Guidance

World Antimicrobial Resistance Awareness Week (WAAW) and European Antibiotic Awareness Day (EAAD)

Updated 12 October 2023

Applies to England

Introduction

World AMR Awareness Week 2023

Background

The World Health Organization (WHO) has renamed World Antimicrobial Awareness Week to World Antimicrobial Resistance Awareness Week (WAAW), or World AMR Awareness Week, after global consultations.

Aim and focus

WAAW aims to increase awareness of global antimicrobial resistance (AMR) and to encourage best practices for using antimicrobials responsibly among the general public, health workers and policy makers, to avoid the further emergence and spread of drug-resistant infections.

The focus for WAAW and EAAD in England is normally on health and social care workers, as well as patients who have been prescribed antibiotics. Whilst this is still an important focus, especially in light of a difficult flu season, the WAAW campaign remains accessible for all members of the community to take part in and learn from, including veterinary, food, and environmental organisations and their users.

Raising awareness of the risks of AMR remains important. This toolkit aims to provide quick and ready-to-use material to support your WAAW campaigns. The toolkit is focused on digital messaging to support speed and ease of communication while including a wide variety of suggestions for engagement with different groups of people.

Whether you intend on supporting a small or big campaign, all antimicrobial stewardship (AMS) helps to keep antibiotics working. Please do what you can to get involved during and beyond WAAW.

For other relevant antibiotic resources, please see previously published toolkits.

If you have any queries about the campaign, contact the WAAW, EAAD and Antibiotic Guardian National Lead, Dr Diane Ashiru-Oredope at ESPAUR@ukhsa.gov.uk

Access all of the digital resources online. For more information on each of the resources, please see the relevant section of this toolkit.

Messages for healthcare professionals on AMS and COVID-19

As the COVID-19 pandemic and recent outbreaks have highlighted, management of viral infection remains an important challenge for healthcare professionals and can have an adverse impact on the use of antibiotics.

Now more than ever, we need to continue to work together to prevent serious infections – including COVID-19 – while reducing inappropriate antibiotic use.

To avoid inappropriate antibiotic prescribing in the context of COVID-19 and other viral infections, we recommend that healthcare professionals:

• follow current NICE guidelines to infer if pneumonia has a COVID-19, viral or bacterial cause
• treat coughs, fever and breathlessness related to COVID-19 in line with clinical guidance, not with antibiotics – please consider appropriate pathways for diagnosis, testing and clinical management
• explain to patients that antibiotics do not prevent or treat viral infections including COVID-19 – antibiotics can cause side-effects, including nausea and diarrhoea; their use can also increase the risk of spreading infections that are caused by bacteria resistant to antibiotics
• consider your local AMS strategy in the context of the COVID-19 pandemic to determine what is still feasible and what may need to be adapted or strengthened

Suggested actions to consider for WAAW and EAAD

Please consider the following list of suggested activities to engage with ahead of and during WAAW. For those with limited time, it is recommended that the first 5 actions are focused on.

1. Choose your Antibiotic Guardian pledge and encourage colleagues, family members and friends to do the same. You may wish to share your pledge on social media platforms to encourage others to join you also. Consider including the following hashtags in your social media posts:

• AntibioticGuardian

• KeepAntibioticsWorking

• WAAW

2. Register your organisation’s AMR awareness activities by using the online registration form (this will take less than 5 minutes). Following registration, you will receive an email with your certificate for your organisation which can be displayed.

3. Access digital resources for healthcare workers that can be used and shared during WAAW. These resources build on those produced in 2020 and 2021, including digital notes, images and social media polls. They are discussed further below, along with the proposed daily themes during WAAW.

4. Visit the FutureNHS AMR programme website for access to key national guidance, updates, and content available relating to infection management and AMR, and as a mechanism to share knowledge and to network with other colleagues across the country.

5. As part of your local WAAW planning, view the recorded ‘Planning your local WAAW or EAAD’ Knowledge Café, which was held by the UK Health Security Agency (UKHSA). This includes discussions from a range of colleagues, while employing knowledge mobilisation principles to help colleagues plan their local WAAW and signpost to resources.

6. Participate in the Global X, formerly Twitter, relay, which will run during WAAW; images and messages for the Global X relay are available online and will be updated as required. Please refer to the section on the Global X relay for further information.

