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Ron Daniels is a Consultant in Critical Care, Vice President of the Global Sepsis Alliance, Chief Medical Officer of the United Kingdom Sepsis Trust, and a Topic leader for Patient Safety Learning’s hub.  In this interview, Ron explains why doctors have to carefully manage the use of antibiotics in order to protect patients, now and in the future.  What’s the issue with prescribing antibiotics? For decades we have been using antibiotics to treat and reduce infection, and to stop people dying from infection. Unfortunately, some of the bacteria (and related organisms) we’ve been fighting have become resistant to certain types of antibiotics (or antimicrobials, in the case of other germs such as viruses, parasites and fungi). This is also known as antimicrobial resistance (AMR). Lots of people wrongly think that a patient can become resistant to antibiotics. It’s the bug, not the person. Prescribing antibiotics unnecessarily leads to more and more bugs becoming resistant, leaving patients with fewer treatment options. This is already having a huge impact on healthcare as we know it, with thousands of people affected. We need to manage the risks now, and as we move forward into the future. What does this mean for patients? If you become poorly with a bug that is resistant to a type of antibiotic, prescribing that antibiotic to you will not make you better. Your symptoms will remain or get worse. As you can imagine, this makes those particular bugs very difficult to treat, and serious life-threatening infections like sepsis more likely to occur. Worryingly, statistics indicate that patients in more deprived areas are more likely to be affected. If a doctor is concerned that you are unwell with a bug that cannot be treated with the usual ‘first choice’ course of antibiotics, they may change it or prescribe something called a ‘broad spectrum antibiotic’ to help you feel better. In some circumstances, this is lifesaving. Unfortunately using these ‘broad spectrum antibiotics’ can lead to even more bugs becoming resistant to even more types of antibiotics. There also tends to be more side effects for the patient. What are the big risks? There are a number of risks and challenges that have to be really carefully managed around the use of antibiotics. Essentially, we want to make sure: Standard and broad-spectrum antibiotics are not being prescribed unnecessarily and contributing to the issue of an increasing number of bugs being resistant to our treatments. Patients get the antibiotics they need and do not become seriously unwell or at risk of sepsis. Health inequalities do not widen. How do doctors know what to do for the best? Deciding whether or not to give antibiotics to a patient, and which type is best if you do, can be very difficult. There are tests that can identify what type of bug a patient has and what it is resistant to. There are other tests – called biomarkers – which can help with the decision as to whether or not antibiotics are needed at all. These tests can really help healthcare professionals make decisions around antibiotics, but these services are not yet widely available. What do you hope to see in future? We need to help the public understand these issues and how they are affecting healthcare and decision-making. Many people visiting their doctor will strongly believe that antibiotics are the solution to their problem. There can be a lot of pressure to prescribe them, and it can be hard to explain why that’s not always the best approach. If someone looks very sick, their GP will be sending them straight to hospital. But if not, having access to a biomarker test in the community would help people feel reassured and support that important doctor-patient relationship, especially when antibiotics are not being prescribed. Doctors need to be empowered to make the best and safest decisions for their patients. I believe we should be piloting having biomarker testing within close access to GP surgeries. For those patients deemed in need of antibiotics, further tests should guide the choice of medicine. That way, patients could quickly and easily be offered testing, and the rapid results would help their doctor decide whether to prescribe antibiotics and if so, which type would be most effective. Focusing the pilots in urban areas where there is significant variation in wealth would also help us understand and manage the risk of widening health inequalities. These actions could help reduce unnecessary antibiotic use and protect patients from serious infection. Ultimately, helping to limit the threat to human life both now and in the future. Related content Top picks: 14 key resources on antimicrobial resistance Tackling antibiotic underdosing: Interview with Ruth Dando, Head of Nursing for Theatres, Critical Care and Anaesthetics at BHRUHT What factors in the workplace enable success in antimicrobial stewardship in paediatric intensive care? Tackling antimicrobial resistance: How to keep antibiotics working for the next century Antimicrobial resistance survivors: calling the world to action Patient capacity building for advocacy and research: The case of the European Patient Group on Antimicrobial Resistance Department of Health and Social Care: Confronting antimicrobial resistance 2024 to 2029

