Insert your organisations name here Insert presenters name here worldantimicrobialawarenessweek Overview Antibiotics are vital lifesaving medicines Antimicrobial resistance is both a global and local problem ID: 914545
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Slide1
Antimicrobial Awareness Week 2020
Insert your organisation’s name here
Insert presenter’s name here
#worldantimicrobialawarenessweek
Slide2Overview
Antibiotics are
vital life-saving medicines
Antimicrobial resistance is both a global and local problemThe link between antibiotic use and resistanceAddressing antimicrobial resistance in AustraliaAntimicrobial stewardship (AMS)Antimicrobial Awareness Week
Slide318 – 24 November
Fixed dates regardless of the first day of the week
Aims to
encourage best practice in relation to antibiotic use, among the general public, health workers and policy makers to prevent and contain the spread of antimicrobial resistance.Antimicrobial Awareness Week in Australia
Slide4Slide5Narrow spectrum antibiotics work against a limited group of bacteria Lower resistance potential
Broad spectrum antibiotics work against a larger group of bacteriaOveruse of unnecessarily broad spectrum antibiotics can drive antimicrobial resistance Broad vs Narrow Spectrum Antibiotics
Bacteria A
Bacteria BBacteria C
Bacteria D
Bacteria E
Bacteria F
Bacteria G
Antibiotic 1
Antibiotic 2 Antibiotic 3 Antibiotic 4 Antibiotic 5 Antibiotic 6 Antibiotic 7 Antibiotic 8Antibiotic 9 Antibiotic 10
It is preferable to narrow spectrum antibiotics wherever possible
Slide6The primary purpose of the PAL is to promote improved prescribing by reducing the total quantity of antibacterial use. The PAL can be used to describe reductions in a way that identifies preferred or quality use in terms of AMR and AMS
Priority Antibacterial List for Antimicrobial Resistance Containment
Slide7Access
Review -
Curb
Review - Containamoxicillin amoxicillin–clavulanic acid amikacin ampicillin azithromycin aztreonam benzathine benzylpenicillin
cefaclor
cefepime
benzylpenicillin
cefalexin
ceftaroline
chloramphenicol cefalothin ceftazidimedicloxacillin cefazolin ceftazidime–avibactamdoxycycline cefotaxime ceftolozane–tazobactamflucloxacillin cefoxitin colistingentamicinceftriaxonedaptomycinmetronidazolecefuroximedoripenemminocyclineclarithromycinertapenemnitrofurantoinciprofloxacinfosfomycinphenoxymethylpenicillinclindamycinimipenem–cilastatin procaine benzyl penicillin erythromycin linezolidstreptomycinfidaxomicinmeropenemsulfamethoxazole– trimethoprim lincomycinmoxifloxacintetracyclinenorfloxacinpivmecillinamtinidazolepiperacillin–tazobactam polymixin B tobramycinrifampicinpristinamycintrimethoprimrifaximintigecyclineroxithromycinsodium fusidate spiramycinteicoplaninvancomycinPriority Antibacterial List for Antimicrobial Resistance Containment
Slide8Antimicrobial resistance (AMR) occurs when bacteria, parasites, viruses or fungi change to protect themselves from the effects of antimicrobial drugs designed to destroy them.
This means previously effective antimicrobial drugs (e.g. antibiotics) used to treat or prevent infections may no longer work.The World Health Organization (WHO) has identified AMR as ‘one of the biggest threats to global health’.The
Australia’s National Antimicrobial Resistance Strategy - 2020 and Beyond was released and is Australia’s national AMR strategy.
What is antimicrobial resistance (AMR)?
Slide9Antibiotics treat infections caused by bacteria
Modern medicine, especially surgery and cancer treatments, depends on effective antibiotics to minimise the risk of infectionCurrently, antibiotics reduce post-operative infection rates to below 2%
Without effective antibiotics, this could increase to around 40% to 50%. Up to 30% of these patients could die from resistant bacterial infectionsThe risk of mortality without access to effective antibiotics may make some treatments and surgical procedures too risky to continue
Antimicrobial resistance results in substantial financial cost for patients and healthcare systems.Why are antibiotics and antimicrobial resistance important?
Slide10Antimicrobial Resistance
Slide11In general, the impact of medications are limited to the patient taking themUse of antibiotics has an impact not just for the patient using them but the global community as well
Antibiotics are a unique medicine
Slide12Antimicrobial resistance is a natural phenomenon Overuse, misuse and inappropriate use of antibiotics may accelerate this
The delivery of more complex health care which may require longer use of antibiotics Prolonged hospitalisation The potential impact of surgical procedures undertaken overseas
Resistant pathogens can now spread easilyduring hospitalisation if infection prevention is poorpotential for cross-border transmission through increased travel.
