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A prescription for success

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VOL: 97, ISSUE: 46, PAGE NO: 52

Sarah Fielder, RGN, Dip Infection Control, was formerly public health infection control nurse, Bromley Health Authority

Angela Emslie, RGN, RCNT, Dip Infection Control, is senior nurse infection control, Bromley Hospitals NHS 'Trust

Antimicrobial resistance is a major concern because many pathogenic bacteria are becoming increasingly resistant to antibiotics. Fewer new antibiotics are being produced, and this will lead to greater difficulty in selecting effective therapy to treat infections. This is already a problem and, according to Spiby (1999), unless everybody takes action now we will revert to a time when the minor ailments of today again become the serious diseases of tomorrow.

Antimicrobial resistance is a major concern because many pathogenic bacteria are becoming increasingly resistant to antibiotics. Fewer new antibiotics are being produced, and this will lead to greater difficulty in selecting effective therapy to treat infections. This is already a problem and, according to Spiby (1999), unless everybody takes action now we will revert to a time when the minor ailments of today again become the serious diseases of tomorrow.

In 1997 the chief medical officer asked the Standing Medical Advisory Committee to examine the issue of antimicrobial resistance in relation to medical prescribing. The committee set up a sub-group and produced The Path of Least Resistance (Standing Medical Advisory Committee, 1997).

In 1999 the Department of Health launched a long-running educational campaign to inform all sections of the community that antibiotics are ineffective against the majority of coughs and colds. These are generally viral in origin, and antibiotics are not effective against viruses.

Patients are being informed that they should not expect their GPs to prescribe antibiotics for these conditions. However, the problem of resistance cannot be resolved quickly, and this campaign will continue with new ideas being introduced as it progresses.

Resistance is defined as 'the ability to survive or flourish in spite of exposure to a substance ordinarily having a noxious or destructive effect' (Churchill Medical Dictionary, 1989). It is now of enormous concern worldwide because if a drug loses its efficacy future treatment may be jeopardised.

While few exhibit total resistance to all antibiotics, methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-intermediate Staphylococcus aureus (VISA), the tubercle bacillus and vancomycin-resistant enterococci (VRE) are but a few of the common organisms that are becoming increasingly difficult to treat. Viruses are also becoming resistant to antiviral drugs, and some antiseptics now show decreased potency against a range of micro-organisms.

As part of a wider strategy to address the problem of antibiotic resistance, the Department of Health included information for hospital staff, vets and agricultural workers alongside the GP programme. Literature was sent to health authorities for distribution.

In Bromley, south London, the director of public health's annual report for 1999-2000 addressed the issue of antibiotic resistance (Spiby, 1999) and stressed that everyone needs to make an effort to save our antibiotics. This colourful and easy-to-read report was specifically designed to appeal to all members of the community, rather than just those with a background in health care provision. It follows the trials and successes of a fictional family throughout a year and covers a range of communicable disease and infection control issues.

The month of January sets the scene, in which the daughter of the family is studying bacterial and viral diseases and their cures for A-level biology. The differences between bacteria and viruses and the appropriateness of antibiotics to treat these organisms are explained.

Later months address the problems of tuberculosis, MRSA and meningitis. A school trip to a local farm in April highlights the problem of E. coli 0157, while food poisoning is addressed when neighbours have a barbecue resulting in a number of guests experiencing diarrhoea and vomiting.

Infections from domestic animals, particularly during pregnancy, are discussed, and headlice is the subject for September, when children start back at school. Along with the story, the report contains a 'did you know?' section in which succinct bullet points highlight the main messages relating to the subject.

Spiby's report provided an ideal platform to advertise different activities taking place in the borough, and many agencies in Bromley planned and promoted events on antimicrobial resistance throughout 2000. The hospital infection control team and the public health nurses, in collaboration with other agencies, provided a seamless educational programme covering the hospital and the wider community.

One of the major events of the campaign was a series of roadshows addressing the problem of MRSA, which emphasised the importance of good hand hygiene.

Display boards and a computer presentation were taken to all four sites in Bromley Hospitals NHS Trust, and a further workshop using a similar format was provided for staff in nursing and residential homes.

Children are often very receptive to messages about health, and a programme was introduced into some schools. Even the toddlers at pre-school groups learnt the story of Bertie the bacteria and how to make sure that he stays away from the nursery school.

During a food safety week in June 2000 staff from the environmental health department highlighted the problems of food poisoning associated with barbecues. Information and leaflets were handed out at garden centres, public houses, schools and leisure groups.

There are many ways to involve the whole community in an initiative like this, and staff in the borough worked hard to help reduce the risk of increasing antibiotic resistance.

Box 1 suggests the way forward for the public, health professionals, animal workers and authorities. Antibiotic resistance is a serious problem and will not be resolved unless the whole community acts now.

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