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Antimicrobial resistance: nurses’ role in fighting this global health threat

Nurses are on the front line in the struggle to stem resistance to antimicrobials, which seriously endangers modern medicine and healthcare

Nurses are on the front line in the struggle to stem resistance to antimicrobials, which seriously endangers modern medicine and healthcare

  • Resistance to antibiotics is growing, making medicines ineffective
  • Their misuse, such as for viruses like colds and flu, is hastening this process
  • Poor infection control, sanitation and food handling are also responsible
  • Loss of antibiotics would raise risk of dying from common infections and minor injuries

Picture: Alamy

Imagine a world in which last century’s medical breakthroughs are lost and curable infectious diseases once again become untreatable.

This new world would render routine surgery such as caesarean sections and hip replacements life-threatening, and bring perilous risk to common procedures including organ transplants, diabetes management and cancer chemotherapy. Drugs used in the fight against conditions such as tuberculosis, HIV and malaria would begin to cease working.

490,000

The number of people globally who develop multi-drug-resistant TB each year.

Source: World Health Organization

A nightmare unfolding

It may sound like a nightmare, but these scenarios have already started to unfold across the globe.

Antimicrobial resistance (AMR), as this phenomenon is known, poses a major threat to global health and seriously endangers modern medicine and healthcare.

Without urgent action, life as we know it may be forever altered.

Public Health England (PHE) senior specialist health protection and consultant nurse Susie Singleton says the threat is very real.

‘We have cases where patients have bugs which are resistant to every single antibiotic we have got’

Susie Singleton, senior specialist health protection and consultant nurse

Ms Singleton says: ‘It is here and it is now. We have cases where patients have bugs which are resistant to every single antibiotic we have got.’


Picture: iStock

Within England alone there are an estimated 5,000 deaths every year due to AMR, according to PHE. 

AMR occurs when microorganisms such as bacteria, fungi, viruses and parasites change when exposed to antimicrobial drugs such as antibiotics, antifungals, antivirals, antimalarials, and anthelmintics or antiparasitics.

As a result, medicines used to treat them become ineffective and infections persist in the body, increasing the risk of them spreading to others.

Microorganisms that develop AMR are sometimes referred to as superbugs.

AMR occurs naturally over time, usually through genetic changes, but the misuse and overuse of antimicrobial drugs is accelerating this process.

In many places, antibiotics are overused and misused in people and animals, and are often given without professional oversight.

Examples of misuse include when they are taken by people with viral infections such as colds and flu, and when they are given as growth promoters in animals or used to prevent disease in healthy animals.

Advice from WHO

The World Health Organization advises health professionals to help prevent and control the spread of antibiotic resistance by doing the following:

  • Prevent infections by ensuring your hands, instruments and environment are clean
  • Only prescribe and dispense antibiotics when they are needed, according to current guidelines
  • Report antibiotic-resistant infections to surveillance teams
  • Tell patients how to take antibiotics correctly and talk to them about antibiotic resistance and the dangers of misuse
  • Talk to patients about preventing infections such as by vaccination, hand washing, safer sex, and covering the nose and mouth when sneezing.

RCN professional lead for infection prevention and control Rose Gallagher says that since the introduction of antibiotics, resistance has always been present.

‘But as we have used more antibiotics, bacteria have naturally evolved and have developed ways of passing resistance between species that now pose a significant threat to human health,’ she says.

5,500

NHS patient deaths occurred in 2015 as a result of gram-negative bloodstream infections such as E-coli, which are increasingly resistant to most antibiotics.

Source: UK government

Antimicrobial resistant-microbes are found in people, animals, food and the environment – in water, soil and in the air.

They can spread between people and animals, including from food of animal origin, and from person to person.

Poor infection control, inadequate sanitation and inappropriate food handling encourage the spread of antimicrobial resistance.

On the front line

Ms Singleton says the perceived complexity of the workings of AMR and often technical language, even that used in public health awareness campaigns, can affect nurses’ understanding about the importance of their role.

​‘Even among our own peers and colleagues, unless we are working in that field we may not grasp it,’ she says.

‘Nurses, doctors, pharmacists and AHPs all have to work together, with international colleagues, to set the same objectives’

Rose Gallagher, RCN professional lead for infection prevention and control

‘It is very technical and microbiologically driven, so people think “it doesn't apply to me”.

‘But nurses have a leadership role in the AMR agenda because they are the ones on the front line.

‘The role of the nurse is vital in reducing AMR and protecting the antibiotics we have, and that can only be done through proper understanding and education.’

What you need to know about AMR

  • Antimicrobial resistance (AMR) threatens the effective prevention and treatment of an ever-increasing range of infections caused by bacteria, parasites, viruses and fungi
  • AMR is an increasingly serious threat to global public health
  • Without effective antibiotics, the success of major surgery and cancer chemotherapy would be compromised
  • The cost of healthcare for patients with resistant infections is higher than care for patients with non-resistant infections due to longer duration of illness, the need for additional tests and use of more expensive drugs
  • Without urgent action there could be a post-antibiotic era in which people would once again be in danger of dying from common infections and minor injuries

Antimicrobial stewardship strategies that focus on preventing the misuse of antimicrobial drugs are key, says Ms Singleton, adding that all nurses administering medication should take responsibility for ‘safe and proper use’ of antibiotics.

