AMR surveillance and you

Introduction

Antimicrobial resistance (AMR) is a major global concern because drug-resistant infections can kill, spread to others, and impose huge costs on individuals and society. In order to tackle this problem we first need to understand it; we can do this by collecting and sharing high-quality data that is relevant to AMR through systematic surveillance.

Surveillance data relating to AMR means that trends in resistance and antimicrobial use can be monitored and used to make better decisions to help tackle the AMR crisis. If you are involved in any activities related to AMR, you are likely to be contributing to AMR surveillance even if this role is not specifically part of your job description. Even if it’s not in your job title, you are an ‘AMR surveillance professional’.

Approaches to AMR surveillance will be covered in the modules An introduction to surveillance, Introducing AMR surveillance systems, An overview of national AMR surveillance and AMR surveillance in animals. As an AMR surveillance professional, you have a key role to play in this surveillance process, whether it is in collecting, analysing or interpreting data, or in using the data to develop new policies and practices.

The aim of Tackling antimicrobial resistance is to help you to identify, develop and apply skills and knowledge relevant to your role in order to change and improve your working practice and the practice of people that you work with. The course’s main focus is AMR surveillance and the course materials are suitable for individuals who have a role in AMR surveillance programmes. However, even if you do not currently have a defined role in an AMR surveillance programme, you may (as noted above) be part of a surveillance system; for example, if you work in a laboratory that reports its results to a national system. And of course, everyone involved in healthcare has a role to play in reducing AMR, so you may find some of the materials in this course relevant to your work.

AMR surveillance and you is the first module in your study pathway. It is an opportunity for you to identify the skills and areas of knowledge that you need to develop for your role and to reflect on how your learning in the other modules can change your working practice in relation to AMR.

After completing this module, you will be able to:

• describe how antimicrobial resistance relates to your work
• understand what AMR knowledge and skills are required for your role
• identify areas where your knowledge and skills require development and plan a strategy to address these skills gaps
• know your responsibilities as a learner and the role that learning plays in your professional practice relating to AMR
• reflect on how your learning has changed your working practice relating to AMR.

1 About this course

Tackling antimicrobial resistance comprises 25 online modules. This module, AMR surveillance and you, is the first.

These online modules are delivered on the Fleming Fund’s OpenLearn Create site and include text, videos, diagrams, reflective activities, self-assessment questions and quizzes. Each module should take up to 6 hours to complete, but you can work through them at your own pace.

You do not need to study every module to complete the course. The modules that you chose to study, and the order that you chose to study them in, will depend on your role, the activities that you undertake and your personal learning goals. Activities 8 and 9 of this module will help you to identify your learning goals and select a recommended study pathway.

In each module there are numerous opportunities to check your learning, including interactive quizzes and activities to reflect on your learning. You will also have opportunities to reflect on how your learning on this course relates to your work.

At the end of each of the other modules in this course you will be awarded a digital badge. Digital badges are like a certificate: they demonstrate that you have gained a skill (Figure 1), or are evidence of your work and achievement on the module. You can download them and share them on your social media profiles on Facebook, Twitter or LinkedIn.

Figure 1 An example of a digital badge for a Fleming Fund module.

To be eligible for the digital badge you must read each page of a module and score 50% or more in the end-of-module quiz. For each quiz, you can have three attempts at the questions. If you get the answer right first time, you will get more marks than for a correct answer at the second or third attempt – so please be aware that it is possible to answer all the questions correctly but not achieve the 50% score to be eligible for a badge. If one of your answers is incorrect, you will receive helpful feedback and suggestions about how to work out the correct answer. When you have successfully achieved the completion criteria, you will receive an email notification that your badge has been awarded. Please note it can take up to 24 hours for a badge to be issued.

If you’re not successful in achieving 50% in the end-of-module quiz, after 24 hours you can try again, and come back as many times as you like.

At the end of this course you will be awarded a statement of participation. To be eligible, you must complete each module in a particular recommended study pathway. You can find out more about these pathways in Activity 9.

2 Introducing AMR surveillance

AMR surveillance is the ongoing collection, analysis, interpretation and dissemination of data related to AMR.

Globally, AMR surveillance provides early warnings about the spread of new resistant strains of bacteria, revealing trends and outbreaks of infection. AMR surveillance is critical to tackling AMR, since the data it yields can help to inform the best treatment and care (the right drug at the right dosage for the right amount of time) for humans or animals at a local level, even where it is not possible to test individually. At regional and national levels, surveillance data informs intervention priorities and helps to identify gaps in service delivery. At a national level, the data guides planning and resource allocation, and informs policies and responses to patterns and trends.

