Shared Learning: Community – Engagement

Projects focused on community engagement

 NHS Bath and North East Somerset (Winner – Antibiotic Guardian Awards 2017)

Name: Sarah Pritchard

Provide a brief overview of your project?: See it, Snap it, Share it: promoting #AntibioticGuardian in Bath and North East Somerset

Bath and North East Somerset (B&NES) Clinical Commissioning Group and Council led a campaign to educate the community about Antibiotic Guardian, specifically, the importance of appropriate antibiotic use and how to prevent the spread of infection. We aimed the campaign at school children, their families and B&NES residents.

We provided B&NES primary schools with ready-to-use materials to deliver lessons to Year 3 (aged 7 and 8 years old) pupils during the autumn 2016 school term. This coincided with World Antibiotic Awareness Week and European Antibiotic Awareness Day. Some of the materials came from the European teaching resource, E-Bug and were based on four key messages:

1. Hand washing prevents infection
2. Antibiotics do not work for viruses and can give you side effects
3. Vaccination prevents infection
4. Use a tissue when coughing and sneezing – Catch it, Bin it, Kill it!

The children were encouraged to talk to their families about what they had learned, to demonstrate good hand washing technique and pledge to become Junior Antibiotic Guardians.

Pupils also designed posters to illustrate the key messages and the best of these were entered into our B&NES-wide competition.

A panel of prominent local health, education, science and public health experts judged the 26 poster entries, selecting winners and runners up for each key message. One judge commented that it was a: “Fantastic effort by so many inspired children. The messages are simply displayed and powerfully delivered”.

Councillor Alan Hale, Chairman of B&NES Council presented the competition winners with prizes at Bath’s Guildhall and all participating schools received a pack of teaching resources from the Wellcome Trust and E-bug.

We published a press release publicising the prize-giving, which was picked up by local press. One parent commented on “how lovely the prize-giving was. I wasn’t sure what to expect…but I thought the whole team made it so welcoming, fun and child-friendly”.

The children’s posters are also on public display at locations across B&NES including GP surgeries, community pharmacies, dentists, the Royal United Hospital, libraries, sports centres, and empty shop fronts.

The displays encourage members of the public to find out more about Antibiotic Guardian and take a pledge. They also ask people to ‘join the poster hunt’ by taking a photo of posters they see and sharing them on social media using the Antibiotic Guardian hashtag.

Please list any supporting partners or organisations worked with: ‐ Bath and North East Somerset Council Public Health Team, Director of Public Health Award Coordinator and Chairman
‐ Bath and North East Somerset Clinical Commissioning Group
‐ Primary schools including head teachers and Year 3 class teachers
‐ Bath and North East Somerset Health and Wellbeing Board and Health Protection Board
‐ Prize sponsors: Wellcome Trust, E-bug, I’m a Scientist
‐ Poster competition judges from Royal United Hospitals Bath, School nurses (Sirona care & health), Director for Public Health, B&NES Councillors, CCG Board member and local GP
‐ Bath and North East Somerset school nursing service, which delivered Antibiotic Guardian messaging while providing flu vaccinations
‐ GP surgeries, community pharmacies, dentists, sports centres, libraries that have displayed posters
‐ Bath University, South Gloucestershire Council using posters for British Science Week
‐ Local commerce e.g. Bath City Farm.

How has your project demonstrated success in highlighting antibiotic stewardship within your chosen category?: The campaign has generated publicity about antibiotic stewardship in B&NES and further afield. It has raises awareness of the Antibiotic Guardian message in non-health environments among audiences that are hard to influence when they are ‘well’ i.e. B&NES residents and the public, educators, Councils, businesses and tourists.

Local organisations are using our posters as part of British Science Week (e.g. Bath University and South Gloucestershire Council) and they have been included in presentations at UK and European health conferences, including the South West Health Protection Conference and the European Congress of Clinical Microbiology and Infectious Diseases.

The local media has promoted the campaign – particularly the poster prize-giving. Bath’s local newspaper, The Bath Chronicle, which has an average online impression rate of 40k published a story on its website within a day of the prize-giving.

The Council and Clinical Commissioning Group have put out 55 social media posts to date about the campaign, resulting in almost 130k impressions (the potential number of people or organisations who have seen these posts). A total of 600 people have engaged with these posts by liking, responding to, or sharing them elsewhere.

The most successful social media posts have included images of the children’s artwork alongside a ‘call to action’ about antibiotic stewardship. The poster captions highlight how well the children understood the lessons they received, with powerful messages like: ‘If you catch a cold, your body is the superhero, not antibiotics.’

The children’s poster displays and Antibiotic Guardian promotion has been physically seen by a large potential number of B&NES residents and visitors. For example, the posters at Bath Library were seen by a possible 50,000 people over the first six weeks they were on display, and one GP surgery reports 3000 – 4000 visitors during that same period. We hope to see an increase in Antibiotic Guardian pledges for this period.

