Antimicrobial Awareness Week 2020: Key Messages

Antimicrobial Awareness Week 2020
Insert your organisation’s name here
Insert presenter’s name here
#worldantimicrobialawarenessweek

Overview
•Antibiotics are vital life-saving medicines
•Antimicrobial resistance is both a global and local problem
•The link between antibiotic use and resistance
•Addressing antimicrobial resistance in Australia
•Antimicrobial stewardship (AMS)
•Antimicrobial Awareness Week

18 – 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

• Narrow spectrum antibiotics work against a limited group
of bacteria
⎻ Lower resistance potential
• Broad spectrum antibiotics work against a larger group of
bacteria
• Overuse of unnecessarily broad spectrum antibiotics can
drive antimicrobial resistance
Broad vs Narrow Spectrum Antibiotics
Bacteria A Bacteria B Bacteria C Bacteria D Bacteria E Bacteria F Bacteria G
Antibiotic 1
Antibiotic 2
Antibiotic 3
Antibiotic 4
Antibiotic 5
Antibiotic 6
Antibiotic 7
Antibiotic 8
Antibiotic 9
Antibiotic 10
It is preferable to
narrow spectrum
antibiotics wherever
possible

The 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

Access Review - Curb Review - Contain
amoxicillin amoxicillin–clavulanic acid amikacin
ampicillin azithromycin aztreonam
benzathine benzylpenicillin cefaclor cefepime
benzylpenicillin cefalexin ceftaroline
chloramphenicol cefalothin ceftazidime
dicloxacillin cefazolin ceftazidime–avibactam
doxycycline cefotaxime ceftolozane–tazobactam
flucloxacillin cefoxitin colistin
gentamicin ceftriaxone daptomycin
metronidazole cefuroxime doripenem
minocycline clarithromycin ertapenem
nitrofurantoin ciprofloxacin fosfomycin
phenoxymethylpenicillin clindamycin imipenem–cilastatin
procaine benzyl penicillin erythromycin linezolid
streptomycin fidaxomicin meropenem
sulfamethoxazole– trimethoprim lincomycin moxifloxacin
tetracycline norfloxacin pivmecillinam
tinidazole piperacillin–tazobactam polymixin B
tobramycin rifampicin pristinamycin
trimethoprim rifaximin tigecycline
roxithromycin
sodium fusidate
spiramycin
teicoplanin
vancomycin
Priority
Antibacterial
List for
Antimicrobial
Resistance
Containment

• Antimicrobial 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)?

• Antibiotics treat infections caused by bacteria
• Modern medicine, especially surgery and cancer treatments, depends on effective
antibiotics to minimise the risk of infection
− Currently, 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 infections
− The 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?

• In general, the impact of medications are limited to the
patient taking them
• Use of antibiotics has an impact not just for the patient
using them but the global community as well
Antibiotics are a unique medicine

• Antimicrobial 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 easily
− during hospitalisation if infection prevention is poor
− potential for cross-border transmission through increased travel.
How has antimicrobial resistance
developed?

Where do we use
antibiotics? USA
UK
• Humans
⎻ Community
⎻ Hospital
• Animals
⎻ Pets
⎻ Livestock
• Agriculture
⎻ Crops
⎻ Aquaculture

Resistance is getting worse
2013 2015
Carbapenem-resistant Enterobacteriaceae

Antibiotic use in Australia
Figure 3.15: Annual total-hospital antibiotic usage rates (DDD/1,000 OBD) in Principal Referral
Hospitals contributing to NAUSP, 2017
0
200
400
600
800
1,000
1,200
1,400
1,600
M7 G4 A9 P6 I7 S4 F3 W6 D8 L8 O2 K3 U2 P4 J8 G5 G8 V5 D2 B2 T4 M6 W5 H9 H7 F8 Z9 G2 U7 G3
Antibiotic
usage
rate
(DDD/1,000
OBD)
Contributor code

Antibiotic use in Australia, 2017

• Trends in sales of recently launched antibiotics
discourage pharmaceutical companies to invest in their
research and development
Decline in antibiotic production

Robust 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

In 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

The 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 Australia
Surveillance of Antimicrobial Use
and Resistance in Australia (AURA)

• In 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
2015-2019
- Initiatives developed and implemented by states and territories, and the
private sector
Australia’s response to antimicrobial
resistance

Surveillance of Antimicrobial Use and
Resistance in Australia (AURA)
National
Notifiable
Diseases
Surveillance
System
National
Neisseria
Network
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.