7. Record and share a short pledge video to affirm your organisation’s (or your individual) commitment to tackling AMR. See below for a quick guide on recording a video and promoting during WAAW.

8. Visit the Antibiotic Review Kit (ARK) website to engage with a range of resources designed to help all healthcare professionals to reduce antibiotic overuse in hospitals. We encourage ARK sites to re-engage and all to learn from and use these resources.

9. Use the Keep Antibiotics Working resources that are still available online and free for healthcare professionals to download and use in local awareness campaigns, including during WAAW. The translated leaflets, posters and social media resources have been translated into 12 additional languages and are available online. See figure 1 for examples. The media campaign will not run on TV and radio this year.

10. Explore the TARGET antibiotics toolkit, which is designed for healthcare professionals in all primary care or community settings. The toolkit includes the Pharmacy antibiotic checklist, which has been designed to follow the antibiotic prescription journey, to be completed by patients and pharmacists, to facilitate individualised advice to the patient.

11. Use the e-Bug suite of educational resources to run engaging activities and sessions on microbes, infection and antibiotics for ages 3 to 16. All activities and lesson plans are designed to complement the National Curriculum and can be adapted to meet the needs of your group.

12. Take the free e-Bug Health Educator Training, which aims to improve your ability to teach children and young people how to prevent the spread of infection and to use antibiotics responsibly.

13. Explore the Health Education England (HEE) elearning for healthcare website, which contains a range of educational resources related to AMR and infections. This is available for use by primary and secondary care.

As an Antibiotic Guardian champion, you can:

• forward this toolkit to colleagues
• continue to encourage colleagues or members, family, friends and patients to join over 190,000 individuals who have personally pledged an action to help to tackle AMR by choosing a pledge at the Antibiotic Guardian website
• use social media and community networks to engage with diverse population groups to promote key messages on AMR throughout the winter season using #AntibioticGuardian and #KeepAntibioticsWorking – social media images and messages are available online

As an individual, you may wish to consider the following for sharing learning and resources ahead of or during WAAW:

• consider professional and personal networks that you can share information on (organisational intranet, community groups, local message boards)
• if you are a parent, consider utilising your school newsletter or parent networks
• find your local council and consider contacting them about sharing resources with schools and healthcare providers (including care homes)
• contact your dentist to ask if they will access posters and leaflets to display in their waiting room
• if you are a pet owner, consider contacting your veterinary practice about sharing resources in the surgery and with other pet owners
• use social media to share some of the digital resources detailed in this toolkit with family, friends, and colleagues
• consider having a conversation with a colleague, a family member or friend over coffee around antibiotics during WAAW – chats could include discussions around:
  • what you think your personal responsibility to keep antibiotics working is
  • why you might be thankful for antibiotics
  • the role of the health provider and patient in shared decision making involving antibiotic prescribing
  • the role of preventing infections
  • self care for self-limiting infections

Letters and bulletins

Letters are written to inform about antibiotic awareness campaigns and request organisations to register their activities with Public Health England (PHE), now UKHSA. These letters are published online and signed by NHS England chief professional officers as well as UKHSA Chief Medical Advisor. They are sent to local authorities, care providers and professional organisations.

During the COVID-19 pandemic, relevant NHS bulletins were also published in place of the letters to signpost to the WAAW toolkit and resources.

Public awareness campaigns

This year to coincide with WAAW, UKHSA is exploring targeted communications activity aimed at members of the public who are known to have low awareness and understanding of the uses of antibiotics and those who inappropriately use or obtain antibiotics, with a specific focus on those aged 18 to 34 years.

This campaign will be social media driven, sharing well targeted creative assets that resonate with younger people. We will share creative assets with key stakeholders closer to the launch of the campaign and welcome support from HCPs to disseminate the key messages. Look out for our stakeholder cascade in the run-up to WAAW for more information.

Keep Antibiotics Working and Antibiotic Guardian campaigns

In 2014, PHE (now UKHSA) developed the Antibiotic Guardian campaign and associated resources to provide educational resources to help tackle AMR in the UK. This was in collaboration with the Department of Health, Veterinary Medicines Directorate (VMD), the devolved administrations, local government, and professional organisations.

The impact and evaluation study of Antibiotic Guardian demonstrated that the campaign increased commitment to tackling AMR in both healthcare professionals and members of the public, increased self-reported knowledge, and changed self-reported behaviour, particularly among people with prior AMR awareness.