Posters displayed in Bath in empty shop fronts will have been seen by a proportion of the 4.8 million visitors and international tourists Bath attracts annually, contributing to a global approach to tackling antimicrobial resistance.

The schools that took part in the campaign were very enthusiastic, and we have given them the tools to teach the next generation the importance of protecting antibiotics. This is one of the goals of the January 2017 National Institute for Health and Care Excellence (NICE) guideline [NG63]: ‘Antimicrobial stewardship: changing risk-related behaviours in the general population’.

Cite 3 examples within the project which highlight promotion of the protection of antibiotics?:


  1. Educating children

    Our campaign meets the recommendations from NICE [NG63] by ‘improving infection prevention knowledge and behaviour among children and young people’.

    We provided primary school teachers with lesson materials from sources including E-Bug and asked them to deliver lessons around the time of World Antibiotic Awareness Week and European Antibiotic Awareness Day. Teachers gave lessons in antimicrobial stewardship and infection prevention to their Year 3 (aged 7 and 8 years old) pupils, and promoted the protection of antibiotics by asking them to pledge to become Junior Antibiotic Guardians.

    All the children who received lessons were also encouraged to talk to their families about what they had learned, to demonstrate correct hand washing procedure and to ask them to sign up to be Antibiotic Guardians. This further promoted the protection of antibiotics in the community.

    2. Sharing the message across the community

    The children designed posters to illustrate key Antibiotic Guardian messages, and these were turned into public displays and a social media campaign. This meets the NICE guideline [NG63] recommendation to provide information to the public about preventing and reducing the spread of infections.

    The poster prize-giving held by the Chairman of B&NES Council and the resulting press and social media coverage also helped to spread the Antibiotic Guardian message through the community.

    In addition, the public displays of posters and Antibiotic Guardian messaging at locations across B&NES encourage members of the public to take action and find out more about how to protect antibiotics on the Antibiotic Guardian website.

    3. See it, Snap it, Share it: getting the conversation going

    We’ve used social media to take our campaign one step further. In addition to promoting the poster competition and prize-giving via corporate and personal social media accounts, we have also asked the public to get involved.

    In particular, we have ‘started a conversation’ with the public by asking anyone who sees the posters in the community to take a photo and share it on social media with the Antibiotic Guardian hashtag. We plan to track the hashtag once the posters are taken down, and hope that some of these conversations will have resulted in more Antibiotic Guardian pledges.

    Our campaign ran across winter 2016/17 and the children’s posters have perfectly complemented national messaging about how to ‘stay well’ over winter. The Clinical Commissioning Group has incorporated the posters into its digital winter communications, as has the Council.

Key outcomes of project?: Our campaign has generated a legacy of resources for future campaigns with schools, campaigns about antimicrobial resistance and winter campaigns.

We have disseminated the campaign widely, not just through the health sector but also into the wider community to local commerce and higher education establishments.

The key messages in our campaign were delivered by primary school teachers to at least 200 Year 3 pupils in Bath and North East Somerset. The children learned about the importance of infection prevention and antibiotic stewardship and we established a new and positive relationship with our local schools.

Our campaign is a great example of collaborative working within the healthcare, science and education sectors in B&NES. Other local authorities in the region are now considering running similar projects, and the children’s posters have been shared at national and international conferences as well as during British Science Week.
This type of collaboration is key to engaging members of the public with any public health matter.

The range of organisations that have supported the campaign reinforces how much antimicrobial stewardship is a local priority. This meets another recommendation from the NICE guildeine [NG63] to show ‘Local system-wide approaches to preventing and limiting the spread of infection’. Bath and North East Somerset is proud to be the Clinical Commissioning Group with the highest proportion of Antibiotic Guardians per population and we hope to demonstrate that our campaign increased this proportion further.

The poster competition also demonstrates schools’ willingness to engage with public health education, a criterion for entry into the Director for Public Health Awards.

How is the project to be developed in the future?: Since our campaign is still active (until end of March 2017) we are awaiting full data to perform a complete evaluation. However, discussions have already been held about how to build on our work for this year’s World Antibiotic Awareness Week and European Antibiotic Awareness Day.

For example, some of the schools that took part in the campaign have expressed an interest in holding ‘antibiotic awareness’ assemblies, to spread the message beyond the Year 3 age group.

We will also be submitting our campaign to the NICE shared learning database as an example of meeting the recommendations of their guideline NG73.
The children’s posters continue to be shared in other health communities (e.g. British Science Week) and by other local authorities. We are also in discussion about possible displays at Bath Spa train station to capture the attention of more visitors and tourists as they pass through the city. We will continue to seek further opportunities to use these excellent resources.

The posters will be made a permanent feature of the Clinical Commissioning Group’s wall art at St Martin’s Hospital in Bath, and we intend to build on the relationships we have established as a result of the public displays to encourage future displays of public health messaging – particularly winter health messaging.