• Australia has very high usage of antibiotics in the community
⎻ 41.5% of individual Australians received an antibiotic in 2017
⎻ Australia 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 declined
• High levels of inappropriate prescribing were found in
⎻ Respiratory tract infections including COPD
⎻ Amoxicillin–clavulanic acid and cefalexin use
AURA 2019 Key Findings –
Antibiotic use in the Community

Aged Care Prescribing in Australia,
2018
LINK

Antimicrobial Resistance in
Australia, 2017

• Treatment failures
• Recurring infections
• Longer hospital stays
• Longer recovery
times
• A higher risk of
mortality or long
term implications
• Significant financial
cost of treatment
Patient impact of antimicrobial
resistant infections
Watch Glen’s Story here
Preventing infections is everybody's business

• Which 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?

• This 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 diagnosis
− bacterium that was resistant to the preferred antibiotic
− medications used to treat the bacterial infection
− time, resources and people involved to treat the infection
− impact on the patient, the patient’s life and patient’s family
− immediate, medium or long-term health implications (if any).
Patient story

Monitoring of Critical Antimicrobial
Resistance (CARAlert)
Link to latest CARAlert Report
Species Critical resistance
Acinetobacter baumannii complex Carbapenemase-producing
Candida 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 aureus Vancomycin, linezolid or daptomycin non-
susceptible
Streptococcus pyogenes Penicillin reduced susceptibility
Pseudomonas aeruginosa Carbapenemase-producing

• Resistance mechanisms to ‘last-line’ antibiotics
• 2,979 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)

The 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

• Insert local antibiotic use data (if available)
• Include information about your contributions to National
Antimicrobial Usage Surveillance Program (NAUSP)
• Insert NAUSP data.
Local Antibiotic Use

Whilst 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

• National 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

• Does 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

May increase risk of
adverse effects, including:
⎻ AMR (current and
future patients)
⎻ Antimicrobial allergy
⎻ Treatment 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?
Reason Yes (%) No (%)
Not
specified
(%)
Spectrum too
broad
21.9% 46.3% 31.8%
Incorrect dose or
frequency
20.1% 50.9% 29.0%
Antimicrobial not
required
17.5% 49.8% 32.7%
Incorrect duration 16.5% 51.0% 32.5%
Spectrum too
narrow
6.6% 58.8% 34.6%
Incorrect route 5.2% 60.6% 34.3%
n = 5,864
Reasons for a reported prescription being
assessed as inappropriate, Hospital NAPS
contributors, 2017

• In 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

• The 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

• In 2017, only 33.4% of antibiotics prescribed had the
reason for the prescription recorded
• An 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

• Variation raises concerns about equity and safety and
appropriateness of care
• There is marked variation in use of antibiotics
− between states
− between hospitals
 different sizes
 within the same size
• The reasons for this are not well understood
• Also 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 2013-14
Understanding Variation

Antimicrobial 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 something
• AMS is a systematic approach to optimising the use of antimicrobials
• Goals of AMS are to:
‒ improve patient outcomes / patient safety
‒ reduce antimicrobial resistance
‒ reduce costs.
• AMS works hand-in-hand with infection prevention and control, and
environmental cleaning strategies
Antimicrobial Stewardship (AMS)

Safety – 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 care
Has 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

A Critical Balance
Risk of toxicity and adverse drug
reactions

Antimicrobial Stewardship
= least harm to current/future patients
Right dose

• Clear organisational structure and governance
• Executive and clinical leadership
• AMS advisory committee
• Multidisciplinary clinical AMS team
• Expert advice from
− infectious diseases experts
− microbiologists
− pharmacists
• Education and training
− prescribers, pharmacists, nurses
− consumers
• Information technology resources.
Enablers for effective for AMS
Programs - Hospitals

Essential strategies for AMS
Programs - Hospitals
Pre-prescription Post-prescription
Formulary management Direct patient input e.g. AMS Round
Restriction System Audit and Feedback
Guidelines Monitor appropriateness – National
Antimicrobial Prescribing Survey (NAPS)
Education Monitor utilisation – National Antimicrobial
Utilisation Surveillance Program (NAUSP)
Antibiograms (susceptibility of
microogranisms to antimicrobials)
Education
Selective reporting of susceptibility
testing
Electronic solutions - eMeds – automatic stops
Confirming patient’s allergy status IV to Oral switch

