1. Summary
Resistance to antibiotics and other antimicrobials is recognised nationally and internationally as a major threat to public health and patient safety which requires rapid and effective intervention. Prudent prescribing of antibiotics also has a major role to play in prevention and control of Clostridium difficile associated disease, though the organism itself is not regarded as antibiotic-resistant.
The recommendations set out in the Antimicrobial Resistance Strategy and Scottish Action Plan ( SEHD 2002) 1 have now largely been implemented, or overtaken by subsequent developments. A Ministerial Healthcare Associated Infection ( HAI) Task Force working group was commissioned to review the progress in delivery of these recommendations, and to produce the Scottish Management of Antimicrobial Resistance Action Plan ( ScotMARAP). ScotMARAP expands on the issues raised in the guidance document Antimicrobial Prescribing Policy and Practice in Scotland (2005) 2, produced by the Scottish Medicines Consortium on behalf of the HAI Task Force, and outlines the national programme for Scotland over the next five years.
The major elements of ScotMARAP include:
- Establishing a communications network for NHSScotland which brings together microbiologists, infection control professionals, pharmacists, prescribers and national expert bodies (e.g. Health Protection Scotland, Information Services Division of National Services Scotland, NES Education for Scotland) within a new national forum
- Ensuring robust and quality controlled systems for data gathering both for surveillance of resistant organisms and use of antimicrobial agents
- Collation, analysis and interpretation of these data at local and national level
- Implementation and monitoring of antimicrobial prescribing policies at local and national level
- Education and training in prudent antimicrobial prescribing.
Key issues for action within ScotMARAP include:
- Utilising existing pharmacy and prescriber networks by tasking the Scottish Medicines Consortium to convene a new national antimicrobial Prescribing Group, membership to include Health Protection Scotland, NHS Education for Scotland, the Information Services Division of National Services Scotland, and other expert sources of information and advice
- Implementing standardised automated sensitivity testing across Scotland, linked to national surveillance programmes
- Driving forward the collection of prescribing information - using standardised definitions - within the hospital and 'out of hospital' sectors, with clear links to antimicrobial resistance data and clinical information
- Ensuring the establishment and effective working of Antimicrobial Management Teams within every NHS Board in Scotland
- Further development of education and training frameworks, programmes and competencies, including promotion of prudent prescribing as part of the mandatory Continuing Professional Development element as stated in the HAI Task Force Code of Practice for the Local Management of Hygiene and HAI ( SEHD 2004) 3.
ScotMARAP is intended as a five-year strategic plan which will undergo continual review within its implementation. A formal review will be conducted in 2013, or earlier if appropriate.
The Action Plan outlines these roles and responsibilities as they apply to the various national and local agencies.