WHO COMPETENCY FRAMEWORK FOR HEALTH WORKERS’ EDUCATION AND TRAINING ON ANTIMICROBIAL RESISTANCE

WHO COMPETENCY FRAMEWORK FOR HEALTH WORKERS’ EDUCATION AND TRAINING ON ANTIMICROBIAL RESISTANCE

WHO/HIS/HWF/AMR/2018.1

© World Health Organization 2018

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iii

Contents

Foreword . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . iv

Acknowledgements . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . v

Abbreviations and acronyms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . vii

Executive summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . viii

Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

Objectives and application of the AMR competency framework . . . . . . . . 2

Methods . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3

Structure of the AMR competency framework . . . . . . . . . . . . . . . . . . . . . 4

Statement of shared goal . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5

Table 1. AMR competency framework . . . . . . . . . . . . . . . . . . . . . . . . . . . 6

Glossary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14

References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15

James Campbell DirectorHealth Workforce Department

Marc SprengerDirectorAMR Secretariat

iv

Foreword

Antimicrobial resistance (AMR) represents a major health and socioeconomic threat, with the potential for devastating consequences to the health of millions of people globally if concrete steps are not taken to address it. The appropriate use of antimicrobial medicines for preventive and curative measures is vital to ensure continued success with common and complex medical interventions, and to slow or reverse the progress of resistance. Since the adoption of the WHO Global Action Plan on Antimicrobial Resistance by Member States in May 2015, remarkable progress has been made by all stakeholders to ensure that AMR is getting the attention it deserves and is a priority on the health action agenda in countries. Global programmes and events, such as the World Antibiotics Awareness Week, continue to help raise public awareness and understanding to scale up action.

The misuse and overuse of antimicrobials in human medicine and food production have contributed to the increase in the prevalence of AMR. In the human health sector, a major reason given by health workers and students for the misuse of antimicrobials is the lack of understanding and adequate expertise to address AMR. A key approach to address this challenge and ensure the appropriate use of antimicrobials is to ensure that health workers acquire, through their education and training, the competencies required to prevent and combat AMR, as stated in the first objective of the WHO Global Action Plan on AMR. Although most countries have a national action plan to address AMR, the variability in quality and uneven coverage of initiatives to strengthen education and training of health workers on AMR require a standardization of educational resources for AMR that reflects global evidence and best practices but can be adapted locally. Education and training capacity and resources are currently known to differ markedly across regions and settings. This WHO competency framework for education on AMR is strategic and timely, given the widespread perception among health workers of insufficient knowledge and expertise on the topic, resulting in inappropriate antimicrobial prescription and use practices. This competency framework is intended to serve as a reference for academic institutions, educators, accreditation bodies, regulatory agencies and other users to help ensure that pre-service education and in-service training equip health workers with the requisite competencies to address AMR. It complements other relevant existing WHO guidance on AMR and lays the foundation for the development of more in-depth educational resources and AMR curricula.

v

Acknowledgements

The development of the WHO competency framework for health workers’ education and training on antimicrobial resistance was coordinated by the WHO Health Workforce Department and the AMR Secretariat with inputs from the Service Delivery and Safety and Essential Medicines and Health Products departments. The following WHO staff were responsible for coordinating the development of the document: Onyema Ajuebor, James Campbell, Giorgio Cometto (Health Workforce Department); Marcus Sprenger, Elizabeth Tayler (AMR Secretariat). WHO staff from other departments also provided contributions: Nicola Magrini, Lorenzo Moja, Ingrid Smith (Essential Medicines and Health Products Department); Sergey Eremin, Breeda Hickey, Karen Mah (AMR Secretariat); Benedetta Allegranzi, Hiroki Saito, Sara Marie Tomczyk (Service Delivery and Safety Department); Andreas Reis (Information, Evidence and Research Department); Saskia Andrea Nahrgang, Danilo Lo Fo Wong (WHO Regional Office for Europe); Klara Tisocki (WHO South-East Asia Regional Office). Administrative assistance was provided by Beatrice Wamutitu (Health Workforce Department). The following WHO interns provided review support: Yumi Ishikawa (Health Workforce Department); Johannes Koehler (Information, Evidence and Research Department); Martin Plymoth (AMR Secretariat).

WHO is grateful to the following individuals for preparing the mapping analysis of AMR educational tools and resources ahead of the WHO expert consultation meeting on health workforce and AMR education held 23–24 March 2017: Steven Hoffman, Sara Jones, Susan Rogers Van Katwyk (Global Strategy Lab, University of Ottawa).

All participants at the WHO expert consultation meeting on 23–24 March 2017 are also acknowledged for their contribution to the conceptualization of the competency framework, the identification of relevant competencies, and for providing quality assurance and feedback on earlier drafts of the document: Israel Bimpe (International Pharmaceutical Students’ Federation), Edith Blondel-Hill (Interior Health Authority, British Columbia), Joana Carrasqueira (International Pharmaceutical Federation), Enrique Castro-Sánchez (Imperial College London), Sabiha Essack (University of Kwazulu-Natal, South Africa), Siobhan Fitzpatrick (World Federation of Medical Education), Lindsay Grayson (University of Melbourne and Monash University), Lauri Hicks (Centers for Disease Control and Prevention, Atlanta), Steven Hoffman (Global Strategy Lab, University of Ottawa), Alison Holmes (Imperial College London), Bijie Hu (Zhongshan Hospital of Fudan University), Frances Hughes (International Council of Nurses), Benedikt Huttner (University of Geneva Hospitals), Kumud Kumar Kafle (Tribhuvan University & Alliance for the Prudent Use of Antibiotics, Nepal), Zuzana Kusynova (International Pharmaceutical Federation), Gabriel Levy-Hara (Hospital Carlos G Durand, Argentina), Caline Mattar (Junior Doctors Network/World Medical Association), Marc Mendelson (University of Cape Town, South Africa), Dilip Nathwani (University of Dundee & British Society for Antimicrobial Chemotherapy), Leonardo Pagani (General Hospital of Bolzano, Italy & European Society of Clinical Microbiology and Infectious Disease), Barbara Potter (Public Health Agency of Canada), Céline Pulcini (Université de Lorraine, France), Susan Rogers Van Katwyk (Global Strategy Lab, University of Ottawa), Susie Sanderson (British Dental Association), Nandini Shetty (Public Health England), Neil Squires (Public Health England), Julia Tainijoki-Seyer (World Medical Association), Karin Thursky (National Centre for Antimicrobial Stewardship, University of Melbourne, Australia), Priit Tohver (International Federation of Medical Students’ Associations).

vi

WHO is also grateful to all individuals, partners and institutions involved in the consultation reviews at the various stages of development of this tool: Bojana Beović (University Medical Centre Ljubljana), Kelly Cairns (Alfred Health, Australia), Maciej Piotr Chlebicki (Singapore General Hospital, Singapore), Aubrey Clark, Jude Nwokike, Farouk Umaru (United States Pharmacopeial Convention), Oliver Dyar (Karolinska Institutet), Linus Ndegwa (Centers for Disease Control and Prevention, Kenya), Douglas Slain (West Virginia University, United States of America), Jorgen Stassijns (Institute of Tropical Medicine, Antwerp, Belgium), Evelina Tacconelli (University Hospital of Tübingen, Germany & European Society of Clinical Microbiology and Infectious Disease), Adrian M Viens (Centre for Health Ethics and Law, University of Southampton), Agnes Wechsler-Fördös (Hospital Rudolfstiftung Vienna & Alliance for the Prudent Use of Antibiotics, Austria).

WHO is grateful to the governments of Japan and the Federal Republic of Germany for their financial contributions to this project.

vii

Abbreviations and acronyms

AMR antimicrobial resistance

AMR GAP Global Action Plan on Antimicrobial Resistance (WHO)

AWaRE access, watch and reserve

EML/EMLc WHO Model List of Essential Medicines/for Children

GReVP good review practices

HAI health care-associated infection

IPC infection prevention and control

MDR multidrug-resistant

SDGs Sustainable Development Goals

WASH water, sanitation and hygiene

WHO World Health Organization

viii

Executive summary

In 2015, the World Health Organization (WHO) launched the global action plan to fight antimicrobial resistance (AMR). The first objective of the plan calls for measures to improve health workers’ education and training on AMR.

This WHO competency framework for health workers’ education and training on AMR provides foundational normative guidance to help countries ensure that health workers are properly equipped with the competencies they need to combat the spread of AMR. Target users of this document include pre-service and in-service health education and training institutions; accreditation and licensing bodies; and health policy- and decision-making authorities.

The framework is configured in a tabular matrix format, containing core and additional AMR competencies, which have been organized across four domain areas and four categories of health workers. The domain areas include: foundations that build awareness of antimicrobial resistance, appropriate use of antimicrobial agents, infection prevention and control (IPC), and diagnostic stewardship and surveillance. The four categories of health worker groupings identify competencies that are required for: all health workers, prescribers, non-prescribers and public health officers/health services managers. This framework provides users with a reference tool to guide the analysis, framing and adaptation of locally relevant education and training materials on AMR.

WHO COMPETENCY FRAMEWORK FOR HEALTH WORKERS’ EDUCATION AND TRAINING ON ANTIMICROBIAL RESISTANCE

1

Introduction

Addressing the issue of antimicrobial resistance is critical to achieving the Sustainable Development Goals (SDGs). Antimicrobial resistance is a significant public health and environmental threat. Left unchecked, common infections and minor injuries could once again become frequent killers. The scale of the AMR threat is such that no single country is free from its health and socioeconomic impact: efforts to tackle the problem will require collaboration across national and continental boundaries. AMR occurs when microbes become resistant to medicines to which they were initially susceptible. This risk is fuelled by the reduced availability of new and effective antimicrobials to treat resistant microbes (1,2). The development of drug-resistance applies to antimicrobials for a wide variety of diseases, including, among others, HIV and tuberculosis.