Antibiotic Guardian images are available for use.

In 2017, PHE launched a national campaign Keep Antibiotics Working (KAW) across England to support the government’s efforts to reduce inappropriate prescriptions for antibiotics by raising awareness of the issue of antibiotic resistance and reducing demand from the public using TV, radio, and social media.

KAW raises awareness of antibiotic resistance amongst the general public and encourages greater trust in the advice from healthcare professionals when it comes to whether consumers need antibiotics or not.

Although the campaign has not actively run on TV and radio since 2019, the KAW resources are still current and available to download and use. The KAW leaflets, posters and social media resources were translated into 12 additional languages in 2022. See figure 1 for examples.

Figure 1. Three examples of a Keep Antibiotics Working campaign poster

From left to right, these posters are written in Urdu, Arabic and Polish. Each poster consists of a white background with a red border and an image of a red and white antibiotic pill, which has been split in half at the centre of the poster. An NHS logo is placed at the top left of the first 2 posters, and at the top right of the third. The ‘Keep Antibiotics Working’ logo is placed at the bottom right of the first 2 posters, and at the bottom left of the third.

One Health

Tackling AMR requires a One Health approach.

Antimicrobial resistant microbes can spread between and within human, animal, and plant populations and migrate through the environment. This means a One Health approach is needed to tackle AMR where people across these sectors work together to combat this problem.

The One Health Antibiotic Guardian campaign, led by UKHSA, aims to stimulate behaviour change and increase engagement across all sectors, to tackle AMR, through an online, action-based pledge system. There have been pledges from over 129 countries and the pledges are available in 5 languages.

UKHSA work closely with partner organisations, such as Veterinary Medicines Directorate (VMD), to ensure initiatives such as Antibiotic Guardian and School Ambassadors scheme include information and resources on AMR that can be utilised across all sectors.

A joint report on antibiotic use in animals and humans and antibiotic resistance in the UK between 2013 and 2017 was published in 2019, called UK One Health Report: antibiotic use and antibiotic resistance in animals and humans.

Antimicrobial resistance systems map

An AMR systems map was developed by Department of Health and Social Care, VMD, Public Health England (now UKHSA), and the Department for Environment Food and Rural Affairs. It influences on the development of AMR at top level. It shows how the animal, human food, humans, the environment, and animals are all interconnected through various means such as pathway for microbes, and high level influences and interventions.

European Antibiotic Awareness Day and World AMR Awareness Week

European Antibiotic Awareness Day (EAAD), led by the European Centre for Disease Control (ECDC) is a public health initiative aimed at encouraging responsible use of antibiotics held on 18 November every year.

World AMR Awareness Week takes place from 18 to 24 November each year. WAAW is led globally by WHO. It aims to increase awareness of global AMR and to encourage best practices among the general public, health workers and policy makers to avoid the further emergence and spread of drug-resistant infections.

WHO’s WAAW 2023 campaign theme will remain as ‘Preventing antimicrobial resistance together’. This theme highlights that fighting AMR is a truly global endeavour and must be addressed through a One Health approach. The slogan of WAAW remains ‘Antimicrobials: Handle with Care’. WAAW campaign materials produced by WHO are available from their campaign website.

Antibiotic Guardian, EAAD and WAAW support the aims of the UK 5-year action plan for AMR 2019 to 2024 and the UK 20-year vision for AMR, which set out actions to slow the development and spread of AMR. The next UK 5-year national action plan for AMR 2024 to 2029 is currently in development and will be published in 2024.

The NHS, local authorities, professional bodies and organisations, universities, educators, and others are asked to support Antibiotic Guardian, EAAD and WAAW which can make impact locally and nationally.

You are invited to register your organisation’s planned AMR awareness activities for EAAD and WAAW.

