An­timi­cro­bial re­sis­tance na­tional strate­gic frame­work

The Poultry Bulletin - - CONTENTS - By Moritz van Vu­uren

A com­mit­ment to prin­ci­ples and ob­jec­tives

In a previous ar­ti­cle, men­tion was made of a num­ber of com­mit­ments in­cluded in the An­timi­cro­bial Re­sis­tance (AMR) Na­tional Strate­gic Frame­work that em­anated from the An­timi­cro­bial Re­sis­tance Sum­mit that took place dur­ing Oc­to­ber 2014 in Jo­han­nes­burg. Par­tic­i­pat­ing stake­hold­ers from var­i­ous sec­tors pub­li­cally signed a doc­u­ment out­lin­ing these com­mit­ments, thereby com­mit­ting to work col­lab­o­ra­tively to in­vest rel­e­vant re­sources and im­ple­ment sound strate­gies and in­ter­ven­tions in or­der to man­age an­timi­cro­bial re­sis­tance in South Africa and to pre­serve the ef­fec­tive­ness of an­timi­cro­bials for fu­ture gen­er­a­tions. From the an­i­mal health sec­tor, rep­re­sen­ta­tives from DAFF and the SAVC signed the doc­u­ment.

The Strat­egy ar­tic­u­lates the vi­sion, mis­sion and goals for im­prov­ing the ap­pro­pri­ate use of an­timi­cro­bials by all users over the next five years. It is recog­nised that for the Strat­egy to achieve its goals, na­tional govern­ment must lead, sup­port and guide its im­ple­men­ta­tion.

The stake­hold­ers com­mit­ted to the fol­low­ing prin­ci­ples: 1. To col­lab­o­rate as in­ter­sec­toral, in­ter­dis­ci­pli­nary or­gan­i­sa­tions and de­part­ments to strengthen, co-or­di­nate and in­sti­tu­tion­alise ef­forts to ad­dress AMR. This will re­quire set­ting

up a Na­tional lnter­sec­toral Min­is­te­rial Ad­vi­sory Com­mit­tee for AMR . 2. To es­tab­lish a na­tional sur­veil­lance sys­tem to track AMR and an­timi­cro­bial use in an­i­mals, crops and hu­mans. This will be pre­ceded by the de­vel­op­ment of an AMR map for South Africa, through data shar­ing be­tween the pri­vate and pub­lic sec­tor lab­o­ra­tory ser­vices. 3. To en­hance the pro­cesses, struc­tures, re­sources and sup­plies needed for ef­fec­tive in­fec­tion pre­ven­tion & con­trol (IPC) and an­timi­cro­bial stew­ard­ship (AMS). All hu­man health es­tab­lish­ments will be en­cour­aged to meet com­pli­ance of the Na­tional Core Stan­dards (NCS) re­lat­ing to AMR by 2016 (see com­ments later). 4. To pro­mote the ap­pro­pri­ate use of an­timi­cro­bials in hu­man and an­i­mal health through suit­able en­abling leg­is­la­tion and

reg­u­la­tions. 5. To build the ex­per­tise and strengthen the com­pe­tency of health care pro­fes­sion­als and vet­eri­nary pro­fes­sion­als and im­prove the staffing lev­els of the work­force in AMR and IPC. To de­velop a strat­egy and im­ple­men­ta­tion plan for the in­te­gra­tion and im­ple­men­ta­tion of AMR and IPC train­ing into the un­der­grad­u­ate and post­grad­u­ate med­i­cal, vet­eri­nary and al­lied health pro­fes­sional stu­dent cur­ric­ula of South African train­ing es­tab­lish­ments. 6. To pro­mote re­search into novel di­ag­nos­tics and clin­i­cal tri­als in IPC and AMR 7. To in­crease the com­mu­nity aware­ness of AMR. The AMR strate­gic frame­work con­sists of four (4) strate­gic ob­jec­tives that are un­der­pinned by 4 key en­ablers.

The strate­gic ob­jec­tives are:

i. Strengthen, co­or­di­nate and in­sti­tu­tion­al­ize in­ter­dis­ci­pli­nary ef­forts through na­tional and health→

estab­lish­ment level gov­er­nance struc­tures.

ii. Op­ti­mise sur­veil­lance and early de­tec­tion of an­timi­cro­bial re­sis­tance to en­able re­port­ing of lo­cal, re­gional, and na­tional re­sis­tance pat­terns to op­ti­mise em­piric and tar­geted an­tibi­otic choice.

iii. En­hance in­fec­tion pre­ven­tion and con­trol of the spread of re­sis­tant mi­crobes to pa­tients in health­care set­tings, fo­cus­ing on im­prove­ment in hand hy­giene and the iden­ti­fi­ca­tion and iso­la­tion of pa­tients with re­sis­tant or­gan­isms. Com­mu­nity mea­sures in­clude pre­vent­ing in­fec­tion through wide-reach­ing vac­ci­na­tion pro­grammes and im­prove­ments in wa­ter qual­ity and san­i­ta­tion.

iv. Pro­mote ap­pro­pri­ate use of an­timi­cro­bials in hu­man and an­i­mal health through an­timi­cro­bial stew­ard­ship.