Globally, major gaps still exist in knowledge and awareness of AMR, as well as in the availability of quality technical resources to address the challenge (3–6). In the case of health workers, a variety of factors can result in the misuse or overuse of antimicrobials, including: a lack of knowledge or up-to-date information, inability to identify the type of infection, yielding to patient pressure to prescribe antibiotics, and a preponderance of situations that allow for financial benefit from the supply of medicines. Inadequate hygiene, sanitation in community settings and IPC measures in health facilities also facilitate the spread of infections and increase the use of antimicrobials (7). Measures to tackle these challenges through a collaboration of various stakeholders are required to avert the increasing occurrence of resistance, particularly in resource-constrained settings (8). To address this challenge, the first objective of the WHO Global Action Plan on Antimicrobial Resistance (AMR GAP) calls for raising awareness and educating and training health workers to improve antimicrobial prescribing and dispensing behaviours (9). On a similar policy level, the Global Strategy on Human Resources for Health: Workforce 2030 (10) complements the AMR GAP by offering policy guidance options on broader policies and approaches to optimize health worker education and training. WHO’s role in collating and making available AMR education and training resources is crucial to support educators, decision-makers and health policy planners in implementing effective policies to guide actions on AMR control (11).

2

Objectives and application of the AMR competency frameworkThe main purpose of this document is to strengthen efforts at the country level to address AMR by outlining a set of core and additional competencies to guide the education and training of health workers.

The competency framework serves as a reference tool to be applied according to local priorities and needs. Given the comprehensive nature and interprofessional structure of the competency framework, certain competencies outlined in this document may not apply to some settings or work environments, depending on factors such as the availability of health workers with an advanced training or technological capacity. For users in such settings, the framework provides for a selective approach to implementation whilst allowing for scale up of health worker competencies whenever additional needs are identified and resources made available. The AMR competency framework is not a scope of practice for specific occupational groups and should not be interpreted as such; rather, the competencies that it identifies should be interpreted and applied in the context of the defined roles and responsibilities in a specific jurisdiction, according to local regulations and practices.

The competency framework is aimed primarily at pre-service and in-service health education and training institutions, accreditation and regulatory bodies and health policy- and decision-making authorities. It is structured to benefit all health workers, including both prescribers and non-prescribers of antimicrobials. It also includes public health and health services managers who lead institutions or have roles that influence decision- and policy-making to deliver AMR-related education and training, or have broader responsibilities through health services management and public health regulations with a bearing on antimicrobial prescription and use practices. The competency framework may be used to plan for AMR skills auditing and strengthening, and optimization of antimicrobial stewardship roles or functions.

WHO COMPETENCY FRAMEWORK FOR HEALTH WORKERS’ EDUCATION AND TRAINING ON ANTIMICROBIAL RESISTANCE

3

Methods

The development of this AMR competency framework has evolved through a combination of a review of AMR competencies obtained from a mapping of education and training resources around the world (12), and a series of refinement steps conducted through consultation exercises with a WHO expert consultation group (13), other AMR research topic experts and key health professional associations.

Building on the first objective of the WHO Global Action Plan on AMR, an informal meeting was held in March 2016 between WHO and health professional associations to describe the needs and challenges health workers face in addressing AMR (14). One of the outcomes from the meeting was an agreement to map existing AMR-related educational resources in order to identify currently available resources, provide information on needs and propose ways to address the gaps. A draft version of the AMR-education mapping report was subsequently prepared, serving as the main background document for the WHO expert consultation meeting on AMR and health workforce education and training held in March 2017.

Key findings of the report revealed a variance across settings in the availability, comprehensiveness, quality, standards and accessibility of currently available tools to address AMR education and training. The mapping report also highlighted best practice models to build upon (15). A recommendation was then made by the group on the basis of these findings to develop a global competency framework for AMR as part of measures to help address the situation of AMR education and training.

In developing the core material, evidence and guidance was extracted from the literature related to competency frameworks on appropriate prescribing and other AMR-related competency domains (16–29). The framework is adapted for human health and is holistic in approach as it brings together the different domains in complementary technical areas such as IPC, diagnostic stewardship and surveillance, leadership, and awareness and appropriate use of antimicrobials. It also features references to recent complementary policy frameworks on the appropriate use of antibiotics such as the AWaRE categorization described in the 2017 WHO Model List of Essential Medicines/for Children (EML/EMLc) (30). The WHO AWaRE system groups antibiotics into three categories – ACCESS, WATCH and RESERVE. The ACCESS group includes antibiotics recommended as empiric, first or second choice treatment options for common infectious syndromes and are listed in the EML/EMLc with the syndromes for which they are recommended. The WATCH group includes antibiotic classes that are considered generally to have higher resistance potential and that are still recommended as first or second choice treatments but for a limited number of indications. The RESERVE group includes antibiotics that should be treated as “last resort” options, or tailored to highly specific patients and settings, and when other alternatives would be inadequate or have already failed (e.g. serious life-threatening infections due to multi-drug resistant bacteria). The aim is to enhance treatment outcomes, reduce the development of drug-resistant bacteria, and preserve the effectiveness of “last resort” antibiotics by ensuring that the right antibiotics are available and prescribed for the right infections.

4

Structure of the AMR competency framework

The AMR competency framework is a tabular matrix of the AMR domains, health worker categories and the competencies (the knowledge, skills and attitudes) necessary to effectively address AMR in practice settings. The framework is organized across four broad categories of health workers and four domains of AMR-related competencies. For the purpose of this framework, the competencies are broadly divided into two types – core and additional. The core competencies are the essential knowledge, skills attitudes that a health worker in a particular category is expected to have. The additional competencies (see italic text in Table 1) are the desirable knowledge skills and attitudes that a health worker may have, depending on factors such as need, relevance to practice setting, and the availability of required resources and capacity to utilize the competency.

The framework adopts an interprofessional approach based on the principle that addressing AMR requires a shared understanding, and effective collaboration and communication among health workers. Given that a number of different health workers are involved in the sequence of events and scenarios leading to the prescription and use of antimicrobials, the categorization of health workers has been structured to reflect, in a comprehensive manner, the most significant roles impacting antimicrobial prescription and use.

As AMR is a complex public health and environmental issue, a systems approach combined with population and patient-centred strategies (including behavioural change elements) are vital to achieve the objectives of the competency framework. Essential competencies in cross-cutting areas, such as leadership, communication, law and ethics, are also important for adequately understanding, monitoring and responding to AMR. Where relevant, these competencies are embedded within related areas of the framework. A glossary is attached to help guide understanding, implementation and application.

WHO COMPETENCY FRAMEWORK FOR HEALTH WORKERS’ EDUCATION AND TRAINING ON ANTIMICROBIAL RESISTANCE

5

Statement of shared goal

Maintaining a shared commitment to address AMR and protect patients in practice settings can enhance action by health policy-makers and promote collaboration among health workers. The AMR competency framework provides foundational guidance that can be adapted to different health care and resource contexts to foster appropriate prescribing and other AMR-related competencies. The use of the competency framework in health worker education and training should be grounded in a shared commitment by all stakeholders, including health workers. Such commitments may be ingrained in practice through the use of joint vision statements, as exemplified in Box 1. Similar statements, adapted to local settings, may be used in national advocacy and communication activities to support the inclusion of relevant AMR elements in educational curricula or licensing and regulatory mechanisms to ensure greater compliance and a culture of collective responsibility.

Box 1.Sample joint vision statement for fighting AMR

We, the health care workers, accept the responsibility to improve patient care and health outcomes by protecting against the emergence and spread of antimicrobial resistance for patients and society, now and in the future. We shall achieve this goal by acquiring and maintaining the competencies related to AMR control including through improving leadership, awareness, knowledge, skills, attitudes and behavioural change regarding the appropriate prescription, dispensing and use of antimicrobials, and implementing better infection prevention and control and diagnostic stewardship.

6

Antim

icrob

ial r

esist

ance

do

mai

nsa

Cate

gory

1: A

ll he

alth

wor

kers

bCa

tego

ry 2:

Pre

scrib

ersc

Cate

gory

3: N

on-p

resc

riber

sd Ca

tego

ry 4:

Pub

lic h

ealth

office

rs/

heal

th se

rvice

s man

ager

se

Nurs

esPh

arm

acist

sLa

bora

tory

scie

ntist

s/te

chni

cians

Foun

datio

ns th

at

build

awar

enes

s of

antim

icrob

ial

resis

tanc

e Co

mpe

tenc

y sta

tem

ent:

Healt

h wor

ker d

emon

strat

es

that

they

have

the k

nowl

edge

an

d awa

rene

ss of

effec

tive

appr

oach

es to

cont

rol A

MR,

an

d has

the s

kills/

attit

udes

to

imple

men

t cha

nge a

ccord

ing

to ro

le an

d lev

el of

train

ing.

Rele

vanc

e: H

igh

Know

ledg

e:1.

Unde

rstan

d the

deve

lopm

ent a

nd

main

caus

es of

AMR.

2.

Unde

rstan

d the

basic

princ

iples

of

infec

tion p

reve

ntion

and c

ontro

l, i.e

. han

d hyg

iene t

o pre

vent

tra

nsm

ission

of in

fectio

ns.

3. Un

derst

and t

he im

pact

of re

sista

nce o

n cho

ice of

an

timicr

obial

ther

apy f

or tr

eatin

g inf

ectio

ns.

4. Un

derst

and t

he m

orbid

ity,

mor

talit

y and

econ

omic

thre

at of

AM

R to h

uman

healt

h.5.

Know

the i

mpo

rtanc

e of

optim

izing

use o

f ant

imicr

obial

s in

the h

uman

and a

nimal

secto

rs to

prev

ent d

evelo

pmen

t of

resis

tanc

e.

Skill

s:1.

Abilit

y to i

nter

pret

and

com

mun

icate

the u

se of

ap

prop

riate

polic

y guid

eline

s on

AMR.

Attit

udes

:1.