Suggested WAAW daily themes

WAAW runs from 18 to 24 November each year, irrespective of which weekdays these fall on. Below are suggestions of themes for each of the 5 weekdays in WAAW that colleagues can use or adapt to base their own local WAAW activities and communications on:

• Day 1 – ‘Prevention’ theme (including Infection Prevention and Control measures and vaccination)
• Day 2 – ‘Antimicrobials in clinical practice’ theme (antibiotic course length, promoting shorter course length, empiric prescribing, intravenous-oral switch, promotion of current clinical guidelines)
• Day 3 – ‘Optimising diagnostics’ theme (increasing understanding of established and innovative methods of detection of infection, antibiotic-resistant or otherwise)
• Day 4 – ‘Antimicrobials and untrue or spurious allergy’ theme (including issues such as untrue penicillin allergy labels and de-labelling spurious antibiotic allergy labels)
• Day 5 – ‘Antimicrobial resistance and the environment and research’ theme (linking AMR with environmental considerations, such as disposal of antibiotics and environmental contamination. One Health approaches to tackling AMR through research may also be highlighted on this day)

A summary of key messages, aligned with each daily theme, can be downloaded to use for communications. There are 3 cross-cutting themes underpinning all 5 days; children, sustainability, and inequalities. These messages are included in the digital notes and teleconference backgrounds.

Throughout WAAW, the WHO is encouraging colleagues globally to ‘Go blue for AMR’ – see Annexe 1 and visit the WHO WAAW campaign page for more information.

Resources to support each of the themes are available online.

Factors associated with health inequalities

One of the underlying threads for the WAAW daily themes is health inequalities. A scoping review undertaken by UKHSA found evidence showing influence of factors commonly known to be associated with health inequalities on both antibiotic use and antibiotic-resistance infections in high income countries.

Health inequalities are a universal problem, however the extent to which certain factors influence the disparities in health vary by country. The study highlighted the influence of race or ethnicity, and antibiotic use was particular to country context. The study found that those in older age groups, particularly in residential care settings, were found to have the highest antibiotic use, and areas of high deprivation had higher antibiotic use compared with areas of no or low deprivation.

Healthcare professionals including those in the pharmacy profession, are ideally placed in community and hospital settings to raise awareness of how inequalities impact infection management and resistance rates, as well as advocating for equity of access in Core20PLUS populations.

Using the key messages are a great way to reach out to certain populations and vulnerable groups to provide information that is clear and concise and can encourage conversations and raise awareness of AMR.

Planning your own WAAW or EAAD workshop and knowledge café

In 2020, a workshop entitled ‘Planning your own WAAW or EAAD 2020 activities in the context of COVID-19’ took place virtually and comprised presentations from PHE (now UKHSA), TARGET, e-Bug and Antibiotic Guardian award-winning projects. This workshop was designed to aid local teams in planning their own WAAW campaigns. The recording of this session is available online.

A second session was run in 2021 and was adapted into a ‘Knowledge Café’ format, which seeks to help surface the group’s collective knowledge; learn from each other; share ideas and insights. A recording of the knowledge café is available online.

It is recommended that colleagues view these 2 local WAAW planning events, to gain insight into national activity, available AMS resources and successful projects from previous years, which may help in planning local WAAW activities.

Digital resources to share during WAAW

A range of digital resources were created for WAAW 2020, with consideration of the difficulty in sharing resources and running local WAAW events due to the COVID-19 pandemic. These digital resources were expanded in 2021 and 2022 and are available for use in planning local WAAW campaigns.

The resources include short messages, images and X, formerly Twitter, polls that can be quickly and easily shared during WAAW, aligned with the suggested themes in the previous section. The use of digital resources also considers the priority to develop a greener NHS and reduce the use of paper resources. Many can also be adapted for local messaging and are available online.

These have been developed by a sub-group of the national WAAW and EAAD planning group. They are designed to be suitable for primary and secondary care and for use by healthcare workers. We also encourage local teams to develop and share their own local messages. They can be shared via WhatsApp, used as screen savers, email signature or social media.

The Sticky notes are available in blue and yellow designs and use different writing styles. A template for creating your own digital notes with custom text is also available. Two examples of the digital notes are shown in Figure 2. They are examples of both the yellow and blue backgrounds with 2 of the writing styles.

Figure 2. Examples of the digital sticky notes available for use during WAAW

This figure shows 2 digital ‘sticky note’ style images – one yellow on the left, and one blue on the right. The yellow digital note contains the text ‘Vaccination prevents infection’ while the blue note contains the text ‘STOP antibiotics if no evidence of bacterial infection’. These messages are both followed by the hashtags #AntibioticGuardian and #KeepAntibioticsWorking.

A range of thank you notes have also been designed, based on 5 core themes (Start smart then focus, Empiric prescribing, Course length, Patient safety and Resistance). These can be adapted for local messaging and include your organisations logo and are available to download. It is recommended to include images or figures to celebrate good practice within your organisation (for example a figure demonstrating reduced antibiotic prescribing in your local trust) to share with colleagues.

