Saq065 amrau report Internal V11

5. Australia’s repsonse – a national coordinating centre

For Australia’s national coordinating centre on antimicrobial resistance (AMR) and usage surveillance and reporting, the Antimicrobial Resistance Standing Committee (AMRSC) recommends:

1. 
   That existing systems and processes be expanded and improved, a national coordinating centre for the surveillance and reporting of AMR and antibiotic use be established, with oversight from AMRSC.
   
2. 
   That responsibility for establishing the centre rests with the Australian Commission on Safety and Quality in Health Care (ACSQHC) as it is well placed to undertake the responsibility of establishing national coordination.
   
3. 
   That a program of work be developed based on supporting, improving and linking existing systems that have statewide or national application, and bringing into play contemporary technologies, systems and assets that together can achieve the desired objectives.
   

5.1 The proposal

The Antimicrobial Resistance Standing Committee (AMRSC) proposes a three-stage program comprising five elements of activity. It is proposed that the program elements be developed, implemented and funded over three stages, as outlined in Table 11 to Table 16.

Table 11: A high-level overview of the proposed program, comprising five elements developed over three stages

Stream	Stage 1 – short term	Stage 2 – medium term	Stage 3 – long term
Element 1 Surveillance of antimicrobial resistance	Leverage existing systems Expand capacity and include additional participants and data sources	Build new capacity Link to nonhuman data	Complete comprehensive system capturing human, animal and food data
Element 2 Surveillance of antibiotic usage	Leverage existing systems Expand capacity and include additional participants and data sources	Build new capacity Link to nonhuman data	Complete comprehensive system capturing human, animal and food data
Element 3 Disease burden and outcomes	Strengthen hospital and community programs	Set up new initiatives for specific disease entities Improve existing initiatives	Set up new initiatives for specific disease entities Improve existing initiatives
Element 4 Analysis and action	Establish definitions and standards Scope analytic and reporting requirements	Improve analytic and reporting capability Reinforce standards and guidelines Identify research priorities Demonstrate progress	Leverage emerging science and technology Increase capacity and authority for action Set research priorities Demonstrate progress
Element 5 Planning	Map complete program Plan for Stage 2	Evaluate Stage 1 Confirm program direction Plan for Stage 3	Evaluate Stage 2 Plan international participation Be a One Health leader

 

Table 12: Element 1 – Surveillance of antimicrobial resistance

Rationale	It is essential to measure the extent and trends in antimicrobial resistance in the community and hospitals if effective interventions are to be developed, and outcomes from interventions demonstrated.
Proposed approach	Review available and potential data sources Develop and promulgate standard approaches Develop existing systems and mechanisms that are operating or have the potential to operate at a national level
Stage 1	Stage 2	Stage 3
Passive surveillance – real-time public and private laboratory data Targeted surveillance Alert – emerging pathogens	New initiatives – explicit aim is to receive data from external entities. The Australian Commission on Safety and Quality in Health Care will not assume authority for animals and food, but may lever funding from existing government departments for animal, food and nonbacterial microorganisms (fungi and viruses) surveillance. Improve existing initiatives – extend targeted and alert surveillance systems	Comprehensive passive, targeted and alert systems for: humans animals food and agriculture.

Table 13: Element 2 – Surveillance of antibiotic usage

Rationale	Understanding where and to what extent antibiotics are used is key to developing strategies to address a range of issues, from appropriateness of prescribing to demonstrating links between use and emerging resistance.
Proposed approach	Review available and potential data sources Develop and promulgate standard approaches Build on existing systems that operate or have the potential to operate nationally
Stage 1	Stage 2	Stage 3
NAUSP: report at local level in real-time increase national participation of all hospitals, including paediatric. Community data from Pharmaceutical and Repatriation Subsidy Schemes, BEACH, Medicine Insight and others.	New initiatives: secure human community data animal usage data indication data for community, hospital and animal. Improve existing initiatives: NAUSP is inclusive of all hospitals build on existing work (e.g. point prevalence) for wider antimicrobial resistance.	Comprehensive indication data systems for: humans animals food and agriculture. Integrated human and community usage systems for: humans animals.

BEACH = Bettering the Evaluation and Care of Health; NAUSP = National Antibiotic Utilisation Surveillance Program

 

Table 14: Element 3 – Disease burden and outcomes

Rationale	A range of measures from hand hygiene to vaccination have been demonstrated to be effective in reducing disease burden from microorganisms. None, however, focus on resistant organisms.
Proposed approach	Build on existing standards, systems and programs Improve coordination, participation and reporting
Stage 1	Stage 2	Stage 3
Hospital level: hand hygiene audit and data hospital-acquired infection surveillance and others antimicrobial stewardship data targeted surveillance of specific infections. Community level: targeted surveillance of specific infections and disease.	New initiative: target program for specific disease entities. Improve existing initiatives: continue existing work.	New initiative: target program for specific disease entities. Improve existing initiatives: continue existing work.

Table 15: Element 4 – Analysis and action

Rationale	Once data sources have been developed and systems implemented, the improvement of health outcomes is dependent on high-quality analysis of the datasets, and action plans being developed and implemented.
Proposed approach	Resource the national coordinating centre for antimicrobial resistance strategy to undertake appropriate analysis and planning Leverage national resources such as the enterprise data warehouse to develop analytical capacity Use the mandate of the Standing Committee on Health to promulgate guidelines, advice and standards Use analysis to drive improvement initiatives and research
Stage 1	Stage 2	Stage 3
Analysis and action from datasets Determine what other elements or programs need to be included or established (e.g. hospital-acquired infections) Establish definitions (e.g. denominator data) Establish reporting methods Develop policies Develop guidelines, advice, standards, particularly education Recommend research priorities Identify the burden of disease and disease outcomes Examine scope and opportunity of the National Antibiotic Utilisation Surveillance Program to include hospital and community within one entity Make recommendations to regulatory authorities	Continue existing work Review emerging science and technology Increase capacity and authority for analysis and action Develop guidelines, advice and standards, particularly education Influence and set research priorities	Continue existing work Review emerging science and technology Increase capacity and authority for analysis and action Develop guidelines, advice and standards, particularly education Influence and set research priorities

 

Table 16: Element 5 – Planning

Rationale	Effective planning is essential to coordinate strategies and implementation, identify and apply resources, ensure outcomes are measured and deliver improvement
Proposed approach	Resource the national coordinating centre for antimicrobial resistance strategy to undertake appropriate planning
Stage 1	Stage 2	Stage 3
Plan for Stage 2 Map ultimate program Scope and determine ultimate comprehensive program	Evaluate Plan for Stage 3 Plan for full system	Evaluate Set up international participation Be a One Health leader