E-Bug intends to share our model of engagement at their school engagement forums to illustrate that children and young people can help spread the Antibiotic Guardian message throughout the whole community.





Bracknell Forest Council – on behalf of Berkshire Antimicrobial Stewardship Network

Name: Jo Jefferies Consultant in Public Health

Provide a brief overview of your project? The recently established, and unique, county-wide Berkshire AMR Stewardship Network is comprised of representatives from all of Berkshire’s seven CCGs, acute, mental health and community health NHS Trusts, private healthcare providers, Public Health England, Local Authority Public Health and Community Pharmacy. It includes microbiologists, pharmacists, public health, infection control nurses, dental public health specialists and a lay member.

The group meets quarterly to review local indicators, share good practice and focus and coordinate AMS strategy across the whole of Berkshire in both secondary and primary care.

Key objectives of the group are to;

• promote excellence in antimicrobial stewardship within organisations in Berkshire, through sharing of good practice and resources (including IT developments).
• conduct, and disseminate within and beyond the Network, collaborative audit, benchmarking and research projects regarding the appropriate use of antimicrobials.
• promoting AMS in Primary & Secondary Care by supporting members of the network around Berkshire
• stimulate and support professional development of Network members.
• secure resource for further work of the Network.
• provide expert opinion and inform the national agenda on antimicrobial stewardship
• share best practice to assist in achieving the CCG Quality Premiums and Trust CQUINs
• promote AMS to local residents and patients & increase public awareness.
• Support organisations to act in compliance with NICE Guidance & Health & Social Care Act.
• Use local and national data to identify priorities for action

Although the group was only established in 2016, it has already led a number of successful AMS initiatives which are outlined in sections 3 and 4 of this submission.

Please list any supporting partners or organisations worked with: • 7 Berkshire CCGs – Reading (South and North and West), Newbury and District, Wokingham, Bracknell, Windsor, Ascot & Maidenhead and Slough
• Berkshire Healthcare NHS Foundation Trust (mental health and community health secondary-care trust provider)
• Royal Berkshire NHS Foundation Trust (acute secondary-care trust provider, West Berkshire)
• Frimley Health NHS Foundation Trust (acute secondary-care provider trust, East Berkshire and Surrey borders)
• Public Health England, Berkshire-wide
• Private and community healthcare provider dental services
• School and pre-school establishments

In addition to the organisations listed above as members of the Network, the group has worked to raise awareness of antimicrobial resistance and antimicrobial stewardship with childcare and early years providers, local councillors and the general public through communication and engagement activities

How has your project demonstrated success in highlighting antibiotic stewardship within your chosen category?: The Network has brought together a wide range of local partners for the first time, which has enabled a strong voice in support of AMS to be heard across a large county with complex health economy needs.

The formation of the Network provides organisations with a forum to review local data, identify areas for development, share ideas and best practice and to hold each other to account in an informal way.

In the short time since the network was established we have demonstrated the power of working together in three main areas, identification of a local issue and responding to this by producing and disseminating guidance, engaging health and wellbeing Boards and running a public-facing Antibiotic Guardian Campaign.

Please cite 3 examples within the project which highlight promotion of the protection of antibiotics?:


4.1 Development, agreement and dissemination of guidance
Following publication of evidence that some childcare settings were excluding children with conjunctivitis until they received confirmation that antibiotics had been taken, the Network collaborated to produce guidance for childcare settings, recommending removal of any requirement for antibiotics in their policies and reminding them of the national guidance that exclusion is not recommended unless the child is ill. The guidance was signed on behalf of the AMS Group and cascaded through local authorities to child minders, nurseries and early years settings in late 2016.

4.2 Development and publication of AMS chapters in Joint Strategic Needs Assessments (JSNA)
All six Berkshire local authorities released new JSNA chapters on AMR during European Antibiotic Resistance Awareness Week (EARAW) 2016, explaining the concepts of antimicrobial resistance and stewardship, advocating for action at all levels and calling for support from the highest level of leadership. The AMR JSNA contains information on;

• what AMR is, how it comes about and why it is a growing problem
• the impact AMR has and will have
• current gaps in public perception
• available local facts, figures and trends concerning AMS
• national and local AMR strategies, and ways to monitor engagement
• health inequalities
• key recommendations for local partners

4.3 Berkshire-wide Antibiotic Guardian campaign

A co-ordinated local campaign using national materials was launched during (EARAW), with the call to action to take an Antibiotic Guardian pledge. A resource pack was developed and disseminated through the Network and local communications leads. The pack included graphics and messages for use on social media, links to printable resources, copy for professional press release or newsletters and suggested channels for communicating with health professionals and the public. Examples of activity included;

  • Items in weekly GP and pharmacy newsletters
    • Chief Executives, Councillors and other local leaders pledging to be guardians and promoting via social media
    • Placing pledge certificates in break-out areas to encourage sharing of pledge ‘selfies’ via social media

    Secondary-care providers also ran awareness raising campaigns in their own trusts via;