A range of One Health digital cards – produced by the Veterinary Medicines Directorate – are also available for use. See figure 4 for an example.

We encourage use of the message style that is most suited to your organisation. The format will allow adaptation for local messages. Figure 3 shows examples of local messaging using ‘digital thank you notes’.

Figure 3. Examples of the digital ‘thank you’ notes available for use during WAAW

This diagram shows 3 examples of these digital notes, 2 with a blue background and one with a red background. Each image includes a yellow ‘sticky note’ style image in the centre, upon which the word ‘Thankyou’ is written in large text. Each note then follows with a specific message. The first blue note at the top left of the figure includes the NHS logo in the top right of the image. The red note at the top right of the figure includes the Antibiotic Guardian logo in the top right of the image. The blue images contain the hashtags #AntibioticGuardian and #KeepAntibioticsWorking at the bottom of the yellow stickynote and the red image contains just the #AntibioticGuardian. The blue image at the top left contains the message text ‘for thinking about antibiotic course length!’ after the large ‘Thankyou’ text, whereas this is followed on the red image by the text ‘for TARGETing patient information and safety netting when you treat infections’. The blue image at the bottom centre of the figure contains free space underneath the ‘Thankyou’ text for colleagues to enter their own message, as well as a space at the top right for colleagues to include their own logo.

Figure 4. An example of the Veterinary Medicine Directorate-produced One Health digital card, for use during WAAW

This image consists of a blue box for silhouette images of a range of animals, fish, humans, and trees arranged in a ring in the centre. Within this ring reads the text ‘Together we can prevent antimicrobial resistance’. Text in the bottom left of the image reads ‘Choose a pledge and become an #AntibioticGuardian via www.AntibioticGuardian.com. The Antibiotic Guardian logo is included in the top right, with the WHO WAAW logo placed in the top left.

Two quick guides have been produced to streamline local engagement with national WAAW initiatives. The first is a guide to engaging with your local communications team ahead of and during WAAW. Its purpose is to facilitate the collaboration of colleagues with their local communications professionals, to produce and release impactful WAAW materials.

The second guide shows how to produce and share an organisational WAAW video. We recommend that colleagues work with senior leaders, or within their own team to record and share a promotional video during WAAW. We suggest the following video types, although you may wish to record other content ahead of WAAW.

AMS pledge video

A short video from a senior leader to highlight the ongoing commitment to – and importance of – tackling AMR.

Resource promotion video

A short video to highlight existing AMS resources and signpost to where users can find them.

‘Meet the team’ video

A short video to highlight current work in tackling AMR, while showing the friendly faces of your organisation.

This guide on organisational WAAW videos, which provides suggested wordings and examples from previous years, is available online and a preview can be seen in Figure 5. These organisational videos can be shared using the organisation’s social media channels, intranet and/or staff newsletters. Please use the following hashtags when sharing:

• AntibioticGuardian

• KeepAntibioticsWorking

• WAAW2023

Figure 5. Screenshot of the quick guide to recording organisational videos for WAAW

This image contains both pages of the quick guide shown side-by-side. Each page contains a 2-tone white and red background designed to align with the red and white pill motif used by Antibiotic Guardian and Keep Antibiotics Working campaigns.

The first page on the left of the figure contains 2 sections – the first is an introduction followed by a summary of the 3 message types that colleagues can choose from when recording a video.

The second section contains suggested wording for colleagues to use when scripting their videos. On the second page – on the right of the figure – a further 2 sections are included. The first section provides a range of tips and suggestions for recording the videos. The second section contains examples of videos shared in 2020, with links to tweets and screenshots of the videos included.

A teleconference background has been developed for use during WAAW and beyond. This has been developed to include key messages that align with the WAAW themes cited earlier in the toolkit. The ‘red and white pill’ design has been used for this background, to align with other WAAW resources used in England, as well as the Antibiotic Guardian campaign. This background is designed to spark conversation when in virtual meetings.

A range of teleconference backgrounds with various messages can be found online, alongside ‘Antibiotic Guardian’ and ‘Keep Antibiotics Working’ general backgrounds, which can be used at any time.

A blue version of the teleconference background has been designed to align with the ‘Go blue for AMR’ day organised by WHO. For more information, see Annexe 1. A guide to applying a virtual background on Microsoft Teams can be found online.

