Sandwell and West Birmingham CCG

Provide a brief overview of your project?
As a CCG, we launched the ‘To Dip or Not To Dip’ Project across care homes in our CCG. We ran 2 sessions – one was in collaboration with the council and one organised by our own team in collaboration with our local Trust.

The session was attended by care home staff including nurses, managers and assistants.

To measure prior knowledge and post session learning, we handed out a quiz which the attendees answered before the session and then again after. The results demonstrated an improvement in knowledge with regards to not dipping in over 65’s, recognising symptoms of UTIs and the importance of hydration.

We delivered education on what a Urinary Tract Infection is, how to recognise the signs and symptoms and why patients over 65 years old should not have a urine dipstick test due to the presence of asymptomatic bacteriuria.

The focus of the educational sessions were on UTI prevention by recognising dehydration, how to prevent it and how to keep patients hydrated and mobile where possible.

Furthermore, we provided a checklist for staff to fill in when they suspected a patient has a UTI to encourage focus on symptoms and not a dipstick and to highlight any red flag symptoms.

We also provided a guide on how to hydrate patients, why dipstick testing should not be carried out in over 65s and how to obtain a mid-stream urine sample for the care homes to add to their training packs.
Please cite 3 examples of outcomes or impacts from the project on tackling AMR.

The event was well received with feedback such as:
90% off attendees found the event good or very good.

In terms of UTI quiz results
14% correctly answered that you should not dip stick test in over 65’s prior to the session.
100% of attendees answered this correctly after the session demostrating an improvement in knowledge and a potential change in practice.

100% did not know that you should drink 1.5 litres of fluid a day to stay hydrated which was answered correctly after the session demonstrating a potential to improve general health of a patient and reduce UTIs by keeping patients hydrated.

Examples of comments from the event were as follows:
“Found the information easy to understand”
“Very interactive and enjoyed the quiz”
“Case study was good to reinforce the information”
“Interesting course, learnt some things to take back to nursing home”
How is the project to be developed in the future?
Following feedback from this event, delegates advised informing our GPs the same message i.e. don’t ask care home staff to dipstick test in over 65’s.

Therefore, a CCG prescribers event will be delivered this year on AMS and, UTI diagnosis and treatment. The expected outcome will be a reduction in inappropriate use of dipsticks and improved management of self-limiting infections.

We will also provide training to CSU staff that provide a Medicines Optimisation Care Home (MOCH) Pharmacist service to care homes.

The University of Manchester

Provide a brief overview of your project?
A multidisciplinary team of staff and students at The University of Manchester have created and launched a free, open access, online course about Antibiotic Resistance (AMR). This course is one-of-a-kind as it focuses on engaging the community and emphasises that they are part of the solution. The course has three topics that introduce Antimicrobial Resistance (AMR) as a global issue, discuss the science behind antibiotics, microbes and resistance, and focus on behavioural changes everyone can adopt to help tackle AMR.

We have taken multiple approaches to ensure the language we used was effective and accessible to a range of reading levels. We used the ‘Wellcome Trust’s Contemporary Research and Guidance on Public Engagement about AMR’ to frame the issue in a motivating way. All materials were reviewed by internal and external subject experts, a patient and patient information charity, for accuracy and usability. We are confident we have achieved a high level of accessibility as users have left positive feedback describing the course as “Easy to follow”, “Scientific concepts were explained in a clear and accessible way” and “Good use of videos to complement learning”.

Since launching in May, we have had almost 1000 users accessing the course, with 238 enrolling and 124 fully completing the course (as of 09/07/2020). These users are from over 80 different countries and gave an average satisfaction rating of 4.7 out of 5.

The result of our project is a comprehensive course on antibiotic resistance that increases the publics’ understanding of this global issue and how they can help in their local community. Upon completing the course the user is encouraged to make a pledge as an Antibiotic Guardian and following completion of an honorary test they will receive a certificate.
Please cite 3 examples of outcomes or impacts from the project on tackling AMR.