    • Promotional stands at their various hospital sites during EARAW, encouraging people to make their pledge
    • Arranging quizzes for staff on good AMS (with prizes for participation)
    • screen-savers on all trust-employee accounts/computer screens to promote and encourage AB guardianship pledges leading up to and including EARAW
    • Executive Board support and sponsorship of the week through Trust websites photographs and announcements
    • Weekly trust-newsletter section on AMS and guardianship

Key outcomes of project?:

5.1 Changes in policies of local childcare providers regarding use of antibiotics for conjunctivitis
In February 2017 a short online survey was cascaded using the same route. Fifty five people undertook the survey with responses from NHS and local authority providers, registered childminders, private providers and primary schools, 41% of respondents reported making changes to the policy or management of children with infectious conjunctivitis receiving the guidance.

5.2 Increased awareness of local health and wellbeing boards members of the concepts of antimicrobial resistance and antimicrobial stewardship and actions that can be taken locally to reduce infection, promote appropriate prescribing and further increase awareness in the local population

Evidenced by inclusion of AMS in the JSNA and discussion at Health & Wellbeing Boards

5.3 Increased engagement of a wide range of local partners on AMS through a successful Berkshire-wide campaign

Measurable activity using the Berkshire campaign short-link generated;
• 149 visits to the Antibiotic Guardian pledge page
• 32 visits to the PHE blog
• 32 clicks on the “What is antibiotic resistance Youtube video.
Numbers of antibiotic guardians per 100,000 population in Berkshire increased between 2015 and 2016, South Reading and Windsor Ascot & Maidenhead CCGs achieved a significant increase, with nearly three times the rate in 2016 than in 2015. South Reading CCG demonstrated a particularly significant increase, from 29.7 per 1000,000 in 2015 to 117 per 100,000 in 2016, one of the largest increases in the country. Within Berkshire, South Reading achieved the highest numbers of Guardians overall (130). A summary of the campaign can be accessed at

How is the project to be developed in the future?: In 2017-18 the Network plans to build on successful work completed in 2016 and to widen our influence in order to more effectively increase awareness and support behaviour change among healthcare professionals and the public.

Planned activities include but are not limited to;

Organisations in the Network are currently undertaking self-assessment against the new NICE Guidance NG63 “Antimicrobial stewardship: changing risk-related behaviours in the general population – this will allow us to identify areas for development and provide baseline information on which to base future evaluation.

The Network plans to continue to engage with Health & Wellbeing Boards and other partners to ensure that AMS is considered in local commissioning decisions

In 2017-18 the Network plans to compare, contrast and share improvements in practice across primary care, this will form part of on-going work for the Network

Alignment of prescribing audits across partner organisations

Engagement with local schools to promote hand hygiene and increase understanding of the need for good antimicrobial stewardship, e.g. through the use of e-Bug resources

Available information on susceptibility of organisms to antimicrobials and on antibiotic prescribing will be reviewed by the Network and used to inform local prescribing policies




Name: Tara Patel, Primary Care Pharmacist

Provide a brief overview of your project? Max 400 words: For World Antibiotic Awareness Week, the Medicines Optimisation Team (MOT) took a multifactorial approach to promote awareness to the public in Southwark – these have been highlighted below:

1. National Public Health England Antibiotic Guardian campaign material was utilised and sent to community pharmacists, via the Local Pharmaceutical Committee who were encouraged to promote WAAW/EAAD messages via their twitter account.

2. The MOT liaised with Southwark Council to share antimicrobial stewardship (AMS) messages with local people via:
i) Southwark resident e-letter
ii) Southwark Life Magazine (50, 000 residents on the mailing list)

3. Infection prevention and AMS messages were promoted to the public through the local media via our CCG Chair’s “Dr Know” column and a “Get Well Soon without Antibiotics” advertorial in Southwark News

4. The CCG’s twitter account was utilised to tweet twice daily messages throughout WAAW, which was continued throughout the winter period. This was linked in further with the Stay Well This Winter campaign

5. The team worked with the Southwark Council school’s lead to promote infection prevention and control to schools via letters to Southwark head teachers and parents

6. An awareness stand was set up in the foyer of the Southwark Council building – visitors were encouraged to complete an Antibiotic Guardian Quiz to educate and also estimate awareness levels. 118 quizzes were completed

7. The awareness stand also included a hand washing station with a UV light box. Visitors to the stand were given a demonstration on correct hand washing technique and encouraged to try for themselves

8. With all of the areas listed above, the public were encouraged to sign up to be an Antibiotic Guardian.

To view the information sent to stakeholders outlined above, please see the attachments.

List any supporting partners or organisations worked with:

    1. Southwark Public Health
    2. Southwark Council
    3. Lambeth Southwark Lewisham Local Pharmaceutical Committee

How has your project demonstrated success in highlighting antibiotic stewardship within your chosen category?: Antibiotic guardian resources were utilised to raise awareness. In terms of demonstrating success, Southwark CCG has the highest number of Antibiotic Guardians per 100,000 population per calendar year out of all of the London CCGs, and is the 4th best in England.