Figure 6. Example of a teleconference background

This image contains a 2-tone white and red background designed to align with the red and white pill motif used by Antibiotic Guardian and Keep Antibiotics Working campaigns. The Antibiotic Guardian and Keep Antibiotics Working logos are included in the top left of the image. At the bottom left of the image, the text ‘World Antimicrobial resistance Awareness Week’ is included in large black text, with the first letter of each word shown in larger lettering in red to highlight the abbreviation. This text is followed by ‘18 to 24 November’ beneath it, to mark the date of the week. At the bottom right of the image, the text ‘Contact me to find out about resources available for tackling Antimicrobial Resistance’ is included in white. At the top right of the image, white text reading ‘Don’t let antibiotics go viral. Cold, COVID-19 or flu? Then antibiotics won’t help you’ is included.

The Twitter polls, now known as X will be hosted by UKCPA PIN social media accounts and we encourage you to engage with and promote these polls during WAAW.

There will be 5 polls with a different poll shared each weekday of WAAW and the answers will be shared the following day. The polls are also available for local use.

Global X relay (formerly Global Twitter relay)

Join the 24 hour Global X relay in collaboration with US CDC, ECDC and others on 18 November. The set time for the UK will be published closer to the date. Please continue to post on social media at anytime but we encourage colleagues to post on X of the same image and message at the start of the UK designated time, then your choice of additional messages for the rest of the hour. See figure 7 for the Global X relay tweet card.

Global X relay message:

AntimicrobialResistance is one of the most urgent global threats to the public’s health. Antibiotics can cause side-effects, including nausea and diarrhoea and contribute to the development of #AntibioticResistance.#AntibioticGuardian #KeepAntibioticsWorking #WAAW

This X relay is an opportunity for colleagues to focus dissemination of AMS-related messages and/or related images on the X platform and other social media account(s).

To add an X relay reminder to your Outlook calendar, you can access a downloadable version of the calendar invite.

In addition to the joint message and tweet card, there are other Global X relay images and messages available for use.

Social media posts can be prepared ahead of time and set to be published at a pre-determined time, in case you are busy during the hour of the X UK relay. To schedule a post on the X app, click the calendar icon in the X post box once you have created your post to open the ‘Schedule’ box , you can then set the date and time that your tweet will be released, before clicking the ‘Confirm’ button. For more information, contact your local communications team.

Colleagues are encouraged to use the following hashtags when taking part in social media activity during WAAW:

• #AntibioticGuardian

• #KeepAntibioticsWorking

• #WAAW2023

Figure 7. An image of the X card available for use during the global X relay

This image includes a logo for UKHSA at the top left and a logo for the ‘Antibiotic Guardian’ and ‘Keep Antibiotics Working’ campaigns at the bottom left, above 3 hashtags in a maroon footer box (#AntibioticGuardian, #KeepAntibioticsWorking, #WAAW). An image of a pile of red and white antibiotic pills is placed next to the Antibiotic Guardian logo and a QR code for the Antibiotic Guardian website is placed above the pill image. To the left of the QR code reads the text ‘#AntimicrobialResistance is one of the most urgent global threats to the public’s health. Antibiotics can cause side-effects, including nausea and diarrhoea and contribute to the development of #antibioticresistance’.

Suggested actions for reducing the impact of antibiotics on the environment

As part of the daily WAAW theme ‘Antimicrobial resistance and the environment and research’, consider how you can play a role in reducing the impact of antimicrobial use on the environment and ensuring sustainable use. Digital resources for information and sharing can be accessed online and used to support your activity.

Please consider the following suggested actions for how healthcare practitioners and the public can help to reduce adverse environmental impacts of antimicrobial use.

Suggested actions for healthcare practitioners to reduce the impact of antibiotics on the environment:

• raise awareness with colleagues about the environmental effects of not disposing of antimicrobials in the correct way

• teach students and junior staff the correct procedures for disposal of antimicrobials

• encourage patients to return unused antimicrobials to their nearest pharmacy for safe disposal and not to flush antimicrobials down the toilet

Suggested actions for healthcare practitioners to reduce the impact of antibiotics on the environment:

• take unused or expired antibiotics to the local pharmacy for safe destruction
• don’t throw antibiotics down the drain or toilet
• talk to my friends and family about the safe disposal of antibiotics

Additional AMR resources, toolkits and wider activity

Toolkits and resources

Previous versions of WAAW or EAAD toolkits

WAAW or EAAD toolkit, including versions from previous years are available online.

