Great Ormond Street Hospital for Children

Provide a brief overview of your project?

During World Antibiotic Awareness Week we had a competition for children to create their own bug using pipe cleaners to win a prize (giant microbes). We had a stand at the front of GOSH which included games from eBUG on iPads, colouring in, microscopy and hand hygiene technique with glow box. The pipe-cleaner competition was by far the most interactive and well received component of the day (no one played with ipads!). The children were given the opportunity to take them away to make whilst waiting for appointments. Parents/careers/staff and children all took part and the winner was selected at the end of the day. The competition was very well received and we shared our experience with the national Paediatric AMS group.

Please cite 3 examples of outcomes or impacts from the project on tackling AMR.

1. We encouraged the children to discuss the bug they have created and what made them choose the particular shape. This allowed us to explore their concerns or ideas about what makes bugs (bacteria/viruses/parasites) good at causing infection. It allowed the children to contextualize some of the concepts of infection with the bug they had just made
2. This also facilitated interactions with the parents/carers allowing them to explore what their child may or may not understand about infection and microorganisms, including ways to stop the spread of infection
3. All the children were allowed to take home the bug and encouraged to share the experience with friends and siblings which we hoped we spread the education beyond the initial interactions

How is the project to be developed in the future?
Pipe-cleaners are just the beginning! We plan for the next WAAW to evolve the competition and build upon the interactive nature of the intervention. The best part of the competition was the ability to facilitate the interaction and discussion between the child and healthcare worker whilst they are building up their knowledge of microorganisms.

Buckinghamshire Healthcare NHS Trust

Provide a brief overview of your project?
Historically, Buckinghamshire Healthcare NHS Trust (BHT) has encouraged local schools to participate in World Antibiotic Awareness Week (WAAW) by producing posters, comic strips and songs to raise awareness of Antimicrobial Resistance (AMR). This year, two primary schools in Wakiso District, Uganda, were asked to participate as an extension to the Commonwealth Partnerships for Antimicrobial Stewardship (CwPAMs) scheme in collaboration with Nottingham Trent and Makerere Universities. This CwPAMs project is focused on utilising one-health and community-based approaches to address the global issue of AMR by catalysing individual responsibility to act as antibiotic guardians.

Two primary schools in Uganda, St Theresa’s and Kawotto Saviour’s Primary Schools, were visited by members of the UK and Uganda CwPAMs team to launch the WAAW competition. e-Bug activities and Hand Glo-germ kits were used to promote good infection prevention principles and to raise awareness of AMR. Selfie-boards were used to display pupil’s Antibiotic Guardian (AG) pledges.

The WAAW competition was re-launched for all schools in Buckinghamshire. Two primary schools who produced award-winning material in 2018, Longwick and Wingrave Church of England Schools, were approached to twin with the two primary schools in Uganda. School assemblies were attended by BHT staff to present the work being undertaken as part of the CwPAMs projects together with the e-Bug activities. Videos and posters received from all schools were shared between the UK and Uganda partners. Furthermore, pen pal exchanges were set up to facilitate exchange of ideas between pupils in the UK and Ugandan schools.

Award ceremonies took place at St Theresa’s and Kawotto Saviour’s Primary Schools. A similar award ceremony was held at BHT, attended by the Medical Director, winners, parents and teachers. Videos and posters of the winning entries from the UK and Uganda were shared during the ceremony, and all winners were presented with Junior AG T-shirts.
Please cite 3 examples of outcomes or impacts from the project on tackling AMR.

The feedback and engagement from Buckinghamshire schools in support of WAAW was positive and the CwPAMs project gave the perfect opportunity to take these WAAW activities forward on a more global level. AG pledges were adapted and pupils often came up with their own pledges.
The involvement of younger generations from the two primary schools in Wakiso District enabled the project to further into communities. The school visits and WAAW competition launch were undertaken at a similar time to Healthcare Professional and Community Health Worker training, to strengthen the same messages.

Utilisation of selfie-boards and children, using language and non-scientific phrasing, helped to explain the issue of AMR and how we can all help to avoid or contain the problem. Promotion of these important messages through social media has increased exposure and target groups. Twinning the primary schools has raised awareness that drug resistant infection do not discriminate and occur in high and low-to-middle income countries.
How is the project to be developed in the future?