The Antibiotic Guardian quiz used as a tool with the aim to provide education to the visitor around antibiotic prescribing and AMS. Participants were encouraged to include their age and sex at the top of the answer sheet. Although not a validated tool, we analysed the results of this to estimate levels of awareness, and to see whether there were any differences between genders and age groups. 118 quizzes were completed. “My GP has only given me a short prescription of antibiotics but I think I need them for longer” was the most correctly answered question, with the exception of 1 person (male, aged 20-29) answering incorrectly. “Drug resistant infections, also known as antibiotic resistant infections are serious because…” was the most incorrectly answered question, with almost 30% of participants answering incorrectly. This information and success of the quiz has increased our focus of the need for more education on antibiotic resistance and inspired further work to be carried out in conjunction with local Public Health on more strategic awareness raising.

Please cite 3 examples within the project which highlight promotion of the protection of antibiotics? Max 400 words:

  1. Dr Know column
    Written by the CCG’s Chair, this column is included in the local newspaper on a fortnightly basis, and is used to provide information to the public, looking at the issue from the GP’s perspective. For WAAW, we used this as a forum to communicate relevant messages about self-care, and antibiotic resistance to the people of Southwark. The column has been emailed through for you to view.

    2. Get well soon without antibiotics advertorial
    This column was also included in Southwark News just before WAAW, to remind the public about hand washing, overuse of antibiotic leading to resistance and promotion of self-care for self-limiting conditions such as coughs and colds. This advertorial has been emailed

    3. Antibiotic guardian quiz
    As highlighted in the previous question, the quiz was used to educate visitors to our stand on antibiotic prescribing, antimicrobial resistance and self-care for self-limiting conditions, as well as estimate levels of awareness

Key outcomes of project?:


  • The Antibiotic Quiz results analysed showed:
  1. 111 out of 112 answered they would ‘take antibiotics exactly as prescribed’, showing that most people follow advice given by their GP
    ii. Awareness on the difference between bacterial/viral infections and how this relates to antibiotic use and awareness around using community pharmacists with self-care appears to be reasonably high amongst all age groups.
    iii. There is still some lack of awareness on how antimicrobial resistance develops. Further public education around this is required.

    • Southwark has the highest number of Antibiotic Guardian for 2016 out of all of the London CCGs, demonstrating that the people of Southwark care about AMS and protecting these drugs for the future.


How is the project to be developed in the future?: – The CCG will be supporting WAAW and EAAD 2017

– The MOT are looking to continue working with Public Health colleagues and Southwark School’s lead with the aim to influence nurseries/school’s exclusion policies, and also provide some education resources to parents, helping them to self-manage self-limiting conditions when appropriate
– We would like to look into the possibility of creating and conducting a validated survey in a wider patient group in Southwark, to get an meaningful insight into public awareness locally. This may be beneficial in identifying particular areas which we can then work on to fill gaps in knowledge and amend patient perception of appropriate prescribing of antibiotics.


Public Health England South West Centre


Name: Chaamala Klinger; Consultant in Communicable Disease Control

Provide a brief overview of your project? e-Bug is an educational resource for children and young people which educates on hygiene, the spread of infection and antibiotics. e-Bug mainly has resources for schools, but the interactive e-Bug activities are suitable for a range of audiences and environments. Co-ordinated by the PHE South West regional team, e-Bug worked alongside the At-Bristol Science Centre to develop activities to run in the Science Centre Live Lab area. This area has activities which are run and facilitated by members of the At-Bristol staff. The activities aimed to increase knowledge on antibiotics, antibiotic resistance and treating common infections. The activities included information on Antibiotic Guardian, a campaign to increase awareness and knowledge on antibiotics.

The activity was divided into three stations and took around 10-15 minutes to complete:

1. The scientist: students were introduced to microbes, bacteria and antibiotic resistance. Students studied agar plates which had been touched with hands and microbes left to grow for at least 2 weeks. Students also saw images of bacteria and antibiotic resistant bacteria growing on agar plates in a lab.
2. The doctor: students listened to 3 scenarios in a GP consultation. One where the patient had a cold and did not need antibiotics, one where the patient had a sore throat and was otherwise healthy and so was not prescribed antibiotics, and the final scenario where the patient had pneumonia and was given antibiotics.
3. Ourselves: students were shown the “snot gun” to demonstrate how far a sneeze can travel. Students stopped the sneeze with their hands, and then they caught the sneeze in a tissue and put the tissue in the bin.

Over six weeks in 2016, children who visited the At-Bristol Science Centre with their school or families took part in the antibiotic activity.
The ability of the activities to improve knowledge on antibiotics was evaluated through knowledge change questionnaires with the students.