Quizzes and crosswords

You can have a virtual competition or share quizzes and crosswords via your organisation or school newsletter.

AMS game

The AMS game is an educational game for healthcare professionals, this explores AMS and AMR; it is available as a face-to-face (board game) and online versions. The 4 broad areas addressed in the game are:

• introduction to AMR and stewardship
• appropriate use of antimicrobial agents
• infection prevention and control
• stewardship and surveillance

The game can be played by all members of staff, including:

• doctors
• nurses
• pharmacy teams
• veterinary teams
• laboratory staff
• other clinical staff
• support staff
• cleaners and porters
• students

A manuscript describing the educational AMS game – which was co-created by a multidisciplinary team of health professionals spanning across high- and low- to middle-income countries – is available online.

Figure 8. A figure demonstrating the AMS game in both a physical and virtual format

The figure is split into 2 images. The image on the left shows a physical version of the boardgame, which sits in front of its box. On the right, there is an image of an individual using a laptop, with an online version of the game on the screen. In both images, the game takes the form of a 10 by 10 grid board, with alternating blue and purple squares.

Posters and leaflets

Posters and leaflets are available for the public and healthcare professionals to support antibiotic awareness campaigns in the UK.

Patient story videos

Patient story videos can be shared as part of WAAW campaigns.

Start smart then focus toolkit

Start smart then focus (SSTF) is a toolkit of evidence-based AMS resources for the secondary healthcare setting. The competencies and algorithms were updated using a stepwise and systematic approach, and were subsequently published on 15 August 2023.

It is recommended that healthcare organisations should monitor adherence to the SSTF principles regularly in all clinical areas (at least annually) and, in England, evidence adherence to the Code of Practice, developing an action plan for improvement as required.

Secondary care prescriber’s checklist

Prescribers in secondary healthcare can use the prescribing antimicrobials checklist to help make decisions about prescribing antibiotics. This checklist was updated in September 2023, and is an updated version of the resource previously published in the SSTF toolkit.

IV to oral switch criteria

IV to oral switch criteria is available to support early switching from intravenous to oral antibiotics, co-produced through a UK-wide consensus process. Note, this tool and associated resources will be published ahead of WAAW and can be accessed via the associate link once published.

Antibiotic Review Kit

The Antibiotic Review Kit (ARK) website holds a range of resources designed to help all healthcare professionals to reduce antibiotic overuse in hospitals.

Antibiotic amnesty resources

Resources for organising a local antibiotic amnesty are hosted on the Royal Pharmaceutical Society website. This initiative encourages individuals to safely dispose of unused or leftover antibiotics in collaboration with community pharmacies and veterinary practices.

Dental toolkit

The dental AMS toolkit helps primary care practitioners promote the appropriate use of antibiotics in dental care.

Antimicrobial and prescribing stewardship competencies

The antimicrobial and prescribing stewardship competencies for all independent prescribers to help improve the quality of prescribing practice are available on GOV.UK. The antimicrobial prescribing and stewardship competency framework was updated and published in August 2023.

Wider activities and resources

European Centre for Disease Prevention and Control resources:

• plan a campaign – European Antibiotic Awareness Day

• resources for healthcare workers

WHO is encouraging that the global community ‘Go blue for AMR’, particularly on 24 November. This can be supported through online presence, physical communities, and workplaces. Find out more in Annexe 1.

Infection Prevention Society’s Infection Prevention Week.

WAAW or EAAD national planning group

The national WAAW or EEAD planning group meets biannually to discuss national plans for WAAW or EAAD and share learning. The group is chaired by Dr Diane Ashiru-Oredope, UKHSA.

The planning group had representation from:

• all UK nations
• UKHSA teams (including AMR Programme Board, e-Bug, TARGET, Behavioural Insights)
• NHS England
• British Society for Antimicrobial Chemotherapy (BSAC)
• Centre for Postgraduate Pharmacy Education (CPPE)
• Royal Pharmaceutical Society (RPS)
• Veterinary Medicines Directorate, Department for Environment, Food and Rural Affairs (DEFRA)
• Health Education England (HEE)
• National Institute for Health and Care Excellence (NICE)
• British Dental Association (BDA)
• Leeds GP Confederation
• Regional Antimicrobial Pharmacists Network

The resources for WAAW are developed through a multidisciplinary subgroup, which has been led by Dr Louise Dunsmure (2020), Fran Garraghan (2021 and 2022) and in 2023, Rakhi Aggarwal.