Prom

ote a

ware

ness

of AM

R and

ap

prop

riate

antim

icrob

ial us

e am

ongs

t all h

ealth

care

wor

kers,

pa

tient

com

mun

ities

and t

he

gene

ral p

ublic

.2.

Act t

o pro

tect

the e

ffecti

vene

ss of

antim

icrob

ials a

s an e

thica

l im

pera

tive a

nd a

publi

c goo

d.

Rele

vanc

e: H

igh

Know

ledg

e:

1. Un

derst

and t

he im

porta

nce o

f an

timicr

obial

choic

e, do

sage

, int

erva

l, dur

ation

, pre

para

tion a

nd

adm

inistr

ation

of an

timicr

obial

s. 2.

Know

the p

rincip

les of

m

icrob

iolog

y in i

dent

ifying

pa

thog

ens f

rom

clini

cal s

ample

s.3.

Know

the b

asic

diagn

ostic

role

of

the m

icrob

iolog

y lab

orat

ory.

4. Un

derst

and l

ocal

AMR

epide

miol

ogy,

resis

tanc

e and

su

scept

ibilit

y pat

tern

s and

use o

f gu

idelin

es.

5. Pa

tient

coun

sellin

g etiq

uette

s, dis

cussi

on te

chniq

ues a

nd

psyc

holog

y for

patie

nt

com

mun

icatio

n.6.

Unde

rstan

d the

princ

iples

of

empir

ic, sy

ndro

mic

or cu

lture-

base

d tre

atm

ent o

ption

s in r

elatio

n to t

he

selec

tion o

f ant

imicr

obial

s.

Skill

s:1.

Appr

opria

te us

e of a

ntim

icrob

ials

to tr

eat a

nd/o

r pre

vent

com

mon

inf

ectio

ns an

d syn

drom

es.

2. Ab

ility t

o com

mun

icate

with

pa

tient

s on t

he ap

prop

riate

use o

f an

tibiot

ics.

3. Ab

ility t

o coll

ect m

icrob

iolog

y sa

mple

s.

Attit

udes

:1.

Prom

ote a

stan

dard

for t

he

appr

opria

te us

e of a

ntim

icrob

ials

and m

anag

e pat

ient e

xpec

tatio

ns

and d

eman

ds es

pecia

lly w

hen

the u

se of

antim

icrob

ials i

s not

ind

icate

d.

Rele

vanc

e: H

igh

Know

ledg

e:1.

Unde

rstan

d the

role

of be

dside

nursi

ng in

an

timicr

obial

stew

ards

hip

prog

ram

mes

.

Skill

s:1.

Asse

ss th

e sou

rce of

infec

tion

and i

dent

ify ap

prop

riate

m

easu

res.

2. Ob

tain

aller

gy hi

story,

pe

rform

med

icatio

n re

conc

iliatio

n, an

d rec

ord t

his

in th

e med

ical re

cord

.

Attit

udes

:1.

Cont

ribut

e to a

patie

nt-

cent

red f

ocus

in th

e clin

ical

team

, and

mon

itor a

nd

com

mun

icate

daily

patie

nt

prog

ress.

2. Co

ntrib

ute t

o pub

lic he

alth

liter

acy a

nd ge

nera

l adv

ocac

y on

the i

mpo

rtanc

e of

infec

tion p

reve

ntion

.

Rele

vanc

e: H

igh

Know

ledg

e:1.

Unde

rstan

d the

sign

ifica

nce

of an

timicr

obial

choic

e, do

sage

, dur

ation

and

prep

arat

ion in

the t

reat

men

t of

infec

tions

.

Skill

s:1.

Advis

e pat

ients

and

pres

cribe

rs on

the a

ppro

priat

e us

e of a

ntim

icrob

ials.

2. Pr

actis

e safe

disp

osal

of

unus

ed an

timicr

obial

m

edici

nes.

Attit

udes

:1.

Advo

cate

for p

atien

t safe

ty

and c

ompli

ance

in th

e pr

escri

ption

and u

se of

an

timicr

obial

s in c

ompli

ance

wi

th fo

rmula

ry pr

otoc

ols.

2. Cr

itica

lly as

sess

infor

mat

ion

and p

harm

aceu

tical

prod

ucts

as pa

rt of

good

proc

urem

ent

prac

tices

.

Rele

vanc

e: H

igh

Know

ledg

e:

1. Un

derst

and t

he di

agno

stic

role

of th

e micr

obiol

ogy

labor

ator

y in d

etec

ting

infec

tions

, resis

tanc

e pa

ttern

s, gu

iding

patie

nt

man

agem

ent a

nd in

form

ing

AMR c

ontro

l stra

tegie

s.

Skill

s:1.

Colle

ct an

d rep

ort d

ata o

n an

timicr

obial

prod

uct q

ualit

y an

d sen

sitivi

ty to

natio

nal

drug

regis

tratio

n bod

ies.

2. Ad

vise p

rescr

ibers

on co

rrect

micr

obiol

ogica

l tes

ting

proc

edur

es.

3. Ab

ility t

o car

ry ou

t bac

terial

iso

lation

, iden

tifica

tion,

susce

ptibi

lity t

estin

g and

rep

ortin

g.4.

Prov

ide fa

cility

-spec

ific

cumu

lative

susce

ptibi

lity

repor

ts for

com

mon

bacte

rial

path

ogen

s aga

inst a

ntibi

otics

th

at ar

e rec

omm

ende

d in t

he

local

or na

tiona

l guid

eline

s.5.

Gene

rate

profi

les of

an

timicr

obial

resis

tanc

e for

iden

tified

antim

icrob

ial

micr

oorg

anism

for p

ublic

he

alth d

ecisi

on-m

aking

.

Attit

udes

:1.

Advo

cate

for a

nd co

mply

wi

th la

bora

tory

and p

ublic

he

alth g

uideli

nes r

egar

ding

antim

icrob

ial su

scept

ibilit

y te

sting

.

Rele

vanc

e: H

igh

Know

ledg

e:1.

Unde

rstan

d the

use o

f qua

lity

impr

ovem

ent f

ram

ewor

ks to

ad

dres

s gap

s in A

MR e

duca

tion.

2. Un

derst

and t

he po

tent

ial fo

r co

st sa

vings

and h

ealth

gains

as

socia

ted w

ith eff

ectiv

e inf

ectio

n con

trol a

nd ap

prop

riate

an

timicr

obial

use.

3. Un

derst

and t

he ro

les an

d res

pons

ibilit

ies of

diffe

rent

stake

holde

rs in

antim

icrob

ial

stewa

rdsh

ip tea

ms.

Mem

bers

of th

e tea

m co

uld in

clude

, but

ar

e not

limite

d to,

the r

oles o

f ph

ysici

ans,

phar

mac

ists,

infec

tion

prev

entio

nists,

micr

obiol

ogist

s, nu

rses a

nd ho

spita

l adm

inistr

ator

s or

othe

rs.

Skill

s:1.

Abilit

y to d

eter

mine

and

imple

men

t bes

t app

roac

hes

to an

timicr

obial

stew

ards

hip

inter

vent

ions o

n the

basis

of

cont

ext.

2. Ab

ility t

o car

ry ou

t res

ource

all

ocat

ion to

imple

men

t and

su

stain

antim

icrob

ial st

ewar

dship

pr

ogra

mm

es.

3. De

velop

polic

y adv

ocac

y and

en

force

men

t to m

anag

e AM

R pr

ogra

mm

es.

Attit

udes

:1.

Prom

ote A

MR a

ware

ness

at he

alth

syste

m, h

ospit

al an

d com

mun

ity

levels

.

Table

1. AM

R com

pete

ncy f

ram

ewor

k

WHO COMPETENCY FRAMEWORK FOR HEALTH WORKERS’ EDUCATION AND TRAINING ON ANTIMICROBIAL RESISTANCE

7

a This

fram

ewor

k assu

mes

that

know

ledge

cont

ents

are s

imila

r for

pre-

serv

ice ed

ucat

ion an

d in-

serv

ice tr

aining

thou

gh em

phas

is sh

ifts t

o im

prov

ing sk

ills an

d atti

tude

s for

in-se

rvice

train

ing.

b Den

otes

the b

asic

AMR c

ompe

tenc

ies th

at al

l hea

lth ca

re w

orke

rs sh

ould

have

. c In

clude

s med

ical d

octo

rs an

d den

tists.

Not

e tha

t pha

rmac

ists,

nurse

s and

midw

ives a

nd ot

her h

ealth

care

wor

kers

are a

lso in

clude

d in t

his ca

tego

ry in

setti

ngs w

here

they

are a

llowe

d to p

rescr

ibe an

timicr

obial

s by r

egula

tion.

The e

xten

t to

whic

h the

pres

cribin

g com

pete

ncies

are r

eleva

nt to

the d

iffer

ent c

adre

s may

vary

acco

rding

to sc

opes

of pr

actic

e and

loca

l regu

lation

.d N

on-p

rescr

ibers

includ

e hea

lth w

orke

rs th

at ar

e not

allow

ed by

regu

lation

to pr

escri

be an

timicr

obial

s. (N

ote t

hat i

n som

e set

tings

, pha

rmac

ists,

nurse

s and

midw

ives a

re al

lowed

by re

gulat

ion to

pres

cribe

antim

icrob

ials.)

e This

cate

gory

may

inclu

de pe

rsonn

el fro

m th

e pre

scribi

ng an

d non

-pre

scribi

ng oc

cupa

tiona

l gro

ups w

ho ha

ve a

leade

rship

role

or au

thor

ity in

man

aging

AMR c

ontro

l.

Antim

icrob

ial r

esist

ance

do

mai

nsa

Cate

gory

1: A

ll he

alth

wor

kers

bCa

tego

ry 2:

Pre

scrib

ersc

Cate

gory

3: N

on-p

resc

riber

sd Ca

tego

ry 4:

Pub

lic h

ealth

office

rs/

heal

th se

rvice

s man

ager

se

Nurs

esPh

arm

acist

sLa

bora

tory

scie

ntist

s/te

chni

cians

Foun

datio

ns th

at

build

awar

enes

s of

antim

icrob

ial

resis

tanc

e

2. Ac

cord

ing to

setti

ngs a

nd w

here

ap

prop

riate

, enc

oura

ge ad

here

nce

to an

timicr

obial

form

ulary

/pr

otoc

ol re

strict

ions.