Please list any supporting partners or organisations worked with: eBug
At Bristol
South West Public Health England Centre

How has your project demonstrated success in highlighting antibiotic stewardship within your chosen category? The evaluation took place over six days. Over these days, students from six primary schools and children who attended with family or home educators completed the activity and participated in the evaluation.

69 before questionnaires and 54 after questionnaires were completed by children aged between 7 and 14 years.

All eight questions showed an improvement in knowledge around antibiotics and antibiotic resistance. The greatest knowledge improvement came in the question “The more we take antibiotics, the more antibiotic resistant bacteria develop”. This had the lowest knowledge prior to the activity.

The questionnaire results suggest that the activities were successful in improving knowledge and awareness of antibiotics in young people. It is hoped that through these activities, key messages around antibiotics will also be passed to family members at home.


Please cite 3 examples within the project which highlight promotion of the protection of antibiotics? Max 400 words: 1. The GP consultation – promoting the idea that antibiotics are not needed for all infections
2. Promoting good hand hygiene and infection control to prevent the spread of infections and therefore reduce the demand for antibiotics
3. Promoting the idea that we can all make a difference and have a role to play in protecting antibiotics.

Key outcomes of project?: This is the first time that PHE and eBug have collaborated with a science centre to promote infection control and AMR messages. At-Bristol provided an informal learning environment where an activity could be piloted. The partnership allowed to pilot a different format for e-Bug activities thus exploring other learning environments than the formal one (i.e. schools). This allowed AMR messages to reach a wider and more diverse range of audiences: for example, mostly family visits during weekends, parents with younger children and school groups during weekdays.

The project was successful and provides support for this method of public engagement being tried elsewhere in the country.

A collaborative partnership between PHE and At-Bristol was established. This will allow further public engagement events to take place in the future.

How is the project to be developed in the future?: We plan to build on the partnership and will develop further public engagement projects; for example around Antibiotic Awareness Week.

At-Bristol is opening its spaces and piloting new formats to expose visitors to contemporary research through partnerships with research groups and initiatives, such as the e-Bug project.



NHS Leeds North Clinical Commissioning Group


Name: Gillian Chapman

Provide a brief overview of your project: Please see tables

List any supporting partners or organisations worked with:

Brainbox Research
Leeds City Council Public Health Dept
S+W Yorkshire and Bassetlaw Commissioning Support Unit
Leeds Involving People
Engaging Voices

How has your project demonstrated success in highlighting antibiotic stewardship within your chosen category? The project has produced some evidence of improvement in public understanding about antibiotics (see below)
Antibiotic insight results:
Insight work completed by: W+S Yorks + Bassettlaw CSU When: Jan – March 14 How many people surveyed: 383 Method: A paper based survey covering established networks and patient groups. GP practice waiting rooms in high prescribing areas were also targeted.
RESULTS: answer to survey questions
Would you go to GP for advice for themselves or family member for cough, sore throat or cold (% yes) % who wouldn’t expect antibiotics for cold cough sore throat % who said doctor had explained why antibiotics not appropriate for them % who thought taking antibiotics would make them less effective in future % who said they understood about superbugs and MHSA
53% 68% 66% 78% 50%

Insight work completed by: Leeds Involving People When: May 15 How many people surveyed: 1274 Method: On line and face to face surveys.
RESULTS: answer to survey questions
Would you go to GP for advice for themselves or family member for cough, sore throat or cold (% yes) % who wouldn’t expect antibiotics for cold cough sore throat % who said doctor had explained why antibiotics not appropriate for them % who thought taking antibiotics would make them less effective in future % who said they understood about superbugs and MHSA
17% 85% 18% 75% 78%

During September 2016 the insight work used different question sets but still with the same purpose of ascertaining different populations’ health beliefs about antibiotics and giving recommendation for the most effective format for future campaigns. They contacted 786 people via an online survey distributed to the Leeds City Councils’ Citizen’s Panel, to organisations and individuals affiliated with Voluntary Action Leeds (VAL) and via the CCG’s social media channels. They also conducted two focus groups with elderly Asian and Eastern European communities.
Results of the 2016 research revealed:
• Majority of people said they believe coughs, colds and sore throats get better on their own, and that antibiotics do not work on these types of illnesses.
• There is a general perception among people that antibiotics are to be avoided; however the link between overuse of antibiotics and antibiotic resistance is not often made in people’s minds.

Please cite 3 examples within the project which highlight promotion of the protection of antibiotics:

  1. Results of the insight work lead us to produce a pictorial non-prescription pad for use in non -English speaking communities
    2. Results of the insight work lead us to translate the ‘Antibiotics are not for you’ leaflet into 15 different languages
    3. Results of insight work has confirmed which are the optimal locations for promotional materials eg outsides of buses was cited as a commonly seen location

Key outcomes of project?:

  1. We have been able to show improvement in our populations knowledge about antibiotics
    2. We have been able to target our campaigns to meet the needs of local communities

How is the project to be developed in the future?: Our research leads us to make the following recommendations regarding antibiotics interventions and campaigns.