Annexe 1. WHO WAAW campaign

WHO is encouraging the global community to ‘Go blue for AMR’, particularly on 24 November. This can be supported through online presence, physical communities and workplaces. More information about the WHO WAAW campaign, including a toolkit, can be found online. An adapted teleconference background designed to align with the ‘Go blue for AMR’ day is shown in Figure 9. An example of ‘Go blue for AMR’ activities being advocated on social media is shown in Figure 10.

Ways to join the campaign

Individuals

1. Wear light blue when participating in WAAW events.

2. Adjust your social media profiles to blue.

3. Share why you are ‘Going blue’ with friends, family, colleagues, and on social media (for example, “I’m Going blue in honour of my uncle, who contracted a drug-resistant infection following hip surgery” or “As a doctor, I’m ‘Going blue’ to spread awareness among my colleagues about responsible antimicrobial prescribing”).

Workplaces or organisations

1. Light up one health stakeholder facilities (human and animal hospitals, clinics, laboratory facilities, pharmaceutical headquarters, universities) in blue.

2. Combine this with workplace actions: create or review AMS programmes, educate staff on AMR and make a workplace commitment to AMR-related change.

3. Share with the world! Use social or traditional media to announce why your workplace staff are going blue.

Figure 9. Example of a teleconference background adapted for use during WAAW as part of the WHO ‘Go blue for AMR’ day on the 24 November.

This image contains a 2-tone white and blue background. The Antibiotic Guardian and Keep Antibiotics Working logos are included in the top centre of the image with the WHO ‘Antimicrobial – Handle with care’ logo below it. To the left of these 2 logos, text ‘World Antimicrobial resistance Awareness Week’ is included in large black text, with the first letter of each word shown in larger lettering in blue to highlight the abbreviation. This text is followed by ‘18 to 24 November’ beneath it – in blue – to mark the date of the week. To the right of the logos in the centre top of the image is the text ‘Go blue for AMR. Contact me to find out about resources available for tackling Antimicrobial Resistance’. The first sentence is in dark blue, with the subsequent wording in lighter blue.

Figure 10. Examples of social media posts for WAAW and EAAD 2022

Figure 10 shows a collage of 4 screenshots of former Twitter posts sitting side by side. Far left screenshot posted by Cheshire West of a bridge and clocktower in the background lit blue. Middle left screenshot posted by Lancashire and South Cumbria ICB is of Blackpool tower, a tall structure, lit up blue at night time, with a building visible in the foreground. Middle right screenshot posted by Gill Damant with three thumbnail images below some text, on the left a picture of a statue of Sir Tom Finney kicking a football over some water with a fountain in the background which are lit blue for Go Blue campaign. To the top right of this image is a smaller thumbnail of Preston North End Football Club stadium lit up in blue, below this is image on the bottom right is a wider angle shot of the same stadium lit up in blue lights with some trees and grass verge in the foreground. The far-right image is a screenshot of a post by Blackpool Gazette with Blackpool tower in the background during the day time and a fairground ride in the foreground, with the text ‘Why Blackpool tower will light blue (spoiler, it’s a micro reason)’.

Public feedback on Go Blue campaign

Research was conducted by the international insight consultancy, Basis, to determine the awareness and impact of supporting WHO’s ‘Go blue for AMR’ campaign. The research focused on the local area of Blackpool to understand the reaction to local activity, including lighting up Blackpool Tower.

This research highlighted the importance of clear, impactful messaging for this campaign. A high number of people interviewed (94%) were aware of the Tower being lit blue before they were interviewed, however the majority (64%) did not see any messages, and 3% of those interviewed thought the messages said ‘keep antibiotics working’.

Although 93% of those interviewed had an understanding of antibiotic usage, such as never sharing antibiotics with anyone else, around 1 in 5 had never heard of AMR week.

Therefore, we encourage that throughout the Go Blue activities, to ensure that there are clear messages highlighting the reasons behind this, to ensure maximum impact on driving the key message and overall awareness of WAAW.

Email ESPAUR@ukhsa.gov.uk for more information on how we can help you with the Go Blue campaign.