For countries supported by the Fleming Fund, most AMR surveillance is carried out using a sentinel site approach. In this approach, rather than collecting data from every healthcare facility or laboratory in the country, a selection of sites are used. Ideally, these sites are chosen because they can represent the population of the country as a whole. Data is gathered from a number of hospital sites and laboratories, and is collated for use as regional or national surveillance data (Figure 2).

Figure 2 The flow of AMR surveillance data.

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An image of an AMR surveillance network. Local hospital veterinary, food safety and environmental laboratories all gather samples. This research feeds into national policy, and national policies feed into global policy. Information flow goes from local to national to global, and feedback goes from global to national to local.

Figure 2 The flow of AMR surveillance data.

At the local level, a clinician, nurse, veterinarian or other AMR surveillance professional takes a sample and sends it to the laboratory to be tested. Laboratories routinely test samples to provide clinicians and veterinarians with information that is used to diagnose and treat infections (Figure 3), such as whether a bacterium is growing, what type of bacterium it is, and what drugs can be used to treat the infection.

Figure 3 The local AMR surveillance process.

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A flow chart, with arrows between a series of boxes and circles. The first box is labelled ‘Doctor, nurse veterinarian, farmer or other individual collecting the sample’. The next circle is labelled ‘Specimen’. The next box is labelled ‘Laboratory testing organism ID, antimicrobial susceptibility testing’. The next circle is labelled ‘Result’. The next box is labelled ‘Surveillance network’.There is an arrow going back from ‘Result’ to ‘Sampling’ that is labelled ‘Inform care: choice of antibiotics, further testing; informs local guidlines/policies’, and ‘Surveillance network’ has a note: ‘Uses data to inform regional/national policies’.

Figure 3 The local AMR surveillance process.

Local surveillance practice comprises the following broad task areas, all of which are critical for good quality data:

• collecting/receiving specimens, and logging specimen and relevant clinical information
• performing tests
• monitoring and documenting data
• interpreting data
• reporting and communicating the test results to the person submitting the test
• reporting and communicating the results/data beyond the laboratory – locally, nationally and globally.

These tasks are undertaken by professionals working together across different roles.

In the next section you will think more about how your role might relate to AMR surveillance.

3 Who is ‘the AMR surveillance professional’?

The responsibility for AMR surveillance is distributed across various professional roles – for example:

• clinicians, nurses and veterinarians collect samples and document the clinical information
• laboratory staff perform tests
• data scientists and epidemiologists analyse, interpret and report data
• senior managers and policy-makers use the data to develop policy and practice
• clinicians, veterinarians and pharmacists use the data to treat patients.

However, even if you do not have a specific, identifiable role in a surveillance programme, everyone involved in animal and human healthcare has a role to play in reducing AMR.

3.1 Communication between AMR surveillance professionals

Since the success of a surveillance system relies on many people working together across different roles, communication between these groups is crucial.

As an example, think about a group of musicians performing a piece of music. Each instrument has its own part that, when played alone, may sound like a series of notes without any melody. However, each member of the group contributes different parts of the piece, so that when they are all playing together their contributions add up to something better than their individual parts and the melody can be heard.

You can learn more about how your role relates to the roles of others in the AMR surveillance process in the modules Introducing AMR surveillance and Communicating AMR data to stakeholders.

Effective cross-team working within local teams is critical for the high-quality data needed for AMR surveillance. Think back to the analogy of the musicians: imagine that one member of the group has been given the wrong piece of music to play, or the performers all start playing at different times. How would the group sound? It is unlikely that their performance would sound very good. Likewise, every person in the AMR surveillance process contributes to the effectiveness of the system.

As you study Tackling antimicrobial resistance, you will see that AMR surveillance requires a One Health approach: the collaboration of multiple disciplines working locally, nationally and globally to achieve the optimal health of people, animals and the environment (Figure 5). You will learn more about this One Health approach in the module Introducing a One Health approach to AMR. Consequently, AMR surveillance that takes a One Health approach does not just require communication between those working in different roles in the human healthcare sector but also across different sectors.

Figure 5 The One Health approach to tackling AMR spans people working with animals, humans and the environment.

