5.4 Core surveillance system components as outlined by GLASS

For the rest of this section you will look at each of these core components of a national AMR surveillance system. Currently GLASS is focused on the surveillance of priority bacterial pathogens relating to human health (GLASS-AMR), although it is, over time, expanding into AMU and One Health surveillance.

• Surveillance sites collect clinical, microbiological and demographic data from patients. These are usually hospitals or out-patient health facilities with access to relevant laboratory support. There is no fixed number of surveillance sites that is needed for a National AMR surveillance system; there could be as few as one site, which might be appropriate in a small nation or if very limited funds are available. There could be 5 or 10 or 50 surveillance sites, depending on the size and diversity of the country and the resources available for running the surveillance program. There is no need for every hospital in the country to be contributing data to the AMR surveillance system – this is unlikely to be practically possible anyway.
• The primary function of a national reference laboratory is to promote good microbiology laboratory practice by compiling and disseminating standard methods to surveillance sites. It may also perform confirmatory testing and support surveillance sites by providing training. Different sectors may have their own national reference laboratories; for example in the UK, where this course was written, the national reference laboratory for healthcare-associated bacteria is the AMR and Healthcare Associated Infections (AMRHAI) laboratory, while the National Reference Laboratory for Food Microbiology monitors AMR in the food chain.
• The national coordinating centre (NCC) establishes and oversees the WHO’s Glass national surveillance system. It gathers AMR data from the surveillance sites and national reference laboratories and communicates this information to national policymakers and global surveillance systems. In many countries this is one of the roles of the AMR coordinating committee (AMRCC).

An example of a country utilising this approach in the animal health sector is Canada. AMC surveillance in animal health is accomplished through the mandatory reporting of antimicrobial sales data from members of the Canadian Animal Health Institute (CAHI), the trade association representing manufacturers and distributors of veterinary pharmaceuticals in Canada. The Canadian Integrated Program for Antimicrobial Resistance Surveillance (CIPARS) – which we will discuss in detail in Section 7 – also collects AMU and AMR data in animals through surveillance in the animal health sector.