‘If a drug is prescribed for five days, it should be taken for five days,’ she emphasises.

‘As a nurse, you have that requirement to understand what you are giving, and also how many other courses of antibiotics the patient has had – you shouldn't just carry on blindly.

‘You need to know the start and stop dates, whether it should be taken with food, whether the patient can swallow or is hydrated enough. It’s about holistic care.’

Ms Gallagher says the RCN sees AMR as a public health issue and believes that within the nursing profession awareness of the challenge is rising.

‘Historically, AMR was seen as a medical issue because nurses weren’t prescribing and it was associated with microbiology and pathology services.


Rose Gallagher: awareness of the
challenge is rising.
Picture: David Gee

‘That is now shifting and nursing is very engaged at a national and international level around how to support this issue.’

‘Bugs have no borders,’ she says. ‘Nurses, doctors, pharmacists and AHPs all have to work together, with international colleagues, to set the same objectives.’Ms Gallagher says multi professional national and international collaborative working are key to future success.

On a purely nursing level, the profession’s contribution to the AMR agenda is very broad, she adds, and covers all settings and specialties of nursing.

‘This includes medicines management in how we administer antibiotics, how we educate and advise our patients and the public on when they need antibiotics, and how, as prescribers, we prescribe them.

‘But our contribution is also in terms of the prevention of infection and our public health role of making every contact count – our opportunity to educate patients is significant.’

Award-winning project

The Nursing and Midwifery Council is considering feedback from a consultation on new draft education standards that propose nursing students attaining prescribing knowledge.

If this standard is approved, a post-registration practice assessment could give new nurses prescribing powers.

195

Antibiotic resistance is present in all of the 195 countries of the world.

Source: WHO

Since PHE started running a campaign on the issue in 2014, more than 6,500 nurses have pledged to become an ‘antibiotic guardian’ and make better use of antibiotics.

Nurses have been recognised for their achievements in tackling aspects of AMR. At the Antibiotic Guardian 2017 Awards, NHS Tayside advanced nurse practitioner for antimicrobial stewardship Jo McEwen won an award for a project that engaged nursing staff in this stewardship role.

What nurses can do

Her 12-month education programme focused on the management of urinary tract infections (UTIs) and was delivered to community hospital nursing teams at the trust.

Jo_McEwen
Jo McEwan: 'Nurses haven't really
been involved in stewardship until
recently.’ Picture: Tim George


Subsequently, there was a 29% reduction in the number of inappropriate samples being sent by nurses to the laboratory.

'Nurses haven't really been involved in stewardship until quite recently,’ Ms McEwen said after the award ceremony.

‘This project was about testing the water and finding out exactly what nurses can do – what they can bring to the table in minimising resistance and optimising the use of antimicrobials within the hospital setting.’

Guiding the public

Last autumn, PHE called for nurses to lead attempts to tackle resistance to antibiotics and launched a Keep Antibiotics Working campaign.

This urged the public to heed advice from healthcare professionals and take antibiotics only when necessary.

Two UK government targets related to AMR include reducing inappropriate prescribing and reducing gram-negative bloodstream infections such as E-coli by 50% by 2021.

How you can help tackle AMR

  • Encourage people to consult their local pharmacist for advice on common ailments
  • Take opportunities to talk to patients and their carers about when antibiotics are appropriate and about the need to complete the whole course
  • If you feel antibiotics have been prescribed unnecessarily, talk to the prescriber  
  • Only take specimens when clinically indicated – never ‘just in case’
  • Check the length of course of patients’ antibiotic medication, and confirm that it has been completed and administered at the right times
  • Use infection prevention techniques to reduce the need for antibiotics
  • Remember that AMR is not just a hospital issue; most antibiotics are prescribed in community settings

Compiled by Rose Gallagher, RCN professional lead for infection prevention and control

RCN training course attracts interest

The RCN has received hundreds of expressions of interest in a new course it is piloting which it intends will ‘set the future standard’ for infection prevention and control (IPC) in nursing.

The introductory module prepares nurses working or interested in IPC for the challenges arising from AMR.

Called the RCN Professional Development Course for Infection Prevention and Control, it is worth 20 academic credits, and can be taken as a standalone module or as an introduction to a related master’s programme.

RCN professional lead for infection and prevention control Rose Gallagher says: ‘In our view, the prevention of infection and AMR are linked. There are a variety of courses in infection control, but no one baseline standard that nurses can use to demonstrate their competency.

‘Our ambition is that this model will go on to set new future standards and will link to the RCN’s career and competency framework. It will support nurses entering that specialist area of nursing to take them from a novice to a competent practitioner.'


Further information

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