  1. Local campaigns to address inappropriate antibiotic use should be increased to reflect the magnitude of the AMR crisis. These should reflect local conditions, features and norms.
    2. A targeted plan of action to raise AMR awareness should be developed, including schools, work-places and engaging local leaders to raise awareness of AMR.
    3. Campaigns should consider which condition they address and what images they feature. Messages about the common cold have become embedded, but people are less sure about the appropriateness of self-care for coughs, sore throats and flu.
    4. Campaigns should specifically highlight AMR, providing people with an understanding of why it is important to reduce antibiotic prescribing and strengthen understanding of the role they each play in reducing the risk AMR presents.
    5. Campaigns should consider utlising the dramatic power of the ‘antibiotic apocalypse’, to facilitate higher levels of behaviour change and reduce the propensity to request antibiotics for coughs, colds and sore throats.
    6. Further interventions/materials to support GPs to be more confident to not prescribe antibiotics should be developed and evaluated.
    7. Materials should include information on self-care and average length of time each condition lasts.
    8. Targeted work to raise the awareness of Eastern European communities should be undertaken. Community Educators could be a suitable way to address this, but also placing mainstream campaign materials, in appropriate languages, in non-health locations would develop this understanding.


Shropshire Clinical Commissioning Group

Name: Nicola Riley

Provide a brief overview of your project?: Shropshire medicine management team and young health champion coordinators created a summer school for young health champions (11- 25years old) to learn about antibiotic resistance and how to be guardians of antibiotics for the future.

The young people met with Fixers a youth charity and used what they had learnt from their summer school to come up with a campaign for Shropshire to raise awareness of antibiotic resistance and how to use, dispose of and safeguard antibiotics for future generations.

The young people designed a capsule which opens to reveal a young and trendy information leaflet about antibiotic resistance and how to best use antibiotics and when they are really needed.

The young people launched their capsules and their campaign at a local swimming pool filled with plastic balls to signify how antibiotics can get into the water system if they are disposed down the toilet. They explain how the best way to dispose of old medicines is to return them to your pharmacy.

The young health champions then gave out capsules in the town over the Christmas period as the gift of health for the new year.

List any supporting partners or organisations worked with: Medicines Management Shropshire Clinical Commissioning Group, Young Health Champions in partnership with Fixers

How has your project demonstrated success in highlighting antibiotic stewardship within your chosen category?: 30 young health champions attended the Summer School participated in fun interactive activities which explored antibiotic resistance the dangers and how we can help safeguard antibiotics for future generations. Such as going to your pharmacist for advice. How to treat coughs and colds. When and how to use antibiotics safely.

The young health champions were all set with homework to talk about antibiotic resistance to their families and check, with the help of a adult, their medicines cabinet for unused or half used antibiotics and return them to their local pharmacy and to educate their families about what they’d learnt about antibiotic stewardship at summer school.

As part of their developing their antibiotic campaign they devised a short questionnaire which they asked people of all ages in the town what they knew about antibiotic resistance and as part of that questionnaires gave passers by the facts about how they could help save antibiotics.

Young health champions designed a young person friendly leaflet to look like an antibiotic when placed in its large clear capsule. These were then given out to the public over the Christmas period 2015.

By delivering this work we estimate we have reached 700 people so far with our work locally.

Please cite 3 examples within the project which highlight promotion of the protection of antibiotics?: Always take the full prescription even if you feel better

Never share antibiotics with others.

Only use antibiotics when prescribed by a certified professional.

Are 3 of the 6 things “you can do” on they leaflet the young people are giving out.

Key outcomes of project?: An awareness of antibiotic resistance and stewardship among young people 11 – 25 in Shropshire.

An awareness of antibiotic resistance and stewardship among their friends family and the public within Shropshire.

A wider awareness raising and stewardship to other young people nationally through Fixers.

For young Health Champions to become peer educators about antibiotic guardianship.

How is the project to be developed in the future?: We hope to expand our reach by adding the capsule leaflet into prescription bags for those who are prescribed antibiotics in Shropshire until our leaflets run out.

We hope to train up more young health champions so they can deliver “antibiotic guardian training” in schools around the county.






Oxford University Hospitals NHS Foundation Trust

Name: Rakhee Mistry, Rotational Specialist Pharmacist, Renal and Antimicrobials

Provide a brief overview of your project? Max 400 words: At Oxford University Hospitals NHS Foundation Trust (OUHFT), the Antimicrobial Stewardship Team (AMST) is trying to empower staff, patients and the local community to contribute to the fight against antibiotic resistance. World Antibiotic Awareness Week and European Antibiotic Awareness Day (EAAD) provided opportunities to raise awareness within the local community about resistance and encourage appropriate prescribing and use of antibiotics.