How has antimicrobial resistance developed?
Slide13Slide14Where do we use
antibiotics?
USA
UKHumansCommunityHospitalAnimalsPetsLivestockAgricultureCropsAquaculture
Slide15Resistance is not new
Slide16Resistance is getting worse
2013
2015
Carbapenem-resistant Enterobacteriaceae
Slide17Relationship between total antibiotic consumption and
Streptococcus pneumoniae resistance to penicillin in 20 industrialised countries.
Antibiotic use is related to antimicrobial resistance
Slide18Antibiotic use in Australia
Figure 3.15: Annual
total-hospital antibiotic usage rates (DDD/1,000 OBD) in Principal Referral Hospitals contributing to NAUSP, 2017
Slide19Antibiotic use in Australia, 2017
Slide20Very few antibiotics have been developed in the last 20 years
Most ‘new’ antibiotics are variations of existing antibioticsOnly 5 novel classes have been developed in the last 20 years.
Decline in antibiotic production
Slide21Trends in sales of recently launched antibiotics discourage pharmaceutical companies to invest in their research and development
Decline in antibiotic production
Slide22Robust monitoring and evaluation are needed in order to measure progress towards the delivery of the global action plan on antimicrobial resistance (GAP) objectives, and help identify key achievements and persisting gaps across human, animal, plant, food, and environment sectors in efforts to tackle antimicrobial resistance
Antimicrobial Resistance – Global Response
Slide23In March 2020,
the Australian Government released the second antimicrobial resistance strategy Australia’s National Antimicrobial Resistance Strategy - 2020 and Beyond
to guide the response to the threat of antimicrobial misuse and resistance. Objectives:
Australia’s response to antimicrobial resistance
Slide24The AURA Surveillance System: Coordinates the integration of data from a range of sources on antimicrobial use and antimicrobial resistance
Contributes significantly to the development and implementation of health strategies to respond to, monitor and prevent antimicrobial resistance in AustraliaSurveillance of Antimicrobial Use and Resistance in Australia (AURA)
Slide25In Australia, antimicrobial resistance also affects aged care homes and the community. High levels of antibiotic use in the community (which includes primary and aged care) is a growing concern
Australia is better placed than many countries to respond to antimicrobial resistance through having: The Antimicrobial Use and Resistance in Australia (AURA) Surveillance System
The National Alert System for Critical Antimicrobial Resistances – CARAlert (as part of AURA)
The Australian Government’s National Antimicrobial Resistance Strategy 2015-2019Initiatives developed and implemented by states and territories, and the private sectorAustralia’s response to antimicrobial resistance
Slide26Surveillance of Antimicrobial Use and Resistance in Australia (AURA)
N
ational
NotifiableDiseasesSurveillanceSystem
N
ational
N
eisseria
N
etwork
OrgTRx
The AURA National Coordination Unit is responsible for the AURA Surveillance System. Funding for AURA is provided by the Australian Government, and state and territory health departments. Multiple partners contribute data.
Slide27Australia has very high usage of antibiotics in the
community41.5% of individual Australians received an antibiotic in
2017Australia remains in the top 25% of countries with the highest community usage compared with European countries and Canada
For the first time since the late 1990s, the rate of antibiotic dispensing under the PBS/RPBS has declinedHigh levels of inappropriate prescribing were found inRespiratory tract infections including COPDAmoxicillin–clavulanic acid and cefalexin useAURA 2019 Key Findings – Antibiotic use in the Community
Slide28Aged Care Prescribing in Australia, 2018
LINK
Slide29Antimicrobial Resistance in Australia, 2017
Slide30Treatment failures
Recurring infectionsLonger hospital stays
Longer recovery timesA higher risk of mortality or long term implications
Significant financial cost of treatmentPatient impact of antimicrobial resistant infectionsWatch Glen’s Story here Preventing infections is everybody's business
Slide31Which infections are we seeing? [Insert surveillance
data, i.e. what is the most common cause of bacteraemia in your facility]What are our susceptibility and resistance patterns?
[Insert hospital data] [Numbers of cases] [Examples of cases]
Are there local antimicrobial resistance issues?What are local rates of MRSA, C diff?Do you have access to a local antibiogram?Antimicrobial resistance locally – What is happening in our health service?
