil society, national public health strategies and practical actions within health and care organisations. Levels of activity will vary, along with financial and other resources but awareness across Europe is moving in the right direction.
As a nurse I can see building blocks are in place. At the strategic level the development of the European competencies for infection control; 1, 2 a global and European action plan;3, 4 and supportive visits by European Centre for Disease Prevention and Control to enable and review EU member states actions are important steps in our journey to tackle AMR. The focus on reducing prescribing antibiotics, innovation and development of new diagnostic tools is also relevant and necessary. A recent Economist event in the UK ‘Antimicrobial resistance – Preventing an antibiotic apocalypse’ focused on the importance of investment and industry – push pull incentives and return of investment common language throughout the day. All necessary but a world away from the day-to-day practicalities of nursing care. The challenge of course is to make AMR and actions to solve this crisis real to everyone. For nurses however there are two current priorities it is essential to tackle – having enough nurses to deliver safe care, and understanding our profession’s contribution to AMR.
Here in the UK, like many other countries we are facing some very practical challenges in our efforts to support healthcare care workers comply with policies and evidence-based guidelines to prevent infection – we simply don’t have enough staff to do the right thing every time. in England alone we currently have around 40,000 registered (qualified) nursing vacancies. With the best will in the world, such a high number of vacancies will affect our ability to deliver safe and effective care. Situations like this represent a huge elephant in the room that is missing in AMR policy 5 – and many other EU member states will have similar challenges. Recognising this the Royal College of Nursing writes ‘Having the right number of registered nurses with the right knowledge, skills and experience is critical to the delivery of safe and effective care. Posts left unfilled also put enormous pressure on nursing staff as patients expect the same level of care, but delivered by fewer nurses’. Fewer nurses but the same expectations for hand hygiene compliance will mean that nurses prioritise when to clean hands with potentially less time for other activities e.g. equipment cleaning between care activities. It also means fewer opportunities for breaks during the working day – essential not only for the health of the workforce but our ability to make decisions and function effectively – all necessary as part of efforts to reduce infection in hospitals.
For the nursing profession to fulfil its full potential in reducing AMR we must understand where we contribute most effectively. Nursing is critical to reductions in AMR, not least as care providers but as educators, public health advocates and health advocates in all parts of society. The rhetoric of prescribing, diagnostics and business is not one that most nurses will necessarily relate to – even with in excess of 53,500 nurse prescribers in the UK it can feel far removed from many nursing roles. That however is changing. Work has begun to describe, in a meaningful way, the antimicrobial stewardship contributions needed to inform undergraduate education curricula, of all professions including nursing 6. Many assume clarity of how our role contributes is obvious but in the case of AMR this is not necessarily so. Acknowledging that the language of ‘stewardship’ needs to be meaningful and developed by the professions themselves, not policy makers, allows us to strengthen the foundations of AMR reduction plans and identify opportunities for sustainable change. As such it will challenge the inevitable rush to create solutions, often by others, which risk reducing capacity whilst increasing work – the new antimicrobial stewardship nurse role is one example. In these days of limited resources we need to stand firm and question what benefit new roles or teams bring if our unique contribution is only just emerging.
Strategies to reduce AMR need to address complex scientific, economic and behavioural components. The role of healthcare professionals needs to extend beyond the practical to the considered use of resources and impact. There are no shortages of possible solutions to reduce AMR, the key is to ensure the building blocks to support success are firmly in place. The right number of staff and clarity of roles in the context of AMR are essential. Policy makers and budget holders have an essential role in delivering success based on this.
1.ECDC (2013) Core competencies for infection control and hospital hygiene professionals in the European Union
2.Brusaferro S et al (2015) Harmonizing and supporting infection control training in Europe. Journal of hospital Infection. 89 (4) 351-356
3.WHO Global Action Plan on AMR
4.European Commission (2016) A European One Health Action Plan against Antimicrobial Resistance (AMR
5.Gallagher R (2018) Commandment 2, Improve hygiene and prevent the spread of infection. The Ten Commandments – two years on – A response. SFAM
6.Courtenay et al (2018) Development of consensus-based national antimicrobial stewardship competencies for UK undergraduate healthcare professional education. Journal of Hospital Infection 100 (3) 245-256