Antimicrobial resistance (AMR) is an important public health issue which impacts on the whole of society within the UK and across the entire world. In short, AMR hampers the control of infectious diseases and effectiveness of treatment, resulting in individuals remaining infectious for longer periods, thus increasing the risk of spreading resistant micro-organisms to others. The UK Five Year Antimicrobial Resistance Strategy 2013 to 2018 UK AMR Strategy responds to these challenges and identifies the future areas of activity that we need to focus on at a national and global level. It sets out the role of government and other organisations in co-ordinating work across these sectors to deliver a UK AMR programme.
Clearly, locally there is an important role for health care professionals in ensuring their own understanding of the challenges which include:
• Infections are increasingly developing that cannot be treated.
• Rapid spread of multi-drug resistant (MDR) bacteria means that we could be close to reaching a point where we may not be able to prevent or treat everyday infections or diseases.
• Many existing antimicrobials are becoming less effective.
• Bacteria, viruses and fungi are adapting naturally and becoming increasingly resistant to medicines used to treat the infections they cause.
• Inappropriate use of these valuable medicines has added to the problem.
• The development pipeline for new antibiotics is at an all-time low.
We must therefore conserve the antibiotics we have left by using them optimally. The process of developing new antimicrobials and new technologies to allow quicker diagnosis and facilitate targeted treatment must be accelerated. Given the enormity of the challenge this necessitates local, national and global action.
AMR cannot be eradicated but multi-disciplinary approaches involving a wide range of partners will limit the risk of AMR and minimise its impact for health, now and in the future. Partners need to work together to ensure the following are in place:
• Effective infection prevention and control measures to help prevent infections;
• Systems to diagnose infections quickly and the right treatment used;
• Recognition and understanding of the importance of antibiotic treatment regimens and adhere to them;
• Identification of new threats or changing patterns in resistance;
• Sustainable supply of new, effective antimicrobials.
Why should antimicrobial resistance (AMR) be of concern to those supporting children, young people and families?
Children’s centres, nurseries and schools are excellent opportunities for children and young people to engage in opportunities for learning, socialising and generally spending time with their peers. Such gatherings are an essential part of a child’s life and we want to ensure children are healthy and happy. We also know that respiratory and gastrointestinal infections are a major cause of childhood illness, with poor respiratory and hand hygiene contributing to increased spread. Parents, siblings and staff within schools or early years settings are also often affected.
The consequences and impact of spread of infection has far reaching implications including school absences, spread of infection to siblings or grandparents and for parents time lost from work – which understandably may prompt parents to request antibiotics as a solution. Antibiotics are widely prescribed, particularly during childhood and there is general public misunderstanding on how to use antibiotics properly. Antimicrobial resistance is an increasing problem and is related to antibiotic use. If antibiotic use could be reduced, the tide of increasing resistance could be stemmed.
Health Visitors and School nurses have a fundamental role in health protection and supporting children, young people and parents to make informed decisions and encourage the uptake of immunisations and vaccines. Starting intelligent conversations with parents during the early years will ensure parents not only make good decisions but they can influence and support their children to grow to make informed health decisions and improve their life chances. Health visitors are crucial in making every contact count and utilising their expertise to influence parents.
School nurses work closely with school leadership teams to reduce school absences due to health related illnesses and reducing the transmission of infections. An essential element of this role includes working with schools and informal educators such as youth workers to help children and parents understand that anti-biotics are not always the answer and to focus minds on reducing transmission of infections and to improve understanding and uptake of immunisations and vaccines.
There are great resources to support schools and informal educators including the free on line e-Bug materials (www.e-bug.eu), which utilise fun and educational opportunities to teach children and young people why it is so important to use antibiotics correctly in order to control antibiotic resistance, and to have good hand and respiratory hygiene to help reduce the spread of infection. We know the influence of parent education programmes, reinforcement of key messages through the school-aged years and delivery of school -led approaches will support behaviour change in the long term through changes in social norms, which are an important determinant of behaviour.
Health visitors and school nurses are well placed to make a difference within families’ and through initiatives with school-aged children through formal and formal education settings. Health visitors and school nurses need to work closely together, develop consistent messaging and take a life course approach (0-19, evidently this will only not positively impact children and young people today but if we embed the messages within educational programmes and reach large cohorts of children and young people now we can change mind sets of future generations – which means every contact has truly counted!