Slide32This is a placeholder for a local example of a patient who experienced a resistant bacterial infection at your healthcare facility
Insert a case study (optional) You may want to detail the:
diagnosis and the method of diagnosisbacterium that was resistant to the preferred antibiotic
medications used to treat the bacterial infectiontime, resources and people involved to treat the infection impact on the patient, the patient’s life and patient’s familyimmediate, medium or long-term health implications (if any).Patient story
Slide33Monitoring of Critical Antimicrobial Resistance (CARAlert)
Link to latest CARAlert Report
Species
Critical resistanceAcinetobacter baumannii complex Carbapenemase-producingCandida auris–
Enterobacterales
Carbapenemase-producing, and/or ribosomal methyltransferase-producing
Enterobacterales
Transmissible colistin resistance
Enterococcus
species
Linezolid resistant
Mycobacterium tuberculosis
Multidrug-resistant (resistant to at least rifampicin and isoniazid)
Neisseria gonorrhoeae Ceftriaxone non-susceptible or azithromycin non-susceptible Salmonella species Ceftriaxone non-susceptible Shigella species Multidrug-resistant Staphylococcus aureusVancomycin, linezolid or daptomycin non-susceptible Streptococcus pyogenes Penicillin reduced susceptibility Pseudomonas aeruginosa Carbapenemase-producing
Slide34Resistance mechanisms to ‘last-line’ antibiotics2,979 results – January 2017 to December 2018
Azithromycin- or ceftriaxone-nonsusceptible Neisseria gonorrhoeae was the most frequently reported in 2017 (48% of isolates)
Carbapenemase producing Enterobacterales (CPE) were the most frequently reported in 2019 (49% of isolates)Over three-quarters of all CARs were from clinical specimens including urine, wound, blood
Critical Antimicrobial Resistances (CAR)
Slide35The National Antimicrobial Utilisation Surveillance Program (NAUSP) is a partner in AURA and collects data on antimicrobial use.
Factors that are likely to have contributed to reduced use include: Increased capacity of local, state and territory, and national AMS programs Changes in clinical practice
More effective adoption of recommendations in Therapeutic Guidelines: Antibiotic.
Aggregate Hospital Antibiotic Use 2017 (NAUSP)Figure 3.1: Annual total-hospital aggregate antibiotic usage rate (DDD/1,000 OBD) in NAUSP contributor hospitals, 2007–2017
Slide36Insert local antibiotic use data (if available)
Include information about your contributions to National Antimicrobial Usage Surveillance Program (NAUSP)
Insert NAUSP data.Local Antibiotic Use
Slide37Whilst antimicrobial utilisation is a good measure for the success of antimicrobial prescribing interventions it does not assess why the antimicrobial was used.
Utilisation: how much we use?Appropriateness: was it a good choice
?
Utilisation vs Appropriateness
Slide38National Antimicrobial Prescribing Survey (NAPS) - In 2017, 22.4% of all prescriptions from all participants were deemed “inappropriate” (n=
24,987 prescriptions)Appropriateness of prescribing in Australia
Slide39Does your healthcare facility audit appropriateness of prescribing?
What tools are used (e.g.. National Antimicrobial Prescribing Survey [NAPS], jurisdictional audit tools)
If participating in NAPS, insert your healthcare facilities results here:Consider
results compared to national results Time series data how the your facility’s NAPS results have contributed to your AMS program.Appropriateness of prescribing at our hospital
Slide40May increase risk of adverse effects, including: AMR (current and future patients)
Antimicrobial allergyTreatment failure Toxicity (e.g. ototoxicity)Clostridioides difficile (
formely called Clostridium difficile)Increased health care costs (i.e. length of stay)
Why is inappropriate use important?ReasonYes (%)No (%)Not specified (%)Spectrum too broad21.9%46.3%
31.8%
Incorrect dose or frequency
20.1%
50.9%
29.0%
Antimicrobial not required
17.5%
49.8%
32.7%
Incorrect duration16.5%51.0%32.5%Spectrum too narrow6.6%58.8%34.6%Incorrect route5.2%60.6%34.3%n = 5,864Reasons for a reported prescription being assessed as inappropriate, Hospital NAPS contributors, 2017
Slide41Slide42In 2017, a large proportion of the Australian population had at least one antimicrobial dispensed under the PBS (41.5%, n = 10,215,109)
Antibiotics in primary care – Pharmaceutical Benefit Scheme (PBS)
Figure 3.24: Quantity of antibiotics dispensed under the PBS/RPBS
(DDD/1,000 inhabitants/day), 2013–2017
Slide43The Antimicrobial Medicines Dispensing from 2013–14 to 2017–18 report out today also has some encouraging findings, with a downward trend in national antimicrobial dispensing rates, which fell 13.3% over five years.