The key en­ablers of these strate­gic ob­jec­tives are:

i. Leg­isla­tive and pol­icy re­form for health sys­tems, strength­en­ing these to sup­port the qual­ity of an­timi­cro­bials in the coun­try and to en­able con­trol over pre­scrib­ing of an­timi­cro­bials in the an­i­mal health sec­tor.

ii. Ed­u­ca­tion of all lev­els of health providers in hu­man health and agriculture in the crit­i­cal con­cepts of an­timi­cro­bial stew­ard­ship, in­fec­tion con­trol, in­fec­tious dis­eases, mi­cro­bi­ol­ogy and phar­ma­col­ogy.

iii. Com­mu­ni­ca­tion to ed­u­cate the pub­lic, cre­ate aware­ness and en­hance pa­tient ad­vo­cacy of the dan­gers of in­ap­pro­pri­ate an­timi­cro­bial use.

iv. Re­search into novel di­ag­nos­tics and clin­i­cal tri­als in IPC and AMR.

Mem­bers of the vet­eri­nary pro­fes­sion may not be fa­mil­iar with a num­ber of acronyms and terms used and in­cluded in the Na­tional Strate­gic Frame­work. How­ever, the con­cepts and prin­ci­ples that un­der­pin these terms are all ap­pli­ca­ble to the vet­eri­nary pro­fes­sion al­beit in some cases with a dif­fer­ent em­pha­sis. These in­clude in­ter alia IPC, PPE and NCS.

In the med­i­cal pro­fes­sion, IPC places heavy em­pha­sis on hand hy­giene, res­pi­ra­tory hy­giene, cough eti­quette and per­sonal pro­tec­tive equip­ment (PPE). Health care work­ers that fo­cus on IPC are known as IPC prac­ti­tion­ers.

In the vet­eri­nary pro­fes­sion the same stan­dard pre­cau­tions ap­ply to a lesser or greater ex­tent, but in terms of an­i­mal health, the con­cep­tual, struc­tural and pro­ce­dural com­po­nents of biose­cu­rity will be of greater im­por­tance.

The NCS for hu­man health es­tab­lish­ments in South Africa have been cre­ated to im­prove the qual­ity of hu­man health care and do not ap­ply to the vet­eri­nary pro­fes­sion. Through a na­tional process of cer­ti­fi­ca­tion, an ex­ter­nal body will for­mally as­sess each health estab­lish­ment for com­pli­ance with these NCS’S.

It is clear from the Strate­gic Frame­work that the use of an­tibi­otics in the wa­ter and feed of live­stock (in­clud­ing aquatic species) will be put un­der the spot­light. This frame of mind is not unique to South Africa. The US Food and Drug Ad­min­is­tra­tion is mak­ing at­tempts to re­duce the pub­lic health threat of an­timi­cro­bial re­sis­tance by re­strict­ing live­stock uses of an­timi­cro­bials that are in the same drug classes as those used in hu­man medicine.

The FDA has set a De­cem­ber 2016 dead­line to elim­i­nate pro­duc­tion uses (such as per­for­mance en­hanc­ing) of those drugs and to re­move over-the­counter ac­cess to any an­timi­cro­bials that are im­por­tant for hu­man medicine and are ad­min­is­tered to live­stock through their feed or wa­ter. A pos­i­tive de­vel­op­ment in this re­spect will be in­creased vet­eri­nar­ian over­sight of an­timi­cro­bial use in food-pro­duc­ing an­i­mals. There is gen­eral con­sen­sus that in­creased vet­eri­nar­ian over­sight and su­per­vi­sion of such drug use will con­trib­ute to ef­forts to con­trol the spread of an­timi­cro­bial re­sis­tance.

Vet­eri­nary prac­ti­tion­ers in South Africa will sooner rather than later ex­pe­ri­ence ma­jor changes in the way that an­timi­cro­bial drugs will be pre­scribed and dis­pensed. The Min­is­ter of Health, Dr. Aaron Motswaledi pointed out at the re­cent AMR Sum­mit that self-reg­u­la­tion by pri­vate in­dus­tries, as far as an­timi­cro­bial drugs are con­cerned will not help to evade the dis­as­ter that ad­vanced AMR will rep­re­sent and em­pha­sised that se­ri­ous reg­u­la­tion is now re­quired.¡

Dr Char­lotte Nkuna

Newspapers in English

Newspapers from South Africa

© PressReader. All rights reserved.