It is hoped that relationships will be further developed and strengthened using the pen-pal arrangements that have been initiated. This will give pupils in both Uganda and the UK a more global perspective of daily life in each other’s countries, and the opportunity to share ideas to raise awareness of the issue of AMR.

There are further possibilities of twinning more extensively with partners in Uganda, for example secondary schools and nursing and midwifery students running similar campaigns to share ideas.

The University of Manchester

Provide a brief overview of your project?
Our undergraduate midwifery programme has championed Antibiotic Guardianship amongst our students to provide newly qualified midwives who are fit for practice in an era where antibiotic resistance is a global health concern and anticipated to pose a bigger threat to health than cancer by 2050 unless we take immediate action. Currently, resistant organisms that were once amenable to treatment pose the greatest risk to mortality/morbidity. Some of these organisms contribute to sepsis of the genital tract; a significant cause of maternal mortality/morbidity in the UK.

As midwifery educators, we feel that it is vital that all maternity healthcare workers and students understand this serious threat and minimise the risk of perinatal infection to help lessen the potential global impact of antibiotic resistance.

Our undergraduate programme enables future maternity workers to develop knowledge and understanding of this crucial health challenge, to advance their clinical practice to help reduce morbidity/mortality due to infections and sepsis, and to provide effective parent education and support. Regular workshops with our students enable exploration of every opportunity where they could influence antimicrobial resistance in the childbearing continuum. Midwifery students have also been involved in raising awareness for other students and staff at Antibiotic Guardian stands. Our student midwife stand obtained the highest number of Antibiotic Guardian pledges across the University.

Midwives have a significant contribution to maternal health; reduced infection incidence is promoted by adoption of healthy lifestyle behaviours. Midwives also have an important role in the prevention of cross-infection by adhering to infection control practices and provide advice on the importance of drug concordance/compliance. Our forward-thinking curriculum comprises background to the global threat of antibiotic resistance, the importance of timely intervention strategies, the role of maternity workers in antibiotic stewardship by reducing maternal/neonatal infection, and innovative strategies to increase understanding of this public health issue.
Please cite 3 examples of outcomes or impacts from the project on tackling AMR.

1. Our two midwifery educators specialising in public health are invited members of The University of Manchester Antimicrobial Resistance and Stewardship steering group involved in the mapping of healthcare education programmes to the WHO Competency Framework for Health Workers’ Education and Training on Antimicrobial Resistance (2018) and Consensus-Based National Antimicrobial Stewardship Competencies for UK Undergraduate Healthcare Professional Education (Courtenay et al 2018) competencies.
2. Our midwifery education programme has been mapped to the WHO Competency Framework for Health Workers’ Education and Training on Antimicrobial Resistance (2018) and the Consensus-Based National Antimicrobial Stewardship Competencies for UK Undergraduate Healthcare Professional Education (Courtenay et al 2018). It was found to be 100% compliant due to the innovative teaching strategies implemented by the two midwifery educators who provide the public health aspect of the midwifery education programme.
3. Our midwifery students are provided with the knowledge and awareness to influence Antimicrobial Resistance and Stewardship as newly qualified midwives across the childbearing continuum from pre-conception through to the early years period. Subsequently, they have developed competency in recognising their influence and making each contact with women, children and families count.

How is the project to be developed in the future?
Our midwifery programme is in the process of developing a new curriculum for September 2021. This new programme is mapped to the new Future Midwife: Standards of proficiency for midwives (NMC 2019). For the first time these standards are explicit in stating that for the midwife’s role in public health, health promotion and health protection, the midwife must demonstrate effective health protection through understanding and applying the principles of infection prevention and control, communicable disease surveillance, and antimicrobial resistance and stewardship (standard 3.10, page 19).

Our existing programme has been fit for purpose ahead of its time in ensuring that Antimicrobial Resistance and Stewardship has been at the forefront of our midwifery public health education. Newly qualified midwives from The University of Manchester are recognised by NHS Trusts as highly employable. Our programme of the future will build on this work so that our students are even better equipped to understand and engage in tackling this growing public health issue. Plans include developing online interactive real-life settings with individual characters and scenarios that enable students to creatively develop care plans and public health strategies targeting antimicrobial resistance. Our outreach work in schools promoting midwifery as a profession will also include innovative health promotion messages focusing on keeping well, healthy and infection free.