This report provides an overview of keynote speeches and panel sessions at the third annual Safety For All Conference at the Royal College of Physicians in London on Tuesday 10 December 2024 The Safety For All campaign is focused on driving improvements in and between healthcare worker safety and patient safety. It seeks to highlight how poor staff safety standards and practice impact adversely on patient safety, and vice versa. The campaign champions the need for a systematic and integrated approach to improve safety for staff and patients across health and social care. Safety For All is jointly coordinated by the Safer Healthcare and Biosafety Network and Patient Safety Learning, supported by Boston Scientific and Stryker. The event was chaired by Professor Rob Galloway, Accident and Emergency Consultant at the University Hospitals Sussex NHS Trust. It was attended by over 100 members of the healthcare community, including occupational health professionals, patient safety experts, frontline staff, patients and academics. The report includes summaries of the conference’s speeches by: Professor Nicola Ranger, Chief Executive of the Royal College of Nursing Jane Murkin, Deputy Director Safety and Improvement – Nursing Directorate at NHS England. It also provides an overview of the following panel sessions across the day: Protecting lives while protecting the planet. Navigating the many faces of violence in healthcare. Caring for caregivers and patients – Mental health and safety in healthcare. Antimicrobial Resistance – Ensuring patient safety in an era of rising resistance. Implementing the Patient Safety Incident Response Framework. Throughout the speeches and panel discussions that ran across the day, there were several recurring themes: The important role of leadership in improving staff safety and patient safety. This being cited as the key to creating safer organisational cultures, modelling safety behaviours and advocating on behalf of patients and staff. The need for healthcare workers and patients to speak up in order to create a safer healthcare system, and the challenges of empowering staff to do this and organisations to create safety cultures in a system under significant strain. Communication and engagement is key – with staff and patients, and in convening people so they can collaborate for safety. Listening was mentioned throughout as being seen as a luxury, but it is essential to providing person-centred care. The challenge of sharing and spreading patient and staff safety initiatives when healthcare workers don't have time/capacity beyond trying to do the day job.

This report highlights the burden of health care-associated infections (HAIs) and antimicrobial resistance (AMR) and the related harm to both patients and health workers in care settings. It also presents an updated global situation analysis of the implementation of infection prevention and control (IPC) programmes at the national and health care facility levels, including a focus on the WHO regions. Headline points from this report include: On average, out of every 100 patients in acute care hospitals, seven patients in high-income countries (HICs), and 15 patients in low and middle-income countries (LMICs), will acquire at least one HAI during their hospital stay. Almost up to one third (30%) of patients in intensive care can be affected by HAIs, with an incidence that is two to 20 times higher in LMICs than in HICs, in particular among neonates. One in four (23.6%) of all hospital-treated sepsis cases are health care-associated and this increases to almost one half (48.7%) of all cases of sepsis with organ dysfunction treated in adult intensive care units. In 2023–2024, according to the system established to monitor the status of country progress towards the implementation of the AMR global action plan (the Tracking AMR Country Self-assessment Survey), 9% of countries did not yet have an IPC programme or plan. Only 39% of countries had IPC programmes fully implemented nationwide, with some being monitored for their effectiveness.

WHO Infection Prevention and Control Global Webinar Series Each year the WHO’s World Hand Hygiene day aims to maintain a global profile on the importance of hand hygiene in health care and to ‘bring people together’ in support of hand hygiene improvement globally. On this day, everyone, in countries and health facilities, can renew their support and promote and implement strategies and innovations to improve hand hygiene practices in health care. Objectives: To promote a shared understanding of the fact that IPC education and training should be in place for all health workers by utilizing team- and task-based strategies that are participatory and include bedside and simulation training to reduce the risk of HAI and AMR. To outline the importance of campaigning for hand hygiene and WHHD 2024 resources. To outline and describe proposed WHHD 2024 activities. To stimulate engagement with the campaign on and around 5 May 2024. Register

If you work in primary care or primary care research, this one-hour NIHR Evidence webinar is for you. This webinar will cover NIHR research that could help reduce antibiotic prescribing in primary care. Speakers will present actionable evidence on antibiotic stewardship, and safe and effective prescribing. Presentations will be followed by a Q&A session, giving you a unique opportunity to quiz the researchers on how this research could be implemented at your organisation and reflect on potential barriers and facilitators. The webinar will cover: making decisions about who is in most need of antibiotics if antibiotics are needed for children with chest infections how digital tools can help reduce antibiotic prescribing. Register