Australia’s antimicrobial prescription rate remains high by international standards, and is double that of comparable OECD countries such as The Netherlands and Sweden
Antibiotics in Primary Care
Slide44In 2017, only 33.4% of antibiotics prescribed had the reason for the prescription recordedAn indication for antibiotic use could not be identified for 30% of prescriptions
Patients still received antibiotic prescriptions for influenza/upper respiratory tract infections But antimicrobials are not generally recommended for these conditions
Antibiotics in primary care –NPS MedicineWise Medicine Insight
Slide45Variation raises concerns about equity and safety and appropriateness of careThere
is marked variation in use of antibioticsbetween statesbetween hospitalsdifferent sizes
within the same sizeThe reasons for this are not well understoodAlso marked variation in community dispensing of antibiotics in 2016-17
The magnitude of variation was 4.5 times A reduction in the rate of antimicrobial prescriptions nationally by 9% compared to 2013-14Understanding Variation
Slide46Antimicrobial Stewardship isn’t about “not using antimicrobials” but rather “identify that small group of patients who really need antibiotic treatment and then explain, reassure and educate the large group of patients who don’t”
Stewardship means to protect somethingAMS is a systematic approach to optimising the use of antimicrobials
Goals of AMS are to:
improve patient outcomes / patient safetyreduce antimicrobial resistancereduce costs.AMS works hand-in-hand with infection prevention and control, and environmental cleaning strategiesAntimicrobial Stewardship (AMS)
Slide47Safety
– bring up to the minimum acceptable and sustainable standard
Quality – aspiring to the best possible quality and effectiveness of care
Equity – ensuring every patient regardless of their cultural or linguistic background has the same experience of careHas the right patient received the right antibiotic, at the right time, at the right dose, via the right route for the right duration?Is there a systematic approach to ensure each patient using antimicrobials is managed with the principles of AMS?Does your organisation keep up to date with the latest evidence and strive to innovate and implement that standard of care?Antimicrobial Stewardship (AMS) – Safety, Quality and Equity dimensions
Slide48A Critical Balance
Risk of toxicity and adverse drug reactions
Slide49Antimicrobial Stewardship
= least harm to current/future patients
Slide50Clear organisational structure and governance
Executive and clinical leadership AMS advisory committee Multidisciplinary clinical
AMS team Expert advice from infectious diseases experts
microbiologists pharmacistsEducation and training prescribers, pharmacists, nursesconsumers Information technology resources.Enablers for effective for AMS Programs - Hospitals
Slide51Essential strategies for AMS Programs - Hospitals
Pre-prescription
Post-prescription
Formulary managementDirect patient input e.g. AMS Round Restriction SystemAudit and Feedback GuidelinesMonitor appropriateness – National Antimicrobial Prescribing Survey (NAPS)Education Monitor utilisation – National Antimicrobial Utilisation Surveillance Program (NAUSP)Antibiograms (susceptibility of microogranisms to antimicrobials)EducationSelective reporting of susceptibility testingElectronic solutions - eMeds – automatic stops
Confirming patient’s allergy status
IV to Oral switch
Slide52Insert information on your AMS service:
Structure, governance – who is responsible?Who leads AMS activities?Who is on your local AMS team?What AMS activities are undertaken?
What AMS activities are you / your department involved in?Antimicrobial Stewardship in our healthcare facility
Slide53In the community General PracticeNot
prescribing antibiotics for colds and fluDelayed prescribingShared decision makingPublic declarations in the practice about conserving antibioticsPharmacies
Offering symptomatic support for cold and fluAntimicrobial Stewardship – not just for hospitals
Slide54In the home Not taking antibiotics that haven’t been prescribed for youDiscarding old antibiotic medicines appropriately
In industry Investing in research and development for antimicrobials
Slide55COVID-19 pandemic has presented many additional challenges (including antimicrobial shortages) for managing patients with infectionsIt is even more important to prevent infections and reduce inappropriate antibiotic use
Key message:Explain to patient that antibiotics do not prevent or treat COVID-19 but can cause adverse effects, allergic reactions, drug interactions and increase risk of future resistant infections
AMS during COVID-19
Slide56Slide57Commission Resources for AMS
Slide58New Chapters!General Practice – Published!In the Care of Children – Published!