Ducit Blue Foundation

Provide a brief overview of your project?
Background
Antimicrobial resistance (AMR) is captured as one of the 13 urgent health challenges for the new decade by (WHO). In Nigeria, major gaps still exist in public knowledge and awareness of AMR including integration in school’s curricula.

In recent times, awareness activities in Nigeria have been majorly focused on the public (adult population) and health care professionals. There have been a dearth of activities focusing the children. In light of this, Ducit Blue Foundation conducted a maiden AMR sensitisation quiz and debate programme for Junior Secondary Schools in Abuja Nigeria. A preliminary event took place in October prior to the grand finale that happened during the week of the National Antibiotics Awareness Week in November 2019.

Rationale
AMR is a shared global concern, but the problems and solutions have strong local components. Progress in tackling AMR is best made through collaborative efforts with solutions that cuts across all categories and age group. This gave rise to the antimicrobial resistance sensitisation quiz and debate programme. It is targeted at school children between the ages of ages 9-14 years. It aims to increase young people’s understanding of why it is so important to use antibiotics correctly, in order to control antibiotics resistance and to maintain good hand hygiene to help reduce the spread of infection.

Objectives
The awareness is centred on the mantra: Know (education and awareness creation); Stop (change in practice towards responsible antibiotics use) and Save the future (preserving the efficacy of antibiotics). It aims to:

• Inform students of the threat AMR poses and reaffirm commitment to reducing the spread
• Educate on AMR burden and preventive practices in schools through an antibiotic resistance awareness quiz and debate, school clubs, workshops and conferences.
• Increase adherence to healthy behaviour and sensitisation on how to prevent the spread of infections among students

Please cite 3 examples of outcomes or impacts from the project on tackling AMR.
1. Increased understanding of AMR and infection prevention practices

Following feedback from the students and teachers at the end of the programme, 100% of respondents had improved knowledge of antibiotic resistance control strategies.

2. Raised new AMR ambassadors that encourage behavioural change practices

At the end of the event, 30 students from 6 different schools in Abuja were inducted as AMR Ambassadors. They pledged to be agents of change among their peers, family and in the community

3. Integrated AMR into school activities.

Feedback from students and teachers highlighted a gap in this area with activities to undertake in their respective schools. Below are excerpts from the student’s teachers:
“I will use the students I came with to this programme to dramatize it on the assembly and I personally will throw more light on it and push for continuous AMR awareness activities in my school”. “Educating pupils/students in my school about antibiotics”. “To use the students from my school to create awareness on hygiene and right use of antibiotics”.
How is the project to be developed in the future?

Following the successful maiden edition of AMR debate and quiz in 2019, we plan to leverage on the established platform to expand the scope beyond Abuja and to include the Geo-political zones and national programmes. Furthermore, we plan to work with the education boards to integrate AMR into curriculum and extra-curricula activities in line with the National action plan (NAP), e.g. school clubs, workshops and conferences. In addition, it will be included as part of the components for the larger project titled “Youths Against Antibiotics Misuse” project in Nigeria. The youths have the potential to lead the desired change in practice by generating evidence and potential solutions, in addition to acting as educators to their peers and members of the public towards ensuring rational use of antibiotics in the community and ultimately reducing the burden of AMR in Nigeria. Our goal is to raise nationwide children and youths Antibiotic guardian champions through education, engagement and advocacy towards a culture of stewardship and conscientious, evidence-informed use of antimicrobials.

DRASA (Dr. Ameyo Stella Adadevoh) Health Trust

Provide a brief overview of your project?

School settings are a major source of infection exposure due to close personal contact between students, which inherently means increased risk of infection and potential increased use of antibiotics. Communities often suffer when students are exposed to diseases as parents or caregivers may have to stay at home to care for sick children, affecting their work and productivity. Also, families often bear the large financial burden of treatment. Hence, school interventions impact both students and their communities.