3. Un

derst

and b

asic

princ

iples

of

beha

viour

chan

ge in

the c

onte

xt

of pr

escri

bing a

ntim

icrob

ials a

nd

mod

el go

od pr

escri

bing b

ehav

iour

to co

lleag

ues.

2. Es

tabli

sh an

d enf

orce

com

plian

ce

with

antim

icrob

ial fo

rmula

ry/

prot

ocol

restr

iction

s at l

ocal

and n

ation

al lev

els ac

cord

ing to

co

untry

polic

ies.

3. To

geth

er w

ith ci

vil so

ciety,

ad

voca

te fo

r the

resp

onsib

le de

velop

men

t of n

ew

antim

icrob

ials a

nd en

sure

the

corre

ct pr

omot

ion of

exist

ing on

es.

8

Table

1. AM

R com

pete

ncy f

ram

ewor

k, co

ntinu

ed

Antim

icrob

ial r

esist

ance

do

mai

nsa

Cate

gory

1: A

ll he

alth

wor

kers

bCa

tego

ry 2:

Pre

scrib

ersc

Cate

gory

3: N

on-p

resc

riber

sd Ca

tego

ry 4:

Pub

lic h

ealth

office

rs/

heal

th se

rvice

s man

ager

se

Nurs

esPh

arm

acist

sLa

bora

tory

scie

ntist

s/te

chni

cians

Appr

opria

te u

se

of an

timicr

obia

l ag

ents

Com

pete

ncy s

tate

men

t: He

alth w

orke

r dem

onstr

ates

th

at th

ey ha

ve th

e kno

wled

ge

and u

nder

stand

ing, a

ccord

ing

to th

eir fie

ld an

d lev

el of

ex

perti

se, t

o fac

ilitat

e opt

imal

and s

afe us

e of a

ntim

icrob

ial

agen

ts fo

r man

agem

ent o

f inf

ectio

ns.

Rele

vanc

e: H

igh

Know

ledg

e:1.

Unde

rstan

d tha

t ant

imicr

obial

s ha

ve di

ffere

nt re

sista

nce p

oten

tial

(AW

aRE c

ateg

ories

). 2.

Unde

rstan

d the

spec

ific r

oles o

f ot

her h

ealth

care

wor

kers.

3.

Unde

rstan

d the

cons

eque

nces

(in

tend

ed an

d unin

tend

ed) o

f the

us

e of a

ntim

icrob

ial th

erap

y in

hum

ans.

Skill

s:1.

Ensu

re eff

ectiv

e man

agem

ent o

f an

timicr

obial

s (ac

cord

ing to

scop

e of

prac

tice)

in in

fectio

n the

rapy

.

Attit

udes

:1.

Enco

urag

e pat

ient a

nd pe

er

prof

essio

nal in

tera

ction

s on

antim

icrob

ial pr

escri

ption

and

ther

apy.

2. En

sure

tim

ely an

d app

ropr

iate

feedb

ack t

o pre

scribe

rs an

d oth

er

care

grou

ps.

3. W

illing

ness

to pa

rticip

ate i

n qu

ality

impr

ovem

ent p

rogr

amm

es

for a

ntim

icrob

ial us

e.4.

Willi

ngne

ss to

com

mun

icate

th

e risk

of de

velop

men

t and

tra

nsm

ission

of AM

R spr

ead w

ithin

and o

utsid

e of m

ultidi

scipli

nary

an

timicr

obial

team

s.

Rele

vanc

e: H

igh

Know

ledg

e:1.

Diag

nosis

of di

seas

e inc

luding

the

abilit

y to d

iscrim

inate

dise

ases

of

differ

ent i

nfec

tious

path

ology

.2.

Indic

ation

for a

ntim

icrob

ial

ther

apy,

includ

ing as

sessm

ent o

f th

e sev

erity

of th

e inf

ectio

n (se

psis

synd

rom

e rec

ognit

ion) t

o inf

orm

ur

genc

y for

ther

apy.

3. Un

derst

and t

hat t

rave

l, rec

ent

hosp

italiz

ation

or pr

eviou

s m

icrob

iolog

y find

ings o

f re

sista

nt ba

cteria

are f

acto

rs th

at pr

edisp

ose t

o colo

nizat

ion/

infec

tion w

ith a

resis

tant

pa

thog

en.

4. Un

derst

and c

omm

on dr

ug

inter

actio

ns be

twee

n an

timicr

obial

s and

othe

r th

erap

eutic

agen

ts, an

d be

twee

n ant

imicr

obial

s and

fo

od. U

nder

stand

their

clini

cal

signifi

canc

e and

the s

trate

gies t

o av

oid in

tera

ction

s.5.

Appr

eciat

e the

risk,

bene

fits a

nd

limita

tions

of th

e ant

imicr

obial

tre

atm

ent i

n the

cont

ext o

f the

pa

tient

and s

ettin

g. 6.

Unde

rstan

d the

conc

ept o

f bro

ad-

and n

arro

w-sp

ectru

m an

tibiot

ics

and t

he im

porta

nce o

f avo

iding

th

eir un

nece

ssary

use,

espe

cially

th

ose w

ith br

oad-

spec

trum

ac

tivity

.7.

Unde

rstan

d the

use o

f an

timicr

obial

s in s

pecia

l ca

re gr

oups

(e.g.

paed

iatric

s, pr

egna

ncy,

brea

stfee

ding,

rena

l dis

ease

s and

obes

e per

sons

).8.

Unde

rstan

d the

mec

hanis

ms

of ac

tions

of th

e diff

erent

an

timicr

obial

drug

s clas

ses.

9. Un

derst

and h

ow to

deve

lop a

hosp

ital fo

rmula

ry.

Rele

vanc

e: H

igh

Know

ledg

e:1.

Unde

rstan

d nur

ses’ r

ole in

the

ther

apeu

tic m

anag

emen

t of

infec

tious

dise

ases

.

Skill

s:1.

Adm

iniste

r and

reco

rd

antim

icrob

ial m

edici

nes u

se

includ

ing re

view

of do

se/ti

me

for a

ccur

acy.

2. Pe

rform

aller

gy ch

ecks

.3.

Upda

te cl

inica

l and

lab

orat

ory r

esult

s inc

luding

re

nal fu

nctio

n res

ults,

drug

lev

els, a

nd pr

elim

inary

/fina

l m

icrob

iolog

y res

ults.

4. M

onito

r and

repo

rt ad

verse

ev

ents

of an

timicr

obial

tre

atm

ent.

5. In

tera

ct wi

th ot

her m

embe

rs of

the s

tewa

rdsh

ip te

am

to pr

omot

e opt

imal

antim

icrob

ial tr

eatm

ent i

n pa

tient

s (te

amwo

rk).

Attit

udes

:1.

Educ

ate p

atien

ts an

d fam

ily,

and p

erfo

rm di

schar

ge

teac

hing.

Rele

vanc

e: H

igh

Know

ledg

e:1.

Unde

rstan

d the

sign

ifica

nce

of effi

cacy

data

for c

linica

l be

nefit

for e

ach i

ndica

tion

(mag

nitud

e of b

enefi

t es

timat

ed in

clini

cal t

rials)

.2.

Phar

mac

okine

tics:

rout

e of

ther

apy,

conc

ept o

f bio

avail

abilit

y, do

sing

frequ

ency

, the

rape

utic

drug

m

onito

ring a

nd cl

eara

nce.

3. Ph

arm

acod

ynam

ics: t

issue

/or

gan a

dver

se eff

ects

(e.g.

ab

norm

al liv

er fu

nctio

n tes

ts,

rena

l tox

icity

).4.

Aller

gy: im

med

iate,

non-

life

thre

aten

ing, s

ever

e adv

erse

dr

ug re

actio

ns (e

.g. St

even

Jo

hnso

n Syn

drom

e).

Skill

s: 1.

Asse

ss pr

escri

ption

s in

acco

rdan

ce w

ith lo

cal p

olicie

s fo

r ant

imicr

obial

use.

2. Re

view

antim

icrob

ial ch

oice,

dose

, inte

rval,

dura

tion a

nd

rout

e of a

dmini

strat

ion.

3. Gi

ve ad

vice o

n dos

age

form

, pre

para

tion a

nd

adm

inistr

ation

(esp

ecial

ly fo

r sp

ecial

patie

nt co

horts

such

as

child

ren)

.4.

Coun

sel in

dividu

als an

d po

pulat

ions o

n the

safe

and

ratio

nal u

se of

antim

icrob

ials

(inclu

ding t

he se

lectio

n, us

e, co

ntra

indica

tions

, sto

rage

, dr

ug in

tera

ction

s and

side

eff

ects)

.5.

Accu

rate

ly dis

pens

e pr

escri

bed a

ntim

icrob

ials f

or

majo

r and

mino

r infec

tions

.

Rele

vanc

e: Av

erag

e

Know

ledg

e:1.

Unde

rstan

d the

use o

f the

an

tibiog

ram

in de

tectin

g and

rep

ortin

g AMR

patte

rns i

n se

tting

s whe

re an

tibiog

ram

s ar

e com

mon

ly us

ed.

Skill

s:1.

Reco

gnize

com

mon

m

echa

nism

s of r

esist

ance

wi

thin

an in

stitu

tion f

or

differ

ent a

ntim

icrob

ial/

orga

nism

com

binat

ions.

Unde

rstan

d the

ir im

pact

on re

sista

nce t

o oth

er

antim

icrob

ials.

2. Co

nduc

t ant

ibiot

ics sp

ectru

m

of ac

tivity

analy

sis us

ing th

e an

tibiog

ram

to he

lp de

term

ine

the a

ntibi

otic

agen

t of h

ighes

t effi

cacy.

