Editorial, /

On 9th November 2018, the first stakeholder meeting of the Joint Action on Antimicrobial Resistance and Healthcare-Associated Infections took place in Vienna to discuss a cross-sector and multi-level approach to tackle AMR and foster synergies to keep antibiotics working.

On behalf of Health First Europe, I had the pleasure in joining the round table debate on evidence-informed public health policies and practices to combat AMR and HCAI. The debate focused on the role of evidence, measurable indicators, and reliable data which are critical to foster public health policy and to gather the necessary political traction to trigger policies and social behaviour changes.

The latest data released from the ECDC estimates that about 33000 people die each year as a direct consequence of an infection due to bacteria resistant to antibiotics and that the burden of these infections is comparable to that of influenza, tuberculosis and HIV/AIDS combined. It also explains that 75% of the burden of disease is due to healthcare-associated infections (HAIs) and that reducing this through adequate infection prevention and control measures, as well as antibiotic stewardship, could be an achievable goal in healthcare settings.

Health First Europe believes that AMR policies need to ensure patient safety and keep future bacterial infections treatable. Effective AMR policy should address 2 main mechanisms:

  • Preventing the spread of (resistant) micro-organisms by effective infection control measures
  • Reducing inadequate prescription and inadequate use of antibiotics

Clear evidence and measurable indicators are the main enablers when raising awareness on these key priorities. Thereof, 24 months ago we launched the HFE Patient Safety Indicators project. Health First Europe has developed 11 policy indicators and carried out 3 steps of in-depth analysis of patient safety policy in 7 European countries (Italy, France, Belgium, Spain, Germany, Netherlands and UK). This analysis aimed to assess the implementation of the Council Recommendation on Patient Safety, including the prevention and control of health care associated infections (2009). The goal of the research was to achieve better standards on patient safety, and how to reduce the spread of antimicrobial resistance (AMR) and HAIs in Europe.

In order to have a clear understanding about information accessibility, HFE put itself in the shoes of citizens who are keen on learning more about the latest policies framework about safety, AMR, HAIs.

As shared during the round table, HFE mapping faced a shocking lack of evidence, widespread information, and access to data related to each country’s national policies on AMR, surveillance, screening programmes, training etc. As shown by the 24-month research, notwithstanding the fundamental right to safe treatment and healthcare for all, patient safety policies are far behind from being effectively and correctly implemented in Europe. Information provided by national health Ministries’ websites is incomplete, and national associations are not fully aware of all aspects of national policy on patient safety in their country.

Several initiatives to monitor the implementation of the One Health approach to combat AMR are already in place and many more will be carried out in the upcoming months under the coordination of the EU-JAMRAI. It is important to keep in mind that access to clear and consistent evidence needs to be a priority of any dissemination campaign. While AMR and HAI prevention requires everyone’s effort, I regret to admit there are many disparities in education and training courses of healthcare workers. Active engagement of both providers and patients is critical. A dedicated person, responsible for patient safety should exist in as many healthcare facilities as possible. In addition, patients must be more proactively involved in awareness trainings for HAIs, AMR and adverse events. European citizens are partially engaged in their healthcare pathway but lack a proper understanding for the potential that adverse events may affect not only them and their families but also the economics of the healthcare system in their country. Data on adverse events is not available and, unfortunately, harm to patients is chronically under-reported.

To make sure that tackling AMR and HAIs will turn from a high-level scientific debate to everyone’s concern and political priority, it is necessary to foster and make easily accessible:

  • Concrete data be used and understood by the large public and politicians;
  • Measurable indicators for screening programmes
  • Data on surveillance and reduction of HAIs.
  • Data on the consumption and correct use of all antibiotics
  • Data on the implementation and use of diagnostic tool term of costs, patient safety and efficiency to encourage a transparent uptake on RDT.

AMR is a public health emergency and – today is the time to act. Public awareness is still too low and behaviour changes take time to occur. The debate highlighted how all health stakeholders from patients to industries are willing to tackle AMR and to join their efforts to keep antibiotic working. Only by working together, i.e. hospitals, health centres and professionals, patient safety organisations, health insurance companies, and competent national, regional and local authorities – is it possible to implement effective patient safety policies to reduce the spread of AMR and ensure the highest standards of care in Europe in any healthcare facilities.

Learn more about the NEW HFE Patient Safety Indicators Report.


Melina Raso

HFE Executive Director