It is important to prepare future generations of antibiotic users to understand the consequences of improper antibiotic use in order to safeguard the effectiveness of existing treatments and reduce the risk of resistance. As such, DRASA Health Trust – in collaboration with World Health Organization (WHO) Nigeria Country Office and support from WHO Antimicrobial Resistance (AMR) Secretariat and WHO Regional Office for Africa – established and managed Health and Hygiene Clubs in 8 public government secondary schools and 2 private secondary schools across Lagos, Nigeria. Student members of the Clubs were called “Ambassadors” and DRASA used a peer-training framework to empower them to drive positive health and hygiene-related behavior changes within their schools, families, and wider communities.

The program was implemented for 6 months and produced an average of 30 Ambassadors per school, totaling 320 Ambassadors who are now influencing the health and hygiene of their immediate community and environment. DRASA visited the schools to conduct Club meetings on a bi-monthly basis (every 2 weeks). Each meeting, Ambassadors were educated and engaged through a mix of didactic teaching and interactive activities ranging from games to pop quizzes to presentations/skits. Ambassadors were in turn charged with passing on the information they learned by educating and engaging others within their circles of influence (within and outside the school community) to drive positive behavior change.
Please cite 3 examples of outcomes or impacts from the project on tackling AMR.
Surveys conducted upon completion of the Health and Hygiene Club program show significant improvement in the Ambassadors’ knowledge of antibiotic resistance and prevention. At the beginning of the program, only 34.1% of the Ambassadors were aware that antibiotics only kill bacteria and not viruses. By the end of the training, this increased to 80%.

Similar progress was noted regarding the need to fully complete antibiotic treatment even if feeling better with a change from 39% to 74%. Also, knowledge of the need to get tested before taking malaria drugs and not self-medicate improved from 67% to 89% and handwashing behavior improved from 56% of Ambassadors always using soap to wash hands to 72% by the end of the program.

As their understanding improved, the Ambassadors effectively shared their new knowledge with their family members and community. “I saw a girl playing. When she finished her mother called her to come and eat. Instead of her to wash her hands before eating, she used that hand and ate. I warned her that next time, before anything else, she was supposed to wash her hands with soap and water,” said one of the Ambassadors. Another reported that during the Christmas carol service at her church, she was given 10 minutes to address all church members and teach them the proper handwashing technique.

Children are our future generation of users of drugs. Educating them now about the need to adhere to good hygiene practices and use antibiotics better will have an important impact in the years to come. They are true Ambassadors in our efforts to improve the health and well being of all Nigerians and reduce antibiotic resistance.
How is the project to be developed in the future?

Through this program, DRASA has tested and refined the strategy for youth-targeted community engagement interventions and found that the Health and Hygiene Club model can achieve the program objectives, is cost-effective, and can be scaled and expanded effectively. The expansion of the Health and Hygiene Club model can be achieved across Nigeria in two ways: 1. State by State (short-term): continue expanding throughout Lagos and add other states one-by-one; and 2. National System (long-term): establish a national system and embed this model within existing structures. DRASA and WHO are currently exploring the state-by-state expansion option.

Betsi Cadwaladr University Health Board

Provide a brief overview of your project?
Antibiotic resistance is a global threat. Betsi Cadwaldr Univeristy Health Board (BCUHB) has successfully managed to reduce its antibiotic consumption over the past years. Stewardship efforts have focused on prescribers and allied health professionals through the introduction of antibiotic guidelines and education sessions. The purpose of this project was to explore a different approach to stewardship. Children are the future consumers of antibiotics and possible health professionals. Teaching them from an early age the importance of infection prevention and prudent antibiotic use may reduce the burden on antimicrobial prescribing.

e-Bug is a free online resource providing fun and interactive teaching material on microbes, infection prevention and antibiotic use. Through delivery of four free half day ‘train the trainer’ style sessions to primary school teachers we hoped to facilitate the delivery of e-bug material within our classrooms. Teachers from each primary school in two counties within BCUHB were invited to attend an English or Welsh language session. In return for demonstrating evidence of delivering an e-Bug session to their classroom in the form of completed worksheets and / or activity photos, each school attending was given £90 towards the cost of a supply teacher required to cover their absence to attend the session.

