Maggie Heginbothom, Public Health Wales

Hello. I’m Maggie Heginbotham. I’m a clinical scientist, and I work for Public Health Wales. I’m responsible for the day-to-day running of the Antimicrobial Resistance Programme Surveillance Unit. The unit carries out surveillance of antimicrobial resistance and antimicrobial usage and facilitates the annual National Antimicrobial Point Prevalence Survey for Wales. In 2008, all of the acute hospitals in Wales and the community hospitals with acute beds took part in a European Antimicrobial Point Prevalence Survey, which was organised by ESAC. The results of the point prevalence survey in Wales showed heterogeneity in prescribing between and within hospitals, and noncompliance with guidance for certain indications.

The point prevalence survey provided a tool to evaluate and target interventions to improve the quality of antimicrobial prescribing, and a means to assess the progress achieved through a repeated PPS. Since 2008, an annual National Antimicrobial Point Prevalence Survey has taken place, and has become an integral part of the Antimicrobial Stewardship Programme in Wales. In Wales, the point prevalence survey is undertaken annually on a day in November to mark European Antibiotic Awareness Day. Locally, antimicrobial pharmacists choose the day that best suites them, and they organise their pharmacy teams. Data is collected by ward pharmacists during daily ward rounds although some hospitals have moved to using a team of pharmacists to survey all of the wards.

The point prevalence survey data is collected on paper forms which are returned to Public Health Wales for electronic transcription, data analysis, and reporting. Public Health Wales provides refresher sessions on data collection for the pharmacists on request. Each year, the point prevalence survey has been expanded to collect more information on specific areas of interest, but the core data on drug, dose, duration, diagnosis, and indication remains the same. And so we are able to compare the base data for the current year with previous years. There are certain patient groups where patient numbers are low, and so information is limited. We carry out a point prevalence survey series collecting data on these patients on a single day each month for six months.

Point prevalence survey series have been carried out in paediatrics, neonates, and in intensive care. We publish and report, which includes a number of quality measures to inform and support antimicrobial stewardship. Some of the quality measures measure processes. For example, what’s the reason for the antimicrobial recorded in the patient notes? And what’s the stop-review date recorded? The other measures measure compliance to guidance. For example, the duration of surgical prophylaxis and the duration of treatment for infection. The point prevalence survey report provides an overview into prescribing practises at hospital and national level.

It supports our reports on antimicrobial usage in secondary care, and provides a baseline for local audit, and allows comparisons with other UK and European countries that use the same point prevalence survey format. The quality measures are published on the Public Health Wales website using a business intelligence tool which provides the user with interactive access to their data. An in-depth report is published, providing prescribing information for a number of diagnoses down to ward-level. The information is shared, and recommendations are make to our stakeholders at our bi-annual Antimicrobial Stewardship Forum and in an annual publication.