Attit

udes

:1.

Prov

ide la

bora

tory

user

s wi

th gu

idanc

e on t

he m

ost

appr

opria

te te

sts an

d the

ir lim

itatio

ns.

2. En

sure

read

y acce

ss to

the

tests

and c

omm

unica

tion

of re

sults

to cl

inicia

ns –

op

timize

clini

cal li

aison

. 3.

Ensu

re ti

meli

ness

in th

e ha

ndlin

g of m

icrob

iolog

y sa

mple

s and

com

mun

icatio

n of

susce

ptibi

lity r

esult

s.

Rele

vanc

e: Av

erag

e

Know

ledg

e:1.

Unde

rstan

d whe

re an

d how

to

sear

ch/re

triev

e bes

t scie

ntifi

c ev

idenc

e to s

uppo

rt op

timal

use

and t

hera

py.

2. Un

derst

and t

he im

porta

nce

of pr

omot

ing ap

prop

riate

an

timicr

obial

use a

ccord

ing to

th

eir AW

aRE c

ateg

ories

, in or

der

to im

plem

ent s

pecifi

c res

istan

ce-

prev

entio

n acti

ons f

or th

ese

antim

icrob

ials.

Skill

s:1.

Deve

lop a

syste

mat

ic ap

proa

ch

to an

timicr

obial

pres

cribin

g and

de

sign i

nter

vent

ions t

o add

ress

gaps

.2.

Asse

ss ne

eds a

nd re

spon

d to

antim

icrob

ial sh

orta

ges.

3. Ad

dres

s issu

es re

lated

to th

e av

ailab

ility o

f ant

imicr

obial

s inc

luding

the a

cceler

ated

re

gistra

tion o

f qua

lity,

cost-

effec

tive e

ssent

ial an

timicr

obial

s as

well

as th

e use

of go

od re

view

prac

tices

(GRe

VP).

Attit

udes

:1.

Advo

cate

for a

cond

ucive

en

viron

men

t and

man

agem

ent

struc

ture

that

prior

itize

s an

timicr

obial

stew

ards

hip an

d en

cour

ages

acco

unta

bility

for b

est

prac

tices

on ac

tions

to im

prov

e ap

prop

riate

antim

icrob

ial us

e in

hosp

itals

and c

omm

unity

setti

ngs.

2. En

sure

a re

gular

supp

ly of

es

sent

ial an

timicr

obial

s. 3.

Ensu

re th

e ava

ilabil

ity of

adeq

uate

hu

man

and m

ater

ial re

sour

ces f

or

deliv

ering

healt

h car

e.

WHO COMPETENCY FRAMEWORK FOR HEALTH WORKERS’ EDUCATION AND TRAINING ON ANTIMICROBIAL RESISTANCE

9

Antim

icrob

ial r

esist

ance

do

mai

nsa

Cate

gory

1: A

ll he

alth

wor

kers

bCa

tego

ry 2:

Pre

scrib

ersc

Cate

gory

3: N

on-p

resc

riber

sd Ca

tego

ry 4:

Pub

lic h

ealth

office

rs/

heal

th se

rvice

s man

ager

se

Nurs

esPh

arm

acist

sLa

bora

tory

scie

ntist

s/te

chni

cians

Appr

opria

te u

se

of an

timicr

obia

l ag

ents

10. U

nders

tand

the b

asics

of

antim

icrob

ial pr

oduc

t res

earch

, de

velop

men

t, reg

ulatio

n and

m

arke

ting.

Skill

s:1.

Selec

t and

pres

cribe

antim

icrob

ials

in ac

cord

ance

with

stan

dard

tre

atm

ent g

uideli

nes a

nd

asso

ciate

d esse

ntial

med

icine

s lis

ts (w

here

appli

cable

) kee

ping i

n m

ind th

e pat

hoge

n, do

se, d

urat

ion

and r

oute

of ad

mini

strat

ion.

2. Re

cogn

ize th

e im

med

iate a

nd

long-

term

patie

nt an

d eco

logica

l co

nseq

uenc

es of

inap

prop

riate

an

timicr

obial

pres

cript

ion.

Attit

udes

:1.

Prom

ote b

est p

racti

ce ap

proa

ches

to

pres

cribin

g ant

imicr

obial

s and

en

sure

adhe

renc

e to g

uideli

nes.

2. Pr

omot

e cap

acity

to se

arch

for

relia

ble so

urce

s of u

nbias

ed/

unco

nflict

ed in

form

ation

on be

st us

e of a

ntim

icrob

ials.

3. Be

ware

of m

arke

t inc

entiv

es

to pr

olifer

ate t

he pr

escri

ption

of

antim

icrob

ials a

gains

t the

un

derst

andin

g of p

rescr

ibing

gu

idelin

es an

d pra

ctica

l ap

plica

tion.

6. En

sure

tim

ely su

pply

of

appr

opria

te m

edici

nes.

7. En

sure

appr

opria

te

docu

men

tatio

n of

antim

icrob

ials d

ispen

sed

includ

ing ro

ute,

time,

dose

, th

erap

eutic

drug

mon

itorin

g an

d res

pons

e for

indiv

idual

patie

nts.

Attit

udes

: 1.

Prom

ote a

ppro

ache

s to

incre

ase i

ndivi

dual

or

com

mun

ity kn

owled

ge

of us

ing an

timicr

obial

s ap

prop

riate

ly.2.

Prom

ote t

he us

e of q

ualit

y as

sure

d ant

imicr

obial

s for

pa

tient

trea

tmen

t.3.

Prom

ote A

MR d

rug u

tiliza

tion

studie

s.4.

Prom

ote b

ette

r pat

ient

unde

rstan

ding o

f all

treat

men

t issu

es su

ch as

sa

fety c

once

rns i

nclud

ing

alerts

, and

adhe

renc

e.

4. En

cour

age t

he us

e of lo

cal a

nd

natio

nal m

etric

s to a

udit/

quali

ty

impr

ovem

ent a

nd ad

here

nce t

o gu

idelin

es.

5. Pr

ovide

clea

r mec

hanis

ms f

or

the g

over

nanc

e of a

ntim

icrob

ial

stewa

rdsh

ip inc

luding

addr

essin

g re

spon

sibilit

y and

acco

unta

bility

fo

r the

quali

ty an

d qua

ntity

of

antim

icrob

ials p

rescr

ibed w

ithin

a sy

stem

.6.

Prom

ote p

rodu

ct qu

ality.

7. Ad

opt a

shar

ed re

spon

sibilit

y for

m

ainta

ining

prod

uct q

ualit

y.

10

Table

1. AM

R com

pete

ncy f

ram

ewor

k, co

ntinu

ed

Antim

icrob

ial r

esist

ance

do

mai

nsa

Cate

gory

1: A

ll he

alth

wor

kers

bCa

tego

ry 2:

Pre

scrib

ersc

Cate

gory

3: N

on-p

resc

riber

sd Ca

tego

ry 4:

Pub

lic h

ealth

office

rs/

heal

th se

rvice

s man

ager

se

Nurs

esPh

arm

acist

sLa

bora

tory

scie

ntist

s/te

chni

cians

Infe

ctio

n pr

even

tion

and

cont

rol (

IPC)

Com

pete

ncy s

tate

men

t: He

alth w

orke

r und

ersta

nds

and i

mple

men

ts th

e prin

ciples

of

hygie

ne, s

anita

tion a

nd IP

C to

redu

ce th

e spr

ead o

f AM

R.

Rele

vanc

e: H

igh

Know

ledg

e:1.

Unde

rstan

ds th

e inf

ectio

n cha

in es

pecia

lly th

e fou

r com

pone

nts

requ

ired f

or tr

ansm

ission

of an

inf

ectio

n: (o

rgan

ism, s

ource

, rout

e of

tran

smiss

ion an

d sus

cept

ible

host)

. 2.

Unde

rstan

d the

role

of ha

nd

hygie

ne to

prev

ent t

rans

miss

ion of

pa

thog

ens.

3. Un

derst

and t

he pr

incipl

es of

pr

even

tion o

f hea

lth ca

re-

asso

ciate

d inf

ectio

ns (H

AI),

includ

ing su

rgica

l site

infec

tions

, ca

thet

er-a

ssocia

ted b

loods

tream

an

d urin

ary t

ract

infec

tions

.4.

Impo

rtanc

e of s

trate

gies t

o pr

even

t inf

ectio

n at c

omm

unity

an

d hea

lth fa

cility

leve

ls, e.

g. wa

ter, s

anita

tion a

nd hy

giene

(W

ASH)

, was

te m

anag

emen

t and

im

mun

izatio

n.5.

Intro

ducti

on to

infec

tious

dise

ases

an

d role

of th

e lab

orat

ory

in ide

ntific

ation

of m

icrob

es

and s

usce

ptibi

lity t

estin

g to

antim

icrob

ials.

Skill

s:1.

Prac

tise h

and h

ygien

e at t

he rig

ht

mom

ent a

nd w

ith ap

prop

riate

te

chniq

ue, a

ccord

ing to

WHO

re

com

men

datio

ns.

2. Co

ntrib

ute t

o the

desig

n and

im

plem

enta

tion o

f pro

cedu

res f

or

crisis

man

agem

ent i

n inf

ectio

n co

ntro

l: aler

t man

agem

ent,

patie

nt id

entifi

catio

n, re

call

of po

tent

ially

cont

amina

ted

equip

men

t and

supp

lies,

repo

rting

an

d exc

hang

e with

relev

ant h

ealth

ca

re pr

ofes

siona

ls.3.

Imple

men

t and

prac

tise u

nivers

al pr

ecau

tions

and t

rans

miss

ion-

base

d prec

autio

ns in

healt

h car

e.

Rele

vanc

e: H

igh

Know

ledg

e:1.

