Antimicrobial stewardship: changing risk-related behaviours in the general population

Work with health and wellbeing boards, commissioners and local authorities to ensure that the following are a priority locally:

• the public health aspects of local antimicrobial stewardship programmes (see NICE's guideline on antimicrobial stewardship: systems and processes for effective antimicrobial medicine use)

• local system-wide infection prevention programmes.

Ensure that:

• Local authorities and clinical commissioning groups work collaboratively to provide consistent information and advice to:

  • the public

  • healthcare professionals, including GPs, other prescribers and community pharmacists.

• Health and social care practitioners and organisations that commission, provide or support the provision of care are:

  • aware of NICE's guideline on antimicrobial stewardship

  • supported to implement it.

Ensure resources are available for healthcare professionals to use with the public to provide information about self-limiting infections. These resources should be used to encourage people to manage their infection themselves at home if it is safe to do so. The resources should include information on:

• How someone can recognise whether they, or someone they are caring for, have a self-limiting infection (for example, by checking the NHS website).

• How to seek further advice if they not sure whether their infection is self-limiting; for example, by:

  • contacting a community pharmacy

  • calling 111 or a local advice line or helpline

  • using other local triaging arrangements such as practice nurses.

• Where to seek advice on managing self-limiting infections; for example, from:

  • community pharmacists

  • other reliable health resources, such as NHS Choices

  • other local triaging services.

• The natural course of self-limiting infections, including the length of time symptoms are likely to last.

• How people can self-care (for example, by resting, drinking plenty of fluids and taking over-the-counter preparations to relieve their symptoms, if needed).

• Explicit advice on when to seek medical help, which symptoms should be considered red flags and safety-netting advice.

Ensure resources and advice are also available for people who are prescribed or supplied with antimicrobials, to ensure they take them as instructed by their healthcare professional (see NICE's guideline on medicines adherence: involving patients in decisions about prescribed medicines and supporting adherence). This should include taking the correct dose for the time specified and via the correct route.

Ensure the resources advise people not to:

• Use or take prescription-only antimicrobials without a prescription and advice from a suitably qualified healthcare professional.

• Keep leftover antimicrobials for use another time.

• Share, or give, prescription-only antimicrobials to anyone other than the person they were prescribed or supplied for.

• Use or take antimicrobials prescribed for animals.

• Use or take prescription-only antimicrobials or give them to others if they have been obtained from anywhere other than their healthcare professional or pharmacist (for example, prescription-only antimicrobials bought online without a prescription).

• Ask for antimicrobials as a preventive measure against becoming ill or as a 'stand-by' measure; for example, when going on holiday (unless the person has a specific condition that makes this necessary or there is a specific risk; for example, if travelling to areas where malaria is endemic [see the NHS information on how to avoid malaria and antimalarial medication], or there is a high risk of travellers' diarrhoea).

Consider linking to awareness-raising initiatives for the public on reducing inappropriate antimicrobial demand and use and antimicrobial resistance (for example, European Antibiotic Awareness Day and Public Health England's Antibiotic Guardian).

Use opportunities that may arise through other local authority activities to distribute information about antimicrobial resistance (for example, waste disposal and recycling information could include advice not to flush leftover antimicrobials down sinks or toilets but to return them to a community pharmacy for safe disposal).

Ensure information and advice directed at the general public aims to prevent and reduce the spread of infections. Resources such as posters, leaflets and digital resources should be made available through multiple routes to provide a coordinated system of information.

Ensure information is available in a variety of formats to meet people's literacy and language needs and the needs of people with sensory disabilities.

Consider distributing information and advice through facilities and services operated by local authorities, such as leisure centres and libraries.

When deciding where to distribute information, prioritise settings in which people are more vulnerable to infection or where there is a high risk of transmitting infection to others, for example:

• childcare settings

• residential and day care settings for older people.

Give people information on handwashing that emphasises why it is necessary and effective to thoroughly wash and dry hands to reduce the risk of getting an infection, or passing infection on to their family and other people. Include information on:

• When hands should be washed and dried; for example, after using the toilet, before eating meals or snacks and after being in close contact with people with colds or other infections.

• How hands should be washed and dried, including the need to use liquid soap and tepid running water (a handrub can be used if soap and water are unavailable). See the section on standard principles in NICE's guideline on infection control.
  
  Use resources shown to be effective in helping people develop and use personalised plans to increase handwashing. (See the section on putting this guideline into practice for examples of resources that may be helpful).

Give people advice on food hygiene and signpost them to resources. Include information on:

• Key points at which it is particularly important to thoroughly wash and dry hands (see recommendation 1.3.5); for example:

  • before eating or preparing food

  • after using the toilet or touching the bin

  • before and after handling raw food.