1. 238 users have enrolled on the course and 124 users have successfully earned a credential signifying official completion of the course. This is equivalent to a 52% completion rate (course enrolments v completions). On average, a MOOC (Massive Open Online Courses) completion rate is between 5-10%
2. The students who contributed to this project really enjoyed the experience and have learnt a lot about AMR but also project management and science communication. One student wrote as part of our University blog, “The project opened my eyes to science communications.” and another wrote “Overall, this project was unlike anything I have ever done before and I feel proud to have been part of it.”. From this experience they have set up their own AMR-Society with the ethos of increasing awareness of AMR in the local community and empowering students to work with their communities to spread knowledge about AMR.
3. The course has been endorsed and promoted by the charity ANTRUK, is now listed in the Health Education England (HEE) toolbox and is a listed course on the European CDC website. Furthermore it now forms part of the new Introduction to Public Health course unit on the Master of Public Health programme at the University of Manchester which is a global online masters with a reach of over 300 students.

How is the project to be developed in the future?
Working on feedback received from course users we are broadening our team to include members from across the globe including Rwanda, Uganda and Tanzania. This team is working on translations of the course materials into multiple languages as well as further developing our materials to make them less UK-centric and more widely applicable to a global population.

This course is going to be used alongside resources offered by e-bug for targeted outreach in our local communities to educate about the threats of AMR and what behaviours people can adopt to help reduce AMR. This work will be supported by our newly formed AMR University Society.

Finally, we are also looking into getting more feedback on the accessibility for younger users and users with learning difficulties and developing our materials further so that we can use this course as part of outreach work with primary school children to ensure as many people as possible have the opportunity to learn about the threat of antimicrobial resistance.

Serufusa Inc.

Provide a brief overview of your project?
Using rap music to engage global audiences to act on antimicrobial resistance. Songs are in English, Swahili (spoken by approx 150m in East, Central and Southern Africa) and in Mandarin Chinese. Latest song “Do Something About AMR”, from my latest album ‘The Solutionary Manifesto’ has been a huge success.

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

The rap song “Do Something About AMR” which is in English, Swahili & Mandarin Chinese has had approx 500K plays on Youtube, as well as thousands of streams on Spotify, Amazon music, Apple Music and other China-specific music platforms. Listeners have been globally ranging from Mexico, the US and Europe all the way to Africa, Japan and the Oceania region.

The rap song ” Antimicrobial Resistance Apocalypse” was featured on BBC Hacks as the soundtrack on a documentary about the Dutch response to misuse of antibiotics in animals, which included an interview with Lord Jim O’Neill.

How is the project to be developed in the future?

Fundraising is currently ongoing to develop music videos which will be released globally. Specifically, the videos will be played on national TV in Uganda on a rap-along current news show called Newz Beat as well as on the back of local motorcycle taxis (boda bodas).

For China, the plan is to develop an animated music video.

Healthcare Communications and Social Media South Africa

Provide a brief overview of your project?
I am an antibiotic resistance activist. In 2004, I was injured in a severe car accident in South Africa. My most complex injuries were multiple fractures in my face. The following six years, I had various reconstructive surgeries before my fourth implant developed an infection. After an emergency removal of the prosthetic a year later, I was diagnosed with MRSA. I had never heard about antibiotic resistance before. In that moment I couldn’t understand why this was not common knowledge to me. Once recovered in 2013, having owned an advertising business for 18 years, I truly believed marketing was one of the greatest tools being underutilised to empower patients with information, in fact, I was one of those disempowered patients. I initially introduced medical websites to my company, but as ideas evolved, I shifted towards social media. I advocated online aggressively and very quickly built a global community of diverse health professionals, academics and advocates as well as received invitations to international events like Doctors 2.0 and You in Paris. In 2016, I established the first Twitter chat for South Africa on the hashtag #hcsmSA. I was invited to the South African Antibiotic Stewardship Program working group and in 2017 awarded an e-Patient scholarship at Stanford University. I have since spoken on numerous global and local stages including the ICPIC attended by over 1200 people and Africa Health attended by over 5000. My social media followers have grown to 21,000. I have also shared my story on several radio interviews and in articles featured by Imperial College London, the Wellcome Trust and WHO. In 2019, I was invited by the Africa CDC to be a civil society organisation engagement champion for AMR in Africa. Further information here: www.vanessacarter.co.za
Please cite 3 examples of outcomes or impacts from the project on tackling AMR.