Unde

rstan

d tha

t pres

cribin

g an

timicr

obial

s to p

atien

ts co

lonize

d wi

th m

ultidr

ug re

sista

nt (M

DR)

path

ogen

s (e.g

. MDR

gram

ne

gativ

e pat

hoge

ns in

urine

or

GIT)

, will

not e

radic

ate t

he

path

ogen

s and

shou

ld th

erefor

e not

be

used

as a

prev

entiv

e mea

sure

to

stop t

rans

miss

ion of

the r

esist

ant

path

ogen

s to o

thers

.

Skill

s:1.

Apply

meth

ods a

nd st

rateg

ies

to pr

even

t and

cont

rol H

AIs,

includ

ing su

rgica

l site

infec

tions

, ca

thete

r-asso

ciated

bloo

dstre

am

and u

rinar

y tra

ct inf

ectio

ns,

healt

h car

e-ac

quire

d pne

umon

ia,

gastr

oent

eritis

.2.

Ident

ify an

d man

age t

he sp

ecific

loc

al fa

ctors

respo

nsibl

e for

inc

rease

d risk

of H

AI an

d AMR

ac

cord

ing to

prac

tice s

etting

s.3.

Imple

men

t a pl

an th

at is

focu

sed

on lim

iting

cros

s-inf

ectio

n and

co

ntam

inatio

n to r

educ

e HAI

and

AMR i

n hos

pitals

and c

ommu

nity

setti

ngs.

Attit

udes

:1.

Prom

ote p

rincip

les of

HAI

pr

even

tion a

nd co

ntro

l.2.

Enco

urag

e the

deco

ntam

inatio

n an

d ste

riliza

tion o

f hos

pital

equip

men

t and

patie

nt ar

eas.

Rele

vanc

e: H

igh

Know

ledg

e:1.

Unde

rstan

d the

role

of

nursi

ng in

IPC.

Skill

s:1.

Mon

itor p

atien

t res

pons

e and

ini

tiate

appr

opria

te ch

ange

s in

isolat

ion pr

ecau

tions

.2.

Prov

ide pa

tient

s and

fam

ilies

with

evide

nce-

base

d, ac

cura

te an

d non

-judg

men

tal

infor

mat

ion on

the

bene

fits a

nd im

porta

nce

of im

mun

izatio

n for

healt

h ou

tcom

es.

Attit

udes

:1.

Prom

ote h

ygien

e bes

t pr

actic

es in

healt

h car

e fac

ilities

. 2.

Prom

ote a

nd m

onito

r co

mpli

ance

with

IPC a

nd

patie

nt sa

fety m

easu

res.

Rele

vanc

e: H

igh

Know

ledg

e:1.

Unde

rstan

d the

link b

etwe

en

antim

icrob

ial st

ewar

dship

an

d IPC

.2.

Unde

rstan

ds th

e diff

eren

ce

and t

he im

pact

of no

soco

mial

inf

ectio

ns co

mpa

red w

ith

com

mun

ity-a

cquir

ed

infec

tions

.

Skill

s:1.

Abilit

y to f

ollow

phar

mac

y inf

ectio

n con

trol g

uideli

nes.

2. Us

e hyg

ienic

and s

afety

pr

actic

es to

cont

rol c

ross-

trans

miss

ion.

3. Cle

an an

d disi

nfec

t eq

uipm

ent a

nd su

rface

s.

Attit

udes

:1.

Prom

ote t

he lin

k bet

ween

an

timicr

obial

stew

ards

hip

and I

PC.

2. En

cour

age e

ngag

emen

t with

ot

her h

ealth

prof

essio

nals

to

redu

ce H

AI an

d AM

R.

Rele

vanc

e: H

igh

Know

ledg

e:1.

Unde

rstan

d the

role

of th

e lab

orat

ory (

i.e. id

entifi

catio

n of

micr

obes

, sus

cept

ibilit

y tes

ting,

strain

typin

g and

tim

ely co

mmu

nicat

ion of

res

ults)

in en

ablin

g IPC

m

easu

res.

Skill

s:1.

Prov

ide ac

cura

te an

d tim

ely

labor

ator

y inf

orm

ation

, us

ing cl

ear p

roto

cols,

fo

r IPC

plan

ning a

nd

imple

men

tatio

n, in

cludin

g in

outb

reak

setti

ngs.

2. Co

ntrib

ute t

o alig

nmen

t of

antim

icrob

ial st

ewar

dship

, dia

gnos

tic st

ewar

dship

an

d IPC

plan

ning a

nd

imple

men

tatio

n effo

rts.

3. Pr

actis

e app

ropr

iate I

PC

mea

sure

s in t

he la

bora

tory.

Attit

udes

:1.

Prom

ote t

he im

porta

nt ro

le of

the l

abor

ator

y in I

PC.

Rele

vanc

e: H

igh

Know

ledg

e:1.

Unde

rstan

d the

relat

ionsh

ips

betw

een p

atien

t safe

ty, IP

C, HA

I an

d AM

R.

Skill

s:1.

Supp

ort t

he im

plem

enta

tion

of m

ulti-m

odal

strat

egies

to

achie

ve be

havio

ural

chan

ge in

IP

C pra

ctice

s inc

luding

nece

ssary

re

sour

ces,

mon

itorin

g, au

dit an

d fee

dbac

k.2.

Prop

ose a

ppro

priat

e inf

ectio

n co

ntro

l mea

sure

s for

the

man

agem

ent o

f was

te, a

ir, wa

ter,

laund

ry an

d foo

d.3.

Deve

lop an

d upd

ate p

roce

dure

s re

lated

to de

cont

amina

tion

and s

teril

izatio

n guid

eline

s and

sta

ndar

ds.

Attit

udes

:1.

Prom

ote t

he im

porta

nce o

f pr

even

tion a

nd co

ntro

l of H

AI an

d AM

R.

2. Hi

ghlig

ht th

e hum

an, e

cono

mic

and w

ider p

ublic

healt

h con

cern

s of

HAI

and A

MR.

Use

data

to

illustr

ate t

he pr

oblem

and

com

mun

icate

it to

decis

ion-

mak

ers a

nd th

e affe

cted

com

mun

ities

.3.

Take

an ac

tive r

ole in

risk r

educ

tion

durin

g plan

ning o

f ren

ovat

ions

and n

ew co

nstru

ction

s in t

he

healt

h car

e org

aniza

tion.

WHO COMPETENCY FRAMEWORK FOR HEALTH WORKERS’ EDUCATION AND TRAINING ON ANTIMICROBIAL RESISTANCE

11

Antim

icrob

ial r

esist

ance

do

mai

nsa

Cate

gory

1: A

ll he

alth

wor

kers

bCa

tego

ry 2:

Pre

scrib

ersc

Cate

gory

3: N

on-p

resc

riber

sd Ca

tego

ry 4:

Pub

lic h

ealth

office

rs/

heal

th se

rvice

s man

ager

se

Nurs

esPh

arm

acist

sLa

bora

tory

scie

ntist

s/te

chni

cians

Infe

ctio

n pr

even

tion

and

cont

rol (

IPC)

Attit

udes

:1.

Advo

cate

and d

emon

strat

e ac

tion a

nd ac

coun

tabil

ity fo

r th

e im

plem

enta

tion o

f IPC

and h

ygien

e and

sanit

ation

be

st pr

actic

es in

healt

h car

e fac

ilities

and c

omm

unity

setti

ngs

resp

ectiv

ely.

2. Ad

voca

te fo

r WAS

H an

d for

sc

aling

up va

ccine

s aga

inst

com

mon

infec

tions

caus

ed

by m

icroo

rgan

isms s

uch a

s pn

eum

ococ

cus,

rota

virus

and

Haem

ophil

us in

fluen

zae t

ype b

.3.

Unde

rstan

d how

and w

hen t

o co

ntac

t the

infec

tion c

ontro

l pr

ofes

siona

l for t

heir f

acilit

y or

area

.4.

Prom

ote p

rope

r hea

lth ca

re w

aste

m

anag

emen

t.5.

Prom

ote i

njec

tion s

afety

aw

aren

ess a

nd te

chniq

ues.

12

Table

1. AM

R com

pete

ncy f

ram

ewor

k, co

ntinu

ed

Antim

icrob

ial r

esist

ance

do

mai

nsa

Cate

gory

1: A

ll he

alth

wor

kers

bCa

tego

ry 2:

Pre

scrib

ersc

Cate

gory

3: N

on-p

resc

riber

sd Ca

tego

ry 4:

Pub

lic h

ealth

office

rs/

heal

th se

rvice

s man

ager

se

Nurs

esPh

arm

acist

sLa

bora

tory

scie

ntist

s/te

chni

cians

Diag

nost

ic st

ewar

dshi

p an

d su

rvei

llanc

e Co

mpe

tenc

y sta

tem

ent:

The h

ealth

wor

ker

dem

onstr

ates

an

unde

rstan

ding,

relev

ant

to th

eir fie

ld an

d lev

el of

ex

perti

se, o

f the

prin

ciples

an

d pro

cesse

s of d

iagno

stic

stewa

rdsh

ip, su

rveil

lance

of

AMR a

nd an

timicr

obial

ste

ward

ship

that

unde

rpin

prop

hylax

is an

d tre

atm

ent

guide

lines

and A

MR c

ontro

l str

ateg

ies.

Rele

vanc

e: H

igh

Know

ledg

e:1.

Unde

rstan

d the

role

of na

tiona

l m

edici

ne re

gulat

ory a

utho

rities

in

the r

egula

tion o

f med

icine

s: law

s and

regu

lation

s, re

gistra

tion,

m

anuf

actu

ring,

licen

sing,

inspe

ction

and e

nfor

cem

ent,

phar

mac

ovigi

lance

, pos

t-mar

ket

surv

eillan

ce, q

ualit

y con

trol,

clinic

al tri

als, d

rug i

nfor

mat

ion.