• Safe food preparation and cooking methods (this includes ensuring food is cooked at the right temperature and properly heated throughout before eating).

• How to store food safely, including advice on:

  • fridge temperatures

  • 'use by' and 'best before' dates

  • freezing, defrosting and refreezing food.

• Using food leftovers safely.
  
  See the Food Standard Agency's advice on food safety for more advice on food safety and how to prevent infections from spreading.

Display information or direct parents and carers to resources about managing the symptoms of infection in children, when to seek medical advice and the appropriate use of antimicrobials.

Ensure there are always good standards of food hygiene (see the Food Standard Agency's advice on food safety).

Provide facilities for thoroughly washing and drying hands for children, staff and visitors. These should include liquid soap and tepid running water, and handrubs when these are not available.

Ensure staff talk to children about the importance of thoroughly washing and drying hands, including:

• explaining when to wash and dry hands (for example, after using the toilet and before eating)

• showing them how to wash hands with liquid soap and tepid running water (see the standard principles in NICE's guideline on infection control).

Refer to Public Health England's guidance on infection control in schools and other childcare settings for details of how long children should be kept away from childcare when they have an infection.

Teach all children, in an appropriate way for their age and ability, about the need to reduce inappropriate antimicrobial demand and use. Use existing teaching resources if available (see the section on putting this guideline into practice for examples of resources that may be helpful).

Promote a 'whole-school' approach to preventing infections from spreading. The school environment and staff should support children to act in a way that prevents or minimises infection.

Ensure that there are always good standards of food hygiene (see the Food Standard Agency's advice on food safety).

Provide facilities for washing and drying hands. These should include liquid soap and tepid running water, and handrubs if these are not available (see the standard principles in NICE's guideline on infection control).

Refer to Public Health England's guidance on infection control in schools and other childcare settings for details of the length of time children should be kept away from school when they have an infection.

Teach all children, in an appropriate way for their age and ability, about the importance of washing and drying hands to prevent infections and stop them from spreading. Discuss when and how hands should be washed. Use existing teaching resources if available (see the section on putting this guideline into practice for examples of resources that may be helpful).

Consider giving children information to take home about when and how to wash their hands.

Share information with parents and carers that can support their children's learning. This could include teaching their children how and when to wash their hands.

Give parents and carers advice on other ways to help prevent infections. This should include advice on being up to date with vaccinations (see NICE's guideline on vaccine uptake in the general population) and preventing the spread of airborne infections.

Display information or direct young people to resources that aim to reduce inappropriate antimicrobial demand and use. The information should:

• Take into account that many young people will be managing infections on their own for the first time.

• Explain to young people how to recognise the signs and symptoms associated with a self-limiting infection, when they can safely self-care, how to do so and when they need to seek medical help (see recommendation 1.2.1 and information on the NHS website).

• Promote community pharmacies and minor ailment services, where they are available, as a source of advice and care (see the NHS information on how your pharmacist can help).

Introduce a regularly repeated programme to improve young people's infection prevention knowledge and behaviour. Include:

• Posters promoting handwashing displayed in various locations, such as public areas of the campus, cafeterias, bulletin boards in halls of residence and public toilets.

• Signposts to online awareness-raising resources, with links to information on infection control (see the section on putting this guideline into practice for examples of resources that may be helpful).

• One-off events providing free handrubs.

• Food safety campaigns such as:

  • face-to-face lectures

  • education materials delivered via the web, including digital and social media

  • promotional materials

  • other ways to help prevent infections, such as advice on being up to date with vaccinations and preventing the spread of airborne infections.

When people ask about managing self-limiting infections:

• Share advice on self-care for each of the symptoms.

• Use and share resources that provide written advice to encourage people to change their behaviour (see recommendation 1.2.1).

• Verbally emphasise the key messages given in the written resources.

• Display resources that provide or signpost to advice and information about self-care; for example, the NHS website, 111 and local advice or helplines.

• Signpost them to further information to read at home, such as online advice.

• Discuss with them whether taking or using an antimicrobial is the most appropriate option (see the recommendation on discussions with patients and family members or carers under 'antimicrobial prescribing' in NICE's guideline on antimicrobial stewardship).

• Raise awareness of community pharmacists as an easily accessible first point of contact for advice about managing a self-limiting infection.

Consider using computer prompts or decision support aids to prompt healthcare professionals to share information with people on the appropriate use of antimicrobials, self-care and safety netting (see NICE's guideline on antimicrobial stewardship).