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:
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.
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.
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)
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