2. Un

derst

and t

he im

porta

nce

of re

porti

ng su

spec

ted p

oor

quali

ty pr

oduc

ts, th

erap

eutic

ine

ffecti

vene

ss, an

d adv

erse

ev

ents

as th

ey m

ay ge

nera

te

signa

ls on

the c

ompr

omise

d qu

ality

of th

e ant

imicr

obial

pr

oduc

ts.3.

Unde

rstan

d the

impo

rtanc

e of

prop

er re

cord

keep

ing an

d use

of

drug

code

s (ac

cord

ing to

setti

ngs)

for t

race

abilit

y of m

edici

nes.

4. Un

derst

and i

mpo

rtanc

e of A

MR

surv

eillan

ce fo

r cha

racte

rizat

ion of

res

istan

ce tr

ends

and m

easu

ring

impa

ct an

d bur

den o

f AMR

to

guide

polic

y-m

akers

in de

velop

ing

treat

men

t rec

omm

enda

tions

.

Skill

s:1.

Act a

s first

line o

f sur

veilla

nce

to ac

cura

tely

ident

ify an

d rep

ort

susp

iciou

s, ine

ffecti

ve, a

nd

subs

tand

ard a

ntim

icrob

ials t

o the

ap

prop

riate

auth

oriti

es.

Attit

udes

:1.

Resp

ect a

nd pr

otec

t the

priva

cy

and i

dent

ity of

indiv

iduals

in

supp

ortin

g or c

arry

ing ou

t su

rveil

lance

activ

ities

for A

MR

cont

rol.

Rele

vanc

e: H

igh

Know

ledg

e:1.

Unde

rstan

d the

basic

princ

iples

of

antib

iogra

ms a

nd ot

her r

epor

ting

tools

and t

heir i

nter

pret

ation

.2.

Unde

rstan

d prin

ciples

of

surv

eillan

ce of

AMR a

nd

antim

icrob

ial us

e and

the u

se of

su

rveil

lance

data

.

Skill

s:1.

Abilit

y to i

nter

pret

and u

se

antim

icrob

ial su

scept

ibilit

y tes

ting

resu

lts (i

n set

tings

whe

re th

ey

are c

omm

only

used

) and

othe

r m

icrob

iolog

y tes

ting t

ools.

2. Fo

r infec

tious

dise

ases

expe

rts,

deve

lop in

dicat

ors f

or th

e rat

ional

use o

f ant

imicr

obial

s. 3.

Abilit

y to i

nterp

ret an

d use

AMR

surv

eillan

ce da

ta.

4. Ab

ility t

o app

ly pr

actic

e and

pr

oced

ures

for s

pecim

en se

lectio

n an

d coll

ectio

n and

the c

omple

tion

of cl

inica

l, dem

ogra

phic

and o

ther

epide

miol

ogica

l dat

a tha

t mus

t ac

com

pany

each

spec

imen

, cor

rect

stora

ge an

d tra

nspo

rtatio

n of

spec

imen

s to t

he la

bora

tory.

Attit

udes

:1.

Prom

ote t

he ge

nera

tion o

f re

levan

t clin

ical, e

pidem

iolog

ical

and m

icrob

iolog

ical d

ata t

o su

ppor

t AM

R sur

veilla

nce.

Rele

vanc

e: Av

erag

e

Know

ledg

e:1.

Unde

rstan

d the

role

of

nursi

ng in

the i

dent

ifica

tion,

co

llecti

on, t

rans

porta

tion a

nd

repo

rting

of m

icrob

iolog

ical

sam

ples a

nd te

st re

sults

.

Skill

s:1.

Obta

in cu

ltures

and s

ends

the

cultu

res to

the m

icrob

iolog

y lab

orat

ory.

2. Mo

nitor

cultu

re res

ults a

nd

repor

t res

ults t

o the

phys

ician

.

Attit

udes

:1.

Prom

ote t

he w

elfar

e of

patie

nts’ p

ost-d

ischa

rge

by en

surin

g opt

imal

com

mun

icatio

n of f

or

disch

arge

or re

ferra

l ser

vices

.

Rele

vanc

e: Lo

w

Know

ledg

e:

1. Un

derst

and m

etho

ds fo

r the

ide

ntifi

catio

n of s

ubsta

ndar

d an

d fals

ified

med

ical

prod

ucts.

2. Un

derst

and t

he

mea

sure

men

t of

antim

icrob

ial co

nsum

ption

, qu

ality

and a

ssocia

ted c

osts

in he

alth c

are s

ettin

gs an

d co

mm

uniti

es.

Skill

s:1.

Carry

out m

onito

ring o

f an

timicr

obial

use t

hrou

gh

point

prev

alenc

e sur

veys

etc.

2. Ac

cura

tely

repo

rt de

fectiv

e or

subs

tand

ard a

ntim

icrob

ial

med

icine

s to t

he ap

prop

riate

au

thor

ities

.

Attit

udes

:1.

Ensu

re a

cultu

re of

ris

k awa

rene

ss an

d et

hical

beha

viour

in th

e ide

ntifi

catio

n and

repo

rting

of

AMR d

ata.

Rele

vanc

e: H

igh

Know

ledg

e:1.

Unde

rstan

d the

princ

iples

an

d pra

ctice

of di

agno

stic

stewa

rdsh

ip.2.

Unde

rstan

d the

relev

ant

tech

nique

s and

data

requ

ired

for e

ffecti

ve su

rveil

lance

of

antim

icrob

ial us

e and

AMR i

n ho

spita

l and

com

mun

ity.

3. Un

derst

and t

he us

e of

diagn

ostic

data

in AM

R su

rveil

lance

.

Skill

s:1.

Supp

ort i

mple

men

tatio

n of

diagn

ostic

stew

ards

hip.

2. Ac

t as fi

rst lin

e of s

urve

illanc

e in

the c

orre

ct us

e and

re

porti

ng of

micr

obiol

ogica

l te

sts an

d diag

nosti

c too

ls.3.

Cont

ribut

e to h

ospit

al-sp

ecific

an

timicr

obial

susce

ptibi

lity

data

.

Attit

udes

:1.

Embe

d a su

rveil

lance

cultu

re

in th

eory

and p

racti

ce.

2. Em

brac

e the

use o

f ap

prop

riate

tech

nolog

y in

AMR t

estin

g.3.

Main

tain

effec

tive

com

mun

icatio

n and

co

llabo

rativ

e wor

k with

cli

nician

s, IP

C pro

fessio

nals,

ho

spita

l epid

emiol

ogist

s, an

d ot

her h

ealth

care

wor

kers

involv

ed in

stew

ards

hip

activ

ities

.

Rele

vanc

e: H

igh

Know

ledg

e:1.

Unde

rstan

d inf

ectio

us di

seas

es

epide

miol

ogy.

2. Un

derst

and p

rincip

les an

d m

etho

ds of

publi

c hea

lth

surv

eillan

ce.

3. Un

derst

and A

MR s

urve

illanc

e an

d dat

a ana

lysis

met

hods

and

asse

ssmen

t of t

rend

s to i

nfor

m

inter

vent

ions.

4. Un

derst

and t

he im

porta

nce

of in

corp

orat

ing an

timicr

obial

pr

oduc

t qua

lity a

ssura

nce t

opics

int

o rele

vant

natio

nal p

olicie

s and

re

gulat

ions i

nclud

ing th

e nat

ional

actio

n plan

for A

MR a

nd na

tiona

l re

gulat

ions o

n ant

imicr

obial

pr

escri

ption

sche

dulin

g, co

nsum

ption

, and

trac

eabil

ity.

5. Im

porta

nce o

f ado

pting

stan

dard

te

rmino

logies

such

as th

e AW

aRE c

ateg

ories

to de

velop

dr

ug st

atist

ics fo

r in-c

ount

ry

and i

nter

-cou

ntry

com

paris

on

of an

timicr

obial

utiliz

ation

and

outco

mes

.6.

The b

enefi

t of r

isk as

sessm

ent

and r

isk m

anag

emen

t stra

tegie

s fo

r iden

tifyin

g and

cont

aining

re

sista

nce.

Skill

s:1.

Abilit

y to m

onito

r and

repo

rt on

the p

erfo

rman

ce of

hosp

ital

and/

or co

mm

unity

AMR a

nd

relat

ed an

timicr

obial

stew

ards

hip

prog

ram

mes

. 2.

Iden

tify a

nd re

port

of su

bsta

ndar

d an

d fals

ified

med

icine

s.3.

Audit

the q

ualit

y of a

ntim

icrob

ial

use t

hrou

gh ba

sic sc

ientifi

c m

ethod

s.

WHO COMPETENCY FRAMEWORK FOR HEALTH WORKERS’ EDUCATION AND TRAINING ON ANTIMICROBIAL RESISTANCE

13

Antim

icrob

ial r

esist

ance

do

mai

nsa

Cate

gory

1: A

ll he

alth

wor

kers

bCa

tego

ry 2:

Pre

scrib

ersc

Cate

gory

3: N

on-p

resc

riber

sd Ca

tego

ry 4:

Pub

lic h

ealth

office

rs/

heal

th se

rvice

s man

ager

se

Nurs

esPh

arm

acist

sLa

bora

tory

scie

ntist

s/te

chni

cians

Diag

nost

ic st

ewar

dshi

p an

d su

rvei

llanc

e

Attit

udes

:1.

Ensu

re ad

equa

te pr

otec

tion

includ

ing a

safe

and c

ondu

cive

work

ing en

viron

men

t for

healt

h ca

re w

orke

rs ca

rrying

out A

MR

surv

eillan

ce ac

tiviti

es.

14

Antimicrobials: An agent or substance, derived from any source (microorganisms, plants, animals, synthetic or semisynthetic) that acts against any type of microorganism such as bacteria (antibacterial), mycobacteria (antimycobacterial), fungi (antifungal), parasite (antiparasitic) and viruses (antiviral). All antibiotics are antimicrobials, but not all antimicrobials are antibiotics (31).