The aims and objectives of the project were to

• Increase pupils knowledge and understanding of infection prevention and antimicrobial resistance
• Increase uptake of e-Bug resources in classroom settings by primary schools across Conwy and Denbighshire
• Demonstrate an understanding of the e-Bug resources through pre and post course evaluation

Evaluation of the sessions were completed through pre and post course questionnaires to determine their knowledge prior to and after the session. Further evaluations on the ease of implementation of e-Bug material in the classroom were submitted with evidence of completed activities by the pupils. Qualitative narrative has also been collated from both teachers and pupils.
Please cite 3 examples of outcomes or impacts from the project on tackling AMR.

1. Thirty three teachers attended from a total of 92 primary schools invited. This equated to a 36 % uptake. Of the 33 who attended, 31 completed the pre and post session questionnaire form (five questions) to determine if there had been an improvement in their knowledge on the subject taught. Pre – session knowledge from a score of 1-8 averaged at 2.6 for the attendees. Post session knowledge from the same scoring system averaged at 6.2. Each teacher demonstrated an improvement in knowledge in each question asked. Thirty one completed evaluation forms were also returned, 100% strongly agreed that the stated aims and objectives of the session had been met, 90% strongly agreed that the training delivered their learning needs, and 97% strongly agree that the ideas presented were valuable.
2. Fifteen primary schools have submitted evidence of implementing an e-bug classroom session. A total of 289 children completed an e-bug activity. It has not been possible to follow up the outstanding evaluations due to school closures as a result of covid-19 pandemic, however it is possible to extrapolate the data and it is estimated that if every school was to complete an evaluation to ensure the payment of £90 is secured , 627 children will have participate in an e-bug classroom session.
3. The true impact of the project needs further evaluation but project analysis and feedback to date supports pursuing this alternative approach to antimicrobial stewardship across North Wales. Positive engagement with both the BCUHB Awyr Las charity and cross sector working with the Xplore Science Discovery Centre will enable the e-bug resources to become more accessible and ensure a sustainable approach is made in teaching and engaging school pupils in education around microbes, infection management and antibiotic use.

How is the project to be developed in the future?
The success of the project identified the need for sustained engagement surrounding the importance of e-Bug material not only in the two counties that participated in the project but on a larger scaled throughout North Wales. In January this year a meeting was held between BCUHB and Xplore Science Discovery Centre . Xplore create curriculum based workshops, live science shows and hands on activities based at their centre in Wrexham or at schools throughout North Wales and the English borders. In 2019, 7540 children enjoyed a school trip to the centre, 21,622 people enjoyed a family day out at the centre and 2,958 teachers benefitted from professional development opportunities. Xplore recognised the importance of the project and agreed to an exciting collaboration between themselves and the health board to create workshop content and in centre activities using the e-Bug resources. Despite current restrictions due to the covid-19 pandemic, we continue to work closely with Xplore and BCUHB’S own charity ‘Awyr Las’ to secure funding to implement a series of sustainable and adaptable bilingual workshops on antimicrobial resistance and the importance of prudent antimicrobial use which supports the STEM subjects of science , technology, engineering and maths using the e-bug resources.

With the uncertainty surrounding the reopening of schools and talk of blended learning across Wales as a result of the covid-19 pandemic, four bilingual teaching modules based on the e-bug learning delivered at the training sessions have been produced and sent to the primary schools who attended the training sessions. The modules include a short presentation with supporting voice over followed by activities from the e-bug website and aimed to support remote learning during these uncertain times. The importance of this ready to use teaching material was recognised by Public Health Wales and sent to all healthy schools leads for distribution to all primary schools in the country and not only the primary schools who attended the project training sessions.

Pfizer ltd

Provide a brief overview of your project?
‘Superbugs: Join the Fight’ is a national education campaign funded by Pfizer for students aged 5 to 14 years. It delivers engaging content to increase students’ understanding of antimicrobial resistance (AMR) and raise awareness of this important public health issue. It empowers pupils to act and share what they have learnt with their friends, families and communities.