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A Venn diagram of three circles. The first circle is headed ‘Animal’, which covers lab managers, lab technicians, veterinarians, vet pharmacists, the director of vet services, the OIE, the ministry of agriculture and epidemiologists. The second circle is headed ‘Human’, which covers lab managers, lab technicians, clinicians, nurses, the head of hospital, the WHO, the ministry of health and epidemiologists. The third circle is headed ‘Environment’, which covers lab managers, lab technicians, veterinarians , the FAO and OIE, and the ministry of agriculture. The centre, where the three circles meet, is labelled ‘One Health’.

Figure 5 The One Health approach to tackling AMR spans people working with animals, humans and the environment.

4 The importance of learning as an AMR surveillance professional

For some people, being professional means being smartly dressed; for others, it means having advanced qualifications, being in a position of authority or supervising others. But being a professional is more than this: it is also about developing skills and competence in your chosen field.

Surveillance work must be expanded and updated as new AMR surveillance practices and techniques are developed. This means that AMR surveillance professionals need to continually expand their practice and make sure they have up-to-date knowledge about surveillance techniques and data interpretation. As an AMR surveillance professional, you should be committed to learning and developing new skills and knowledge through continuing professional learning (which is sometimes known as continuing professional development, or CPD).

You probably have already had experience of many different opportunities to learn in relation to your role as an AMR surveillance professional. Some of them may have been formal: lectures or classes at your school, college or university, for example. Others, like learning from one of your colleagues, may have been informal.

Professional learning is an opportunity to update your knowledge and skills, but it is only effective if it changes the way that you work. The modules in Tackling antimicrobial resistance will give you opportunities for learning related to your role as an AMR surveillance professional, but it is important that you realise that professional learning is about bringing together this theory with your own practical experience. One way to bring together learning and practical experience is through reflection.

4.1 Reflection in professional learning

Reflection is the process of thinking about how you work and why you do things in a particular way. It is an important part of professional learning and an essential part of developing new skills. It allows you to analyse what you have learned and how it impacts on your role. There are lots of models of reflection, and key features include the following:

• Reflection results in learning; that is, changing ideas and your understanding of a situation.
• It is an active process that involves not just thinking about what you do at work but why you do things in a particular way and whether it would be better to change what you do or how work is organised.
• It is a cyclical rather than linear process, leading to the development of new ideas that are then used to plan how you will work in the future.
• As you reflect, you should look at issues from different perspectives. This helps you to understand the problem and scrutinise your own values, assumptions and perspective.

For some people, reflection is a very natural process; but for many of us, it is a skill that has to be learned and developed. Activity 5 gives you an opportunity to try some basic reflection.

5 Identifying your goals and planning your study

Research shows that professional learning is most effective when it is planned as a high-level aim and then broken down into smaller, manageable goals.

Before you undertake any professional learning, you need to plan what you will do to make sure that it meets your learning needs. Developing a clear plan will help you to manage your professional learning. This means that you need to:

• identify the skills and knowledge you need
• set your goals
• decide what you need to do to achieve these goals.

The activities in this section will guide you through these steps.

The final stages of this process are to reflect on whether the actions that you have taken have contributed to you achieving your goals and to identify any further actions that you need to take. The final section of this module will help you to do this.

5.1 Identifying the skills required for your role

5.2 Assessing your skills

Reflective practice is very important: it is something that should be (or become) second nature to you in your work. To allow you to record your progress through the course, you will have access to a personal reflective blog space where you can note your thoughts and reflections about your learning. This is personal to you, and nobody else can see it, so you can be as honest as you like! You will be prompted to make an entry in your blog at the end of each module. Each time you will be asked to make notes on the following:

• What is the single most important lesson that you have taken away from this module?
• How relevant is it to your work?
• Can you suggest ways in which this new knowledge can benefit your practice?

Now complete the questions below, which assess your confidence about various aspects of AMR. When you have finished, go to your reflective blog  and start to note down your thoughts

5.3 Setting your learning goals

5.4 Planning your study

You are almost ready to start studying the modules in this course! As you study them, you should return to this module to record your progress towards your learning goals. Before you leave AMR surveillance and you to continue your learning, read Section 6, ‘Bringing it all together’.

6 Bringing it all together

This information is unavailable for now. You can check back here to find out the information you need about pathways.

7 Your experience of this course

This information is unavailable for now. You can check back here to find out the information you need about pathways.

Acknowledgements

Acknowledgements

This free course was written by Rachel McMullan and reviewed by Hilary MacQueen, Allison Littlejohn (Knowledge Lab, University College London), Claire Gordon and Natalie Moyen.

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The material acknowledged below is Proprietary and used under licence (not subject to Creative Commons Licence). Grateful acknowledgement is made to the following sources for permission to reproduce material in this free course:

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