Aboriginal and Torres Strait Islander Populations – on the wayAMS in Australian Health Care Book
Slide59Partnering with consumers
Link
Slide60National Safety and Quality Health Service Standards
Slide61New Version coming in December 2020
Describes best-practice in antibiotic prescribing:Urgent treatment of severe infectionAppropriate investigations collected (preferably before antibiotics)
Information given to patient about diagnosisPrescribing as per Therapeutic Guidelines: Antibiotic
(or other local guidelines)Information given to patient about treatmentDocumentation of treatment plan in the recordNarrowing of broad-spectrum empiric treatment when appropriateInvestigations reviewed in a timely waySurgical prophylaxis in accordance with guidelinesAMS Clinical Care Standard
Slide62Always use the most current version Currently version 16, 2019
Now only in online formatCheck hospital intranetA ‘go to’ reference, especially where there are limited local guidelinesLearn more
www.tg.org.au click ‘Products’, then ‘Antibiotic’
Therapeutic Guidelines: Antibiotic
Slide63Use this slide to highlight any AMS initiatives your organisation has completed recently
This may be A new guidelineA new auditA new service or multidisciplinary team success
Slide64Insert information on AAW in your health service:
Join the conversation on social media:Hashtags
#worldantimicrobialawarenessweek
#WAAW#AntibioticResistance #AMR@ACSQHCLocal activities and contact people Include information about local activities Local Antibiotic Awareness Week Activities
Slide65Ideas!
Get Creative
Pick a target areaExamples IV to Oral SwitchPenicillin AllergySurgical Prophylaxis
Slide66Antimicrobial resistance:
occurs when an organism evolves and develops resistance to an antimicrobial that should inhibit or destroy it is reducing the effectiveness of antimicrobials to treat infections
is happening nowFew new antimicrobials are being developed The misuse, overuse, and inappropriate use o
f antimicrobials contributes to antimicrobial resistanceAntimicrobial stewardship works hand in hand with prevention and control strategies to help address antimicrobial resistance. Key messages
Slide67NPS MedicineWise/ACSQHC Antimicrobial Prescribing Modules - https://
learn.nps.org.au/mod/page/view.php?id=4282 Future Learn - https://www.futurelearn.com/courses/antimicrobial-stewardshipStanford AMS Course -
http://errolozdalga.com/medicine/pages/OtherPages/AntibioticReview.ChanuRhee.html MAD-ID Course - http://mad-idtraining.org/certification/
Infections in Surgery Course - https://infectionsinsurgery.org/management-of-intra-abdomianl-infections-free-online-course/ WHO Course - https://openwho.org/courses/AMR-competency Online Resources for AMS
Slide68References
Slide Number
Website
4https://www.reactgroup.org/toolbox/understand/antibiotics/ 6https://www.safetyandquality.gov.au/publications-and-resources/resource-library/priority-antibacterial-list-antimicrobial-resistance-containment 10
Image -
https://www.researchgate.net/figure/Total-deaths-projected-by-2050-attributable-to-antimicrobial-resistance-AMR-every-year_fig2_340990507
11
Image -
http://blog.nus.edu.sg/singaporesling/2016/11/16/the-resistible-rise-of-antibiotic-resistance/
13
Image courtesy of CDC / Melissa Brower
Centers
for Disease Control and Prevention Public Health Image Library http://phil.cdc.gov/phil/home.asp 14https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/843129/English_Surveillance_Programme_for_Antimicrobial_Utilisation_and_Resistance_2019.pdf https://www.nejm.org/doi/full/10.1056/nejmp1311479 15https://www.businessinsider.com.au/alexander-fleming-predicted-post-antibiotic-era-70-years-ago-2015-7
Slide69References
Slide Number
Website
16https://ecdc.europa.eu/sites/portal/files/media/en/publications/Publications/carbapenem-resistant-enterobacteriaceae-risk-assessment-april-2016.pdf 17Source: The Antimicrobial Resistance Standing Committee (2013) National Surveillance and Reporting of Antimicrobial Resistance and Antibiotic Usage for Human Health in Australia.