The younger generation has a key role in influencing their friends and families to use antibiotics appropriately. AMST approached a local primary school to engage them with the EAAD campaign. A consultant microbiologist and an antimicrobial pharmacist gave a school assembly to local primary school children about ‘mean microbes and awesome antibiotics’. The assembly focused on antibiotic resistance and how to use antibiotics correctly. An information leaflet was developed for children to discuss with their family. The children were asked to design posters about antibiotic resistance to display within OUHFT on EAAD.

Healthcare students are crucial to support the appropriate prescribing and use of antibiotics. As part of preparation for EAAD, junior doctors and medical students at Oxford University were given an educational session about stewardship and invited to develop posters about resistance and stewardship which could be displayed throughout the hospital. The poster competition was a success and engaged many students.

Pre-registration pharmacists within OUHFT were given a seminar about stewardship and asked to develop literature for patients, visitors and staff members that could be distributed on EAAD. They also developed T-shirts for staff members to wear on EAAD and designed posters about resistance and the Antibiotic Guardian campaign to be displayed throughout the Trust.

On EAAD, stands in the hospital entrances were created displaying posters by the school children, the medical students and the pre-registration pharmacists. PHE EAAD resources were available as well as the locally developed information. The pre-registration pharmacists and AMST actively approached members of the public and staff and shared information about appropriate antibiotic use whilst encouraging people to pledge to be an Antibiotic Guardian.

A radio broadcast on BBC Oxford and a press release and social media posts via Facebook and Twitter about OUHFT EADD activities were used to raise awareness of the importance of appropriate antibiotic use and the commitment of OUHFT to do this.

The OUHFT EAAD campaign successfully used a variety of innovative approaches to interact with staff and the local community to raise awareness about antibiotic resistance and stewardship.

List any supporting partners or organisations worked with: 1. John Hampden School, Thame, Oxfordshire
2. Oxford University Medical School

How has your project demonstrated success in highlighting antibiotic stewardship within your chosen category?: The EAAD campaign at OUHFT engaged with a local school and university and reached out to patients, staff members and the visitors of the hospital sites.

Following on from the school assembly, the children were given information leaflets and were asked to demonstrate their learning with a poster competition. Many posters were submitted to OUHFT and most of them included information about taking antibiotics appropriately to avoid resistance; to avoid taking antibiotics for colds and flu and good hand hygiene. This demonstrates that the school assembly and leaflets had successfully educated the children and potentially their families about appropriate use of antibiotics.

Similarly, the medical students at Oxford University were also asked to demonstrate their learning following on from a teaching session, in the form of a poster competition. Several entries were received which primarily focused on appropriate antibiotic prescribing and use of local guidelines. These posters were displayed within the doctors mess and were well-received by the junior doctors.

Lastly, stands were created at the hospital entrances which were manned by pre-registration pharmacists and AMST. Discussions which developed between the pre-registration pharmacists and patients and visitors demonstrated the learning about antibiotic stewardship that they had gained from their teaching session. Additionally, the numbers of pledges to become Antibiotic Guardians have increased in the Oxford area.

Overall, OUHFT developed a very successful EAAD campaign which demonstrated that the local community and staff members learnt about antibiotic stewardship and how to help to fight resistance.

Please cite 3 examples within the project which highlight promotion of the protection of antibiotics?: Protection of antibiotics was paramount throughout the OUHFT campaign. The first example of how this important topic was highlighted was within the school assembly. The school assembly involved a PowerPoint presentation which explained the topic of antibiotic resistance and this led on to the importance of protecting our current antibiotics to avoid resistance. The resulting poster competition demonstrated the children’s understanding of protecting our current antibiotic supply.

The second example of this was in the medical student educational session and subsequent poster competition which aimed to highlight the importance of appropriate antibiotic prescribing to future prescribers and current junior doctors. The use of local guidelines was also promoted in the poster competition to encourage appropriate prescribing which would protect our current antibiotics.

Lastly, on EAAD the pre-registration pharmacists and AMST were encouraging members of the public to protect current antibiotics. Active discussions about taking antibiotics appropriately to protect current antibiotics were common within the general public and patients. The pre-registration pharmacists reiterated to patients and members of the public that protection of antibiotics is the forefront of being an Antibiotic Guardian.

Key outcomes of project?: Key outcomes of this project include:
1. Increased understanding about antibiotic resistance and knowledge of how to take antibiotics properly amongst children and families.
2. Increased awareness of appropriate prescribing of antibiotics amongst medical students and junior doctors.
3. Education of patients, visitors and other members of the general public about antibiotic resistance and how to prevent it.
4. Increased number of Antibiotic Guardian pledges in the Oxford area.

How is the project to be developed in the future?: The OUHFT EAAD campaign could be developed in the future to include greater use of multimedia, for example, a short video. This video could be uploaded onto the Trust Intranet, social media and broadcast via the hospital television.

Furthermore, AMST could build upon the contact made with the local primary school by having a teaching session which could involve an assembly and a class so the children can complete e-bug games and activities with the teachers and AMST.