Makerere University School of Public Health

Provide a brief overview of your project?
Buckinghamshire Healthcare NHS Trust (UK), in partnership with Nottingham Trent University (UK), Makerere University – Uganda, Entebbe Regional Referral Hospital (RRH) – Uganda and Ministry of Health – Uganda are implementing a multidisciplinary project on strengthening antimicrobial stewardship (AMS) in Wakiso district, Uganda.

Using a One Health approach, community health workers (CHWs) from Wakiso district were trained on antimicrobial resistance (AMR) and AMS including the promotion of Infection Prevention and Control (IPC) practices. The trained 227 CHWs were all from Kajjansi Town Council, Wakiso district. In the efforts to fight AMR, IPC measures such as proper sanitation, hand washing, as well as food and water safety was emphasized in the training as key in contributing to spread of AMR.

Balloon experiments (based on the eBug activities by Public Health England) were used to explain the concept of AMR to participants. Balloons were blown up representing microbes; some balloons were popped with the pin representing the killing of microbes with antimicrobials. A square of tape was then added onto another balloon representing the microbe changing and developing resistance to antimicrobial medicines. On trying to pop this balloon with the pin on the tape, it became difficult to pop which represented resistance, signifying microbes becoming harder to kill.

Glo germ gel was used with a handheld ultra-violet torch to emphasize the need for proper handwashing. Gel was rubbed onto each participant’s hands and then trainees washed their hands. Although the hands of many trainees appeared clean, the ultra-violet light determined whether the cleaning was effective and highlighted any shortcomings in the handwashing technique of each participant.
Please cite 3 examples of outcomes or impacts from the project on tackling AMR.
Through the Balloon experiments, the CHWs appreciated and understood better what AMR is and why it is a problem. Through the pre and post training assessments, it was evident that most CHWs had learnt about the various contributors to AMR and how to promote AMS in their communities. The messages that were developed through group discussions and presentations during the training showed that they had understood and were ready to sensitize the communities on how to become better antimicrobial stewards including through improved IPC.
Handwashing among CHWs was greatly improved. The trainees greatly appreciated learning about the proper handwashing procedure and they very much enjoyed the Glo germ activity. This was reflected in their improved handwashing process during and after training.
Following the training, there was increased awareness and knowledge levels on the relevance of IPC. The majority of the CHWs who attended the training depicted improved knowledge on the significance of IPC as an effective way of fighting AMR.
How is the project to be developed in the future?
The project will continue to train CHWs in Uganda from other neighbouring areas on the different ways to promote IPC as one of the major avenues to fight AMR.

The project will also provide hand washing facilities to several CHWs to promote proper handwashing in their communities through crowd funding resources mobilised by Buckinghamshire Healthcare NHS Trust during the course of the project.

Manchester University NHS Foundation Trust

Provide a brief overview of your project?
Antimicrobial stewardship (AMS) goes hand in hand with infection prevention and control (IPC) when it comes to tackling antimicrobial resistance. The AMS pharmacy team at Manchester University NHS Foundation Trust (MFT) have expanded their roles and are strengthening the provision of IPC across the pharmacy department and the wider Trust.

1. AMS pharmacists and other pharmacists trained as “flu champions” vaccinating healthcare workers as part of the flu campaign 2019/20 season.
2. Launching the #cleanhandscampaign2020 for all pharmacy staff across 9 hospital sites in Manchester.
3. AMS pharmacists training as trainers in “donning and doffing” of personal protective equipment (PPE) as part of the emergency preparation for COVID19 at MFT.

Flu champions
Our pharmacy flu champions vaccinated around 300 members of pharmacy staff and other health care professionals during the flu campaign.

Clean hands campaign
The campaign is supported and endorsed by our pharmacy senior leadership team with 2 consistent messages:

1. Importance of effective handwashing.
2. Bare below the elbows (BBE) for all pharmacy staff in all clinical areas.

Features of the #cleanhandscampaign2020

• Development of “Preparation stations” – nail varnish remover, hair bobbles and Alcogel and is positioned in pharmacist offices and dispensary areas. This is an automatic motivation and physical opportunity intervention.
• Organised training sessions on the importance of hand hygiene.
• Opportune/impromptu training sessions with staff at team huddles with UV light box.
• Poster campaign.
• Twitter campaign from @antibioticangel which has received attention on a Trust wide and national level.

#tamethemane #dontfailbecauseofthenails #dontmissthewrists

In the first week of the #cleanhandscampaign2020 120 members of the pharmacy workforce were trained. The training is on-going.

PPE trainers
4 AMS pharmacists and 3 respiratory pharmacists are trained as trainers in “donning and doffing” PPE. This team are providing support to the infectious diseases team and IPC team by training front line staff.
Please cite 3 examples of outcomes or impacts from the project on tackling AMR.
An effective influenza vaccination campaign can reduce the burden of winter pressures across the NHS. Patients who get influenza are at risk of getting secondary bacterial infections which require antibiotics. Increasing the uptake of flu vaccinations amongst staff can reduce the burden of influenza across society and reduce the use of antiviral drugs for influenza and antibiotics for secondary bacterial infections. Pharmacy staff can be “super spreaders” of influenza due to the number of areas across the hospital they visit on a daily basis. Our campaign in the pharmacy department increased the numbers of MFT pharmacy staff vaccinated compared to other seasons.

MFT has experienced problems with AMR, reducing the transmission of carbapenemase resistance (CPE) is a key priority for the Trust. Levels of CPE/KPC transmission are monitored and the main method we have to reduce transmission is effective IPC. There were reportedly varied levels of compliance with the standards of BBE across the pharmacy sites in the Trust. Our campaign has ensured a consistent message for all pharmacy staff with regards hand hygiene and BBE. Senior leadership has been key and a zero tolerance approach to non-compliance with BBE has made a visible difference across the pharmacy department, with all staff removing watches, rings and nail polish. Increased awareness of effective hand washing technique and the “5 moments of hand hygiene” by pharmacy staff will help to reduce the spread of hospital acquired infections (including CPE and MRSA) across the Trust and may assist with the efforts to reduce COVID19 transmission.

Our PPE trainers have increased the number of trainers at MFT, strengthening the efforts and our Trust’s response to dealing with COVID19.
How is the project to be developed in the future?

• Sharing #cleanhandscampaign2020 resources with other Trusts. Other Trusts have requested access to our resources.
• Increased numbers of PPE trainers within the pharmacy team. The next group of PPE trainers will be our respiratory pharmacists so that they can train healthcare staff who haven’t been able to access the training due to demands on the ward.
• Investigating other ways we can assist in MFT’s IPC agenda.
• Increased numbers of pharmacy flu champions and increasing our attendance at Trust flu vaccination events to vaccinate even more staff.