18
AURA 2019 Report -
https://www.safetyandquality.gov.au/aura-2019
19
AURA 2019 Report -
https://www.safetyandquality.gov.au/aura-2019
20
Butler M,
Blaskovich
M, Cooper M. Antibiotics in the clinical pipeline in 2013. J. Antibiot 2013;66: 571-59121Lee Ventola C. The Antibiotic Resistance Crisis Part 1: Causes and Threats. P T 2015 Apr; 40(4): 277–283 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4378521/ Fernandes V, Martens E. Antibiotics in late clinical development. Biochemical Pharmacology 2017 June 1; 133: 152-163 https://www.sciencedirect.com/science/article/pii/S0006295216303082 22https://apps.who.int/iris/handle/10665/325006
Slide70References
Slide Number
Website
23https://www.amr.gov.au/resources/australias-national-antimicrobial-resistance-strategy-2020-and-beyond 24AURA 2019 Report - https://www.safetyandquality.gov.au/aura-201928
https://www.safetyandquality.gov.au/our-work/antimicrobial-resistance/antimicrobial-use-and-resistance-australia-surveillance-system-aura/antimicrobial-prescribing-australian-residential-aged-care
29
https://www.safetyandquality.gov.au/our-work/antimicrobial-resistance/antimicrobial-use-and-resistance-australia-surveillance-system-aura/community-antimicrobial-resistance/australian-group-antimicrobial-resistance
30
YouTube - Glen’s Story -
https://www.youtube.com/watch?v=RIsBB6TmZvA
33https://www.safetyandquality.gov.au/our-work/antimicrobial-resistance/antimicrobial-use-and-resistance-australia-surveillance-system/national-alert-system-critical-antimicrobial-resistances-caralert 34https://www.safetyandquality.gov.au/our-work/antimicrobial-resistance/antimicrobial-use-and-resistance-australia-surveillance-system/national-alert-system-critical-antimicrobial-resistances-caralert
Slide71References
Slide Number
Website
35NAUSP 2018 Report - https://www.safetyandquality.gov.au/our-work/antimicrobial-resistance/antimicrobial-use-and-resistance-australia-surveillance-system-aura/hospital-antimicrobial-use/antimicrobial-use-australian-hospitals38NAPS 2017 Report - https://www.safetyandquality.gov.au/antimicrobial-use-and-resistance-in-australia/naps-2/?section=4 40
NAPS 2017 Report -
https://www.safetyandquality.gov.au/antimicrobial-use-and-resistance-in-australia/naps-2/?section=4
41
Goff D.A, File T.M, The risk of prescribing antibiotics “just-in-case” there is infection, Seminars in Colon and Rectal Surgery 29 (2018), 44-48
https://www.sciencedirect.com/science/article/abs/pii/S1043148917300763
42
AURA 2019 Report - https://www.safetyandquality.gov.au/aura-201943safetyandquality.gov.au/antimicrobials-report-2020 45https://www.safetyandquality.gov.au/our-work/healthcare-variation
Slide72References
Slide Number
Website
46Verheij TJ. The antibiotic revolution should be more focused. Br J Gen Pract. 2009;59(567):716-717. doi:10.3399/bjgp09X472557 - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2751913/ 48Ohio Society of Health-System Pharmacists (2016 Annual Meeting). Meet the Antimicrobial Stewardship Pharmacists https://c.ymcdn.com/sites/www.ohioshp.org/resource/resmgr/AM_2016_Slides/4BoyleCraftetal-MeettheAntim.pdf
53
https://www1.health.gov.au/internet/main/publishing.nsf/Content/Nudge-vs-Superbugs-behavioural-economics-trial-to-reduce-overprescribing-antibiotics-June-2018
56
https://www.tg.org.au/news/antibiotic-summary-table/
57
https://www.safetyandquality.gov.au/our-work/healthcare-associated-infection/antimicrobial-stewardship/
58
https://www.safetyandquality.gov.au/publications-and-resources/resource-library/antimicrobial-stewardship-australian-health-care-2018 59https://www.safetyandquality.gov.au/sites/default/files/2019-06/AURA-2019-Consumer-resource-Trifold-Brochure-Do-I-really-need-Content-from-Literally-Inspired.pdf https://www.nps.org.au/medical-info/consumer-info/antibiotic-resistance-the-facts
Slide73References
Slide Number
Website
60https://www.safetyandquality.gov.au/standards/nsqhs-standards/preventing-and-controlling-healthcare-associated-infection-standard/antimicrobial-stewardship61https://www.safetyandquality.gov.au/our-work/clinical-care-standards/antimicrobial-stewardship-clinical-care-standard/ 62
https://www.tg.org.au/
64
https://thepulse.org.au/2017/11/14/what-is-the-future-of-antibiotics/
65
Acknowledgement: Toronto
East Health Network
Slide74