Through the campaign, Pfizer provided age-appropriate (key stage 1, 2 and 3), science and PSHE curriculum-linked resources for teachers to deliver lessons about AMR and vaccines. This included practical ways to prevent the spread of infection and tackle the inappropriate use and misuse of antibiotics. The resources also included an assembly pack about AMR and for key stage 3, a module about vaccination and its role in tackling AMR. All the teaching materials were developed with the National Schools Partnership, a network of teachers, education experts and school leaders.

At the heart of the resources is a call to action in the form of a competition. It challenges students to tell us how they would tell the world about AMR – how they would ‘spread the word’.

The competition entries were shortlisted by the National Schools Partnership and the winners and runners-up decided by a panel of experts including infectious diseases healthcare professionals from Great Ormond Street, research scientists, patient group leaders and other subject matter experts.

The campaign and competition first launched in 2018 (August to January 2019) and it ran again in 2019 (August to January 2020). Over these two periods, this campaign reached an estimated 264,000 students and generated almost 2,500 competition entries from right across the UK*.

More information is available on Pfizer.co.uk here: https://www.pfizer.co.uk/superbugs-join-fight-school-programme and here:
https://www.pfizer.co.uk/superbugs-join-fight-school-competition-winners

*Source: Pfizer data on file
Please cite 3 examples of outcomes or impacts from the project on tackling AMR.

Teacher surveys** showed the resources were highly successful*:

• Pupils had little awareness of AMR before the ‘Superbugs: Join the fight’ lesson; 64% of teachers thought their pupils were not very/not at all aware before the lesson. Following the lesson 100% of teachers thought pupils were very/somewhat aware.
• Teachers indicate a lack of strong awareness about AMR. 30% claimed to be ‘very aware’ before the lesson, rising to 92% of teachers considering themselves ‘very aware’ after delivering the lesson.
• Feedback indicated that students were empowered to take a role in combatting AMR. ‘Following teaching ‘Superbugs: Join the Fight’ lesson, to what extend do you agree that your pupils’:
  • ‘can describe how bacteria and viruses affect health.’: 100% of respondents agreed or strongly agreed;
  • ‘know personally what they can do to prevent the spread of superbugs.’: 100% of respondents agreed or strongly agreed.
  • ‘can explain the meaning of ‘superbugs’ and AMR and why the issue is important.’: 94% of respondents agreed or strongly agreed.

Competition judges rated the campaign:
Professor Colin Garner, Chief Executive, Antibiotic Research UK said: ‘It was a delight to see such high standard entries for this competition. It has been shown that the earlier children are taught about antibiotic resistance, the greater the impact. Children are amazing advocates so it’s not just about educating them, but letting them educate their parents, grandparents and social circle. I hope very much this initiative will continue.’

Professor Philip Howard, President, British Society of Antimicrobial Chemotherapy said: “Raising awareness and shaping behaviour at a young age to reduce AMR is essential. The British Society of Antimicrobial Chemotherapy is delighted to support this excellent school’s initiative. The standard and originality of the entries this year were outstanding. “

This film highlights the impact on pupils:
https://www.youtube.com/watch?v=CG5IxCFKSV0

*Source: Pfizer data on file. **Total Sample Size: 2019 = 43, 2020 = 52
How is the project to be developed in the future?
The Superbugs: Join the Fight campaign will run again from August 2020. The aim is to reach 500,000 students with impactful, action-oriented AMR lessons over the three years of the campaign to 2021. Each year the communications and the resources are reviewed and adapted to improve impact based on feedback from teachers.

In March 2020, Pfizer took the decision to re-design the teaching resources and make them available for home schooling during the COVID-19 lockdown. From April 2020, the Superbugs resources have been available for free on Pfizer.co.uk in the form of an interactive lesson and teaching guidance. These resources will remain on the site while the original classroom-based resources are provided to teachers in parallel.

The prize for the ‘Superbugs: Join the Fight’ competition provides an opportunity for further communications and engagement. The prize in 2018/19 was a Pfizer funded trip to the Science Museum and a tour of the ‘Superbugs: The Fight for our Lives’ exhibition, of which Pfizer was a major sponsor. The 2019/20 winners’ prize roll out has been impacted by COVID-19 but we intend to find a solution that works for schools, teachers and students. The prize will celebrates the work of the students while reinforcing the messages from the lessons in the public domain.