Insert 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
AMS
Team
Microbiologist
Infectious
Diseases
Specialist
Antimicrobial
Stewardship
Pharmacist
Infection
Control Nurses
AMS
Pharmacy
Technician

• In the community
⎻ General Practice
 Not prescribing antibiotics for colds and
flu
 Delayed prescribing
 Shared decision making
 Public declarations in the practice about
conserving antibiotics
⎻ Pharmacies
 Offering symptomatic support for cold
and flu
Antimicrobial Stewardship – not just
for hospitals

• In the home
⎻ Not taking antibiotics that haven’t been prescribed for you
⎻ Discarding old antibiotic medicines appropriately
• In industry
⎻ Investing in research and development for antimicrobials

• COVID-19 pandemic has presented many additional
challenges (including antimicrobial shortages) for
managing patients with infections
• It 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

• New Chapters!
⎻ General Practice – Published!
⎻ In the Care of Children – Published!
⎻ Aboriginal and Torres Strait Islander Populations – on the way
AMS in Australian Health Care Book

National Safety and Quality Health
Service Standards

• Always use the most current
version
⎻ Currently version 16, 2019
⎻ Now only in online format
• Check hospital intranet
• A ‘go to’ reference, especially
where there are limited local
guidelines
• Learn more
⎻ www.tg.org.au
⎻ click ‘Products’, then ‘Antibiotic’
Therapeutic Guidelines: Antibiotic

• Use this slide to highlight any AMS initiatives your
organisation has completed recently
• This may be
⎻ A new guideline
⎻ A new audit
⎻ A new service or multidisciplinary team success

Insert information on AAW in your
health service:
• Join the conversation on social media:
⎻ Hashtags
 #worldantimicrobialawarenessweek
 #WAAW
 #AntibioticResistance
 #AMR
⎻ @ACSQHC
• Local activities and contact people
• Include information about local
activities
Local Antibiotic Awareness Week
Activities

Ideas!
• Get Creative 
• Pick a target area
• Examples
• IV to Oral Switch
• Penicillin Allergy
• Surgical Prophylaxis

Antimicrobial 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 now
• Few new antimicrobials are being developed
• The misuse, overuse, and inappropriate use of
antimicrobials contributes to antimicrobial resistance
• Antimicrobial stewardship works hand in hand with
prevention and control strategies to help address
antimicrobial resistance.
Key messages

• NPS MedicineWise/ACSQHC Antimicrobial Prescribing Modules -
https://learn.nps.org.au/mod/page/view.php?id=4282
• Future Learn - https://www.futurelearn.com/courses/antimicrobial-
stewardship
• Stanford AMS Course -
http://errolozdalga.com/medicine/pages/OtherPages/AntibioticRevi
ew.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

References
Slide
Number
Website
4 https://www.reactgroup.org/toolbox/understand/antibiotics/
6 https://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
14 https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/843129/English_Sur
veillance_Programme_for_Antimicrobial_Utilisation_and_Resistance_2019.pdf
https://www.nejm.org/doi/full/10.1056/nejmp1311479
15 https://www.businessinsider.com.au/alexander-fleming-predicted-post-antibiotic-era-70-years-ago-2015-7

References
Slide
Number
Website
16 https://ecdc.europa.eu/sites/portal/files/media/en/publications/Publications/carbapenem-resistant-
enterobacteriaceae-risk-assessment-april-2016.pdf
17 Source: 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
20 Butler M, Blaskovich M, Cooper M. Antibiotics in the clinical pipeline in 2013. J. Antibiot 2013;66: 571-591
21 Lee 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
22 https://apps.who.int/iris/handle/10665/325006

References
Slide
Number
Website
23 https://www.amr.gov.au/resources/australias-national-antimicrobial-resistance-strategy-2020-and-beyond
28 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
system/national-alert-system-critical-antimicrobial-resistances-caralert
system/national-alert-system-critical-antimicrobial-resistances-caralert

References
Slide
Number
Website
35 NAUSP 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-
hospitals
38 NAPS 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
43 safetyandquality.gov.au/antimicrobials-report-2020
45 https://www.safetyandquality.gov.au/our-work/healthcare-variation

References
Slide
Number
Website
46 Verheij 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/
48 Ohio 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
59 https://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

References
Slide
Number
Website
60 https://www.safetyandquality.gov.au/standards/nsqhs-standards/preventing-and-controlling-healthcare-
associated-infection-standard/antimicrobial-stewardship
61 https://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

Safetyandquality.gov.au
Twitter.com/ACSQHS
Youtube.com/user/ACSQHC

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