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Antimicrobial stewardship: The critical role of nurses and midwives by Karen Shaw

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karen-shawGlobal threat of AMR

We all face extremely challenging times as the serious threat of antimicrobial resistance (AMR) increases.  The leaders of the G20 group of countries met in September 2016 and acknowledged the gravity of the threat of AMR and the urgent need to progress to international agreement to curb this threat.

A UK-wide   was developed by the Chief Medical Officer in England in 2012 to reduce  AMR.  It calls for actions across human and animal health.

Two of the key interventions are Infection Prevention and Control (IPC) measures and Antimicrobial Stewardship (AMS) which together form a package of interventions that nurses deliver in their everyday roles.  Antimicrobial stewardship is an approach aimed at thoughtful and appropriate use of antimicrobials to improve the safety and quality of patient care and to contribute to reductions in the spread of AMR.

Why are nurses vitally important in delivery of Antimicrobial Stewardship?

The critical partnership of infection prevention and antimicrobial stewardship is not fully acknowledged and the role nurses undertake daily preventing infections cannot be overemphasised.  As an example, catheter associated urinary tract infections and/or central line associated infections - each infection prevented means less antibiotics are used.  Nurses experienced in their role are advocates for patient safety and preventing these infections forms part of their everyday role.

In the UK, the AMS approach aims to educate healthcare workers and the general public about proportional  use of antimicrobials.  The Start Smart Then Focus stewardship programme advocates a ward-focused antimicrobial team emphasising the significant role of nurses in limiting the threat posed by AMR.

Nurses provide the most frequent and sustained face to face care to people of any healthcare professional therefore providing opportunities in the multidisciplinary team to ensure optimal prescribing.  They assess allergy status’ and medication history and often carry out the role of administering the medication during which they can review and challenge prescribing. (medicines optimisation)

Nurses are also in a unique position to collect specimens/cultures to input into a decision about antimicrobial use and to ensure the correct antibiotics are being prescribed.

Education of the general public is also key and gives a unique opportunity for nurses particularly those working in the community which could lead to a reduction of expectation and demand for antibiotics with greater emphasis on prevention of infection or infection prevention.  For example educating people about the importance of remaining fit and healthy and preventing the spread of flu by protecting their own health and the health of family members.  This message is particularly important when people are unwell.  With flu there are important messages about getting a flu vaccine, using a tissue to cover mouth and nose when coughing or sneezing, putting the tissue in the bin as soon as it’s used and washing hands as soon as possible.

Implementation of the overarching AMS programme is local and nurses need to play a critical role in reducing AMR by learning how they can influence the multidisciplinary team of appropriate use of antimicrobials.

Many nurses in a front line role are participating in Antimicrobial Stewardship so the challenge is to embrace this further and lead in advocating optimal use of antimicrobials.

During Health Protection Week, become an antibiotic guardian by choosing one simple pledge about how you will make better use of antibiotics and help save these vital medicines from becoming obsolete #Protect AOH.

Further information

What actions can nurses and midwives take to actively participate in antimicrobial stewardship?  The RCN AMR position statement is a valuable call to nurses and midwives, to show our wide contribution to reducing AMR.

 Karen Shaw- PHE’s Lead for IPC on the national AMR Programme Board


  1. Olans RN, Olans RD, De Maria AJ. The Critical Role of the Staff Nurse in Antimicrobial Stewardship - Unrecognized, but Already There. Clinical Infectious Disease Advance Access. 2015;Clinical Practice September 11:1-6.
  2. PHE. Start Smart then Focus: Antimicrobial Stewardship Toolkit for English Hospitals. . London2015.

2905635-all-our-healthAlso check out Public Health England's All Our Health, a call to action for all health and care professionals to  embed and extend prevention, health protection and promotion of wellbeing and resilience into practice. All Our Health provides a framework and tools and resources to support this ‘health promoting practice’ with quick links to evidence and impact measures and top tips on what works, this includes an AMR topic. #AllOurHealth

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  1. Comment by Junio P posted on

    Your example regarding flu vaccine does not really relate with antimicrobial stewardship because management of flu does not involve use of antibiotics or antivirals.

    • Replies to Junio P>

      Comment by Viv Bennett posted on

      Dear Junio - vaccination is a vital element of antimicrobial stewardship. Secondary infections caused by viruses such as flu will require antibiotics and therefore preventing flu and the spread of flu is essential in the fight against AMR.


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