Antimicrobial resistance: The ability of microorganisms (such as bacteria, fungi, viruses and parasites) to multiply or persist in the presence of an increased level of an antimicrobial agent (such as antibiotics, antifungals, antivirals, antimalarials and antihelmintics) relative to the susceptible counterpart of the same species.

Antimicrobial stewardship: Refers to how the appropriate use of antimicrobials can maximize both their current efficacy and the chances of their being efficacious for future generations. It embodies an organizational or health care system-wide approach to promoting and monitoring judicious use of antimicrobials to preserve their future effectiveness.

Diagnostic stewardship: Coordinated guidance and interventions to improve appropriate use of microbiological diagnostics to guide therapeutic decisions. It should promote appropriate, timely diagnostic testing, including specimen collection, and pathogen identification and accurate, timely reporting of results to guide patient treatment (32).

Drug-resistant infections: Describes infections caused by organisms that are resistant to treatment, including those caused by bacteria that do not respond to antibiotics (33).

Competencies: A “combination of knowledge, skills, motives and personal traits”, development of which should help individuals to continually improve their performance and to work more effectively.

Curriculum: A set of learning goals articulated across different health care workers that outline the intended content and process goals at particular points in time and throughout their professional career. These goals in the context of AMR, are relevant at a personal and societal level.

Infection prevention and control: A pragmatic scientific approach designed to prevent harm caused by infections to patients and health workers.

Interprofessional collaboration: Collaborative practice happens when multiple health workers from different professional backgrounds work together with patients, families, carers and communities to deliver the highest quality of care (34).

Prescribers: All health care professionals qualified to prescribe antimicrobials. In addition to physicians of all specialties and dental practitioners, the term may refer to inter alia prescribing nurses, pharmacists (in some jurisdictions), clinical microbiologists, midwives, optometrists, podiatrists and other health care professionals, depending on local regulations.

Principle: Defined as “an accepted or professed rule of action or conduct or a fundamental, primary, or general truth from which others are derived,” or “a fundamental doctrine or truth.” Principles are core tenets that should be acceptable to all.

Surveillance of AMR and antimicrobial use: Collection, validation, analyses and reporting of relevant clinical, microbiological and epidemiological data on AMR in targeted pathogens from different sources (e.g. humans, animals, food, environment), and on relevant antimicrobial use in humans and animals, and then applying the results to slow down or halt the development of resistance.

Significant and common infections: Refers to a collection of commonly and widely recognized infections occurring in the community or in a hospital setting.

Glossary

WHO COMPETENCY FRAMEWORK FOR HEALTH WORKERS’ EDUCATION AND TRAINING ON ANTIMICROBIAL RESISTANCE

15

1 Carlet J, Jarlier V, Harbarth S, Goossens H, Pittet D. Ready for a world without antibiotics? The Pensières Antibiotic Resistance Call to Action. Antimicrob Resist Infect Control. 2012;1:11.

2 Antimicrobial resistance: Global report on surveillance 2014. Geneva: World Health Organization; 2014.

3 Dyar OJ, Pulcini C, Howard P, Nathwani D. European medical students: A first multicentre study of knowledge, attitudes and perceptions of antibiotic prescribing and antibiotic resistance. Antimicrob Chemother. 2014;69(3):842–6. doi: 10.1093/jac/dkt440.

4 Dyar OJ, Howard P, Nathwani D, Pulcini C. Knowledge, attitudes, and beliefs of French medical students about antibiotic prescribing and resistance. Med Mal Infect. 2013;43(10):423–30. doi: 10.1016/j.medmal.2013.07.010.

5 Minen MT, Duquaine D, Marx MA, Weiss D. A survey of knowledge, attitudes, and beliefs of medical students concerning antimicrobial use and resistance. Microb Drug Resist. 2010;16(4):285–9. doi: 10.1089/mdr.2010.0009.

6 Abbo LM, Cosgrove SE, Pottinger PS, Pereyra M, Sinkowitz-Cochran R, Srinivasan A, et al. Medical students’ perceptions and knowledge about antimicrobial stewardship: How are we educating our future prescribers? Clinical Infectious Diseases. 2013;57(5):631–8.

7 Global action plan on antimicrobial resistance. Geneva: World Health Organization; 2015.

8 World Bank. Drug-resistant infections: A threat to our economic future. Washington (DC): World Bank; 2017 (http://documents.worldbank.org/curated/en/323311493396993758/final-report, accessed 27 April 2018).

9 Global action plan on antimicrobial resistance. Geneva: World Health Organization; 2015 (http://apps.who.int/iris/bitstream/10665/193736/1/9789241509763_eng.pdf?ua=1, accessed 27 April 2018).

10 Global strategy on human resources for health: Workforce 2030. Geneva: World Health Organization; 2016 (http://apps.who.int/iris/bitstream/10665/250368/1/9789241511131-eng.pdf?ua=1, accessed 27 April 2018).

11 WHO fact sheet on antimicrobial resistance [website]. Geneva: World Health Organization; 2018 (http://www.who.int/mediacentre/factsheets/fs194/en/, accessed 27 April 2018).

12 Mapping educational opportunities and resources for health-care workers to learn about antimicrobial resistance and stewardship. Human Resources for Health Observer Series No. 21. Geneva: World Health Organization; 2017.

13 WHO expert consultation meeting report on health workforce education and AMR control. Geneva: World Health Organization; 2017 (http://www.who.int/hrh/news/2017/expert_consultation_workforce_education_amr/en/, accessed 27 April 2017).

14 WHO meeting on health education and antimicrobial resistance. Internal report. Geneva: World Health Organization; 2016.

15 Antimicrobial prescribing and stewardship competencies. London: Public Health England; 2013 (https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/253094/ARHAIprescrcompetencies__2_.pdf, accessed 27 April 2017).

16 Patient safety curriculum guide. Multi-professional edition. Geneva: World Health Organization; 2011 (http://apps.who.int/iris/bitstream/10665/44641/1/9789241501958_eng.pdf, accessed 27 April 2017).

17 Training framework for antimicrobial stewardship program implementation for the Western Pacific Region. Melbourne: National Centre for Antimicrobial Stewardship; June 2016.

18 Cosgrove SE, Hermsen ED, Rybak MJ, File TM, Parker SK, Barlam TF. Guidance for the knowledge and skills required for antimicrobial stewardship leaders. Infect Control Hosp Epidemiol. 2014;35(12):1444–51.

References

16

19 A competency framework for all prescribers. London: Royal Pharmaceutical Society; 2016 (https://www.rpharms.com/Portals/0/RPS%20document%20library/Open%20access/Professional%20standards/Prescribing%20competency%20framework/prescribing-competency-framework.pdf, accessed 27 April 2017).

20 WFME global standards for quality improvement. The 2015 revision. Ferney-Voltaire, France and Copenhagen, Denmark: World Federation for Medical Education (http://wfme.org/standards/bme/78-new-version-2012-quality-improvement-in-basic-medical-education-english/file, accessed 27 April 2017).

21 Proposals for EU guidelines on the prudent use of antimicrobials in humans. Stockholm: European Centre for Disease Prevention and Control; 2017.

22 Pharmacy Education Taskforce: A global competency framework (Version 1). The Hague: International Pharmaceutical Federation; 2012 (https://www.fip.org/files/fip/PharmacyEducation/GbCF_v1.pdf, accessed 27 April 2017).

23 ESCMID competencies for antimicrobial prescribing and stewardship (forthcoming).

24 Core competencies for infection control and hospital hygiene professionals in the European Union. Stockholm: European Centre for Disease Prevention and Control; 2013.

25 Infection prevention and control core competencies for health care workers: A consensus document. November 2016. Winnipeg: Infection Prevention and Control Canada (https://ipac-canada.org/photos/custom/pdf/HCW_Core_Competency_Category_Table-2016November(2).pdf, accessed 27 April 2017).

26 SIRCINF001 - Use pharmacy practices for infection control (Release 1) [website]. Australian Government Department of Education and Training; 2018 (https://training.gov.au/Training/Details/SIRCINF001#, accessed 27 April 2017).

27 Identifying and defining competencies – A clear map for scientific and professional competencies as applied to hospital pharmacy. WP4 final report. Pharmine: Pharmacy Education in Europe; 2011 (https://www.pharmine.org/wp-content/uploads/2014/05/WP4-Final-report-identifying-and-defining-competences-for-hospital-pharmacists.pdf, accessed 27 April 2017).

28 Redefining the antibiotic stewardship team: Recommendations from the American Nurses Association/Centers for Disease Control and Prevention Workgroup on the Role of Registered Nurses in Hospital Antibiotic Stewardship Practices. American Association of Nurses; 2017 (https://www.cdc.gov/getsmart/healthcare/pdfs/ANA-CDC-whitepaper.pdf, accessed 27 April 2017).

29 ICN position statement on AMR. Geneva: International Council of Nurses, 2009 (http://www.icn.ch/images/stories/documents/publications/position_statements/ICN_PS_Antimicrobial_resistance.pdf, accessed 27 April 2017).

30 WHO model list of essential medicines – 20th list. Geneva: World Health Organization; 2017 (http://www.who.int/medicines/publications/essentialmedicines/20th_EML2017_FINAL_amendedAug2017.pdf?ua=1, accessed 27 April 2017).

31 Critically important antimicrobials for human medicine. 5th revision. Geneva: World Health Organization; 2017 (http://apps.who.int/iris/bitstream/10665/255027/1/9789241512220-eng.pdf?ua=1, accessed 27 April 2017).

32 Diagnostic stewardship: A guide to implementation in antimicrobial resistance surveillance sites. Geneva: World Health Organization; 2016 (http://apps.who.int/iris/bitstream/10665/251553/1/WHO-DGO-AMR-2016.3-eng.pdf, accessed 27 April 2017).

33 Mendelson M, Balasegaram M, Jinks T, Pulcini C, Sharland M. Antibiotics resistance has a language problem. Nature. 2017;545(7652):23–25. doi: 10.1038/545023a.

34 Framework for action on interprofessional education and collaborative practice. Geneva: World Health Organization; 2010.

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