1. I have provided training to various institutions including TB Proof, Africa CDC, Wits School of Public Health and the NICD about the effective use of the web and social media to conduct research using tools like Symplur analytics as well as how to disseminate trustworthy information to the public. This was recognised with an award by the Foundation for Innovative New Diagnostics (FINDdx) at the 72nd World Health Assembly
2. After hearing about Antibiotic Guardian on social media and making colleagues aware at the SA stewardship program, working together with Professor Adrian Brink from the University of Cape Town Microbiology Department on the pledge for South Africa, the National Department of Health as well as the Stewardship Program and the Federation of Infectious Diseases Society of South Africa adopted the pledge. I then further assisted in the production of a public educational video using a one health approach: https://youtu.be/C-jueYh89DA
3. Since 2016, numerous Twitter chats about antibiotic resistance and one health have been moderated by me on various hashtags including #hcsmSA #ProtectAntibioticsZA and #AfricaWAAW. During World Antibiotic Awareness Week 2018, I used the geographic hashtag #hcsmSA as an advocacy initiative where I invited a total of 25 panel experts. According to Symplur, the 60-minute session reached 1,475M impressions, 750 Tweets and had 42 Participants. The following year, WAAW 2019, I used the hashtag #ProtectAntibioticsZA which was now registered for the South African Antibiotic Guardian Pledge Campaign and which saw 1,575M impressions, 1009 Tweets and had 47 Participants. The larger #AfricaWAAW 60-minute session which I moderated on behalf of the Africa CDC received 3084M impressions, 1191 Tweets and 121 Participants.

A data report and transcript can be read further for the 2018 chat here: https://healthcaresocialmedia.co.za/analysing-data-from-a-twitter-chat-during-world-antibiotic-awareness-week-hcsmsa/
How is the project to be developed in the future?
Although I am in the process of relocating to the UK later in 2019, I do plan to continue my work for South Africa and Africa as much of it is virtual. I have recently designed a website which I hope could develop into an online learning hub depending on funding available. I do hope to expand my advocacy on a much more global level. In the UK, given that I have already worked with medical researchers as a patient and we have learned about patient partnerships at Stanford University through my e-Patient scholarship, I am hoping to gain further expertise and knowledge in the area of patient and public involvement for antimicrobial resistance, especially as we enter a digital era. I also hope to study digital marketing in-depth and earn a degree so that I can understand data analytics even further. I have already applied and been accepted by the Manchester University for an MSc but lack funding or a scholarship at this stage.

Public Health England

Provide a brief overview of your project?
In 2018 community pharmacy was identified by the national AMR directorate as one of the health and social care staff groups receiving very little training in AMR and antimicrobial stewardship despite their frequent contact with the public, both patients and non-patients. The PHE East of England AMR Programme leads decided to address this gap in training and to promote stewardship within our region.

We worked with the national AMR directorate and the TARGET team to develop a webinar for (all) community pharmacy staff in the region to coincide with a mandatory national AMR campaign in September 2019, “Keep Antibiotics Working”.

The aim of the webinar was to help pharmacy staff to:

• Understand what AMR is and why it is important;
• Understand how they can help stop the spread of AMR;
• Recognise when a client may have a self-limiting infection;
• Improve their confidence in giving advice to clients about self-care and when not to take antibiotics;
• Prepare their pharmacy to make the most of the campaign; and
• Promote Antibiotic Guardian.

We engaged with the Cambridgeshire and Peterborough Local Pharmaceutical Committee to ensure that the content, timing, and mode of delivery were appropriate for our target audience and to help to disseminate information about the webinar. As a result, there was interest from pharmacies across the country. The webinar was delivered by the national Pharmacy Lead with support from the East of England’s Healthcare Public Health team using an online video conferencing platform on the evening of 29 August 2019.

The webinar had 626 registrations from across England and received very positive feedback, along with strengthening relationships between local, regional, and national stakeholders. The Centre will be looking to replicate this again in line with the next national AMR campaign.
Please cite 3 examples of outcomes or impacts from the project on tackling AMR.

1. Increased awareness among pharmacy staff about the importance of antimicrobial stewardship on individual and population health.
2. 91% of respondents agreed that agreed that the webinar gave them a greater appreciation for their personal role in helping to tackle AMR.
3. 93% of respondents agreed that since watching the webinar they intend to give more self-care advice to patients using the TARGET leaflet.

How is the project to be developed in the future?
The project is expected to be repeated in line with the next ‘Keep Antibiotics Working’ campaign. We will build upon our new relationships with the national PHE AMR directorate and Local Pharmaceutical Committees to engage stakeholders earlier to ensure that their feedback and insights are used to inform the next iteration of the webinar and its delivery.