AMR and HCAI: Surveillance, epidemiology and data modelling
UKHSA identifies infection risks, evaluates intervention impact, and generates insights that guide national policy.
Services provided by the AMR and HCAI Division are underpinned by evidence-based research and advanced modelling. Surveillance of infections and data analysis are central to identifying problems and evaluating control measures. These activities are strengthened through cross-divisional collaboration on modelling and health economic research, which assess transmission dynamics and intervention impact to inform national policy. Innovative modelling techniques are applied across community and hospital settings, providing insights that shape decision-making and strengthen the evidence base for the AMR National Action Plan. Close collaboration with academia and external partners, supported by external grant funding, enables the division to deliver translational outputs that drive policy and practice.
Work with our AMR and HCAI teams
We work with industry, academia and government. Contact AMR and HCAI to find out how we can help you.
Antimicrobial Resistance and Prescribing (AMRP) team
UKHSA conducts laboratory and epidemiological surveillance and reporting of high-priority AMR infections, including those caused by carbapenemase-producing Gram-negative bacteria and fungal pathogen Candidaozyma auris. We collaborate with NHS England on data capture, provision and visualisation of AMR and antimicrobial use (AMU) metrics, which are publicly available on Fingertips and NHS England’s internal dashboard, FutureNHS.
The AMRP team is the main contributor to the annual English Surveillance Programme for Antimicrobial Utilisation and Resistance (ESPAUR) reports and led the development of UK-wide human health targets for AMU for the latest UK AMR national action plan (NAP).
AMRP: important outputs
The AMRP team has:
- conducted systematic surveillance of AMR in NHS laboratory samples
- supported NHSE’s Commissioning for Quality and Innovation (CQUIN) framework
- coordinated the 2023 National Point-Prevalence Survey (PPS) on HCAI, MU and AMS in England
- coordinated PPS in intensive care units to estimate carbapenamase-producing enterobacteales (CPE)
- produced the One Health AMR report on antibiotic use, sales and resistance in collaboration with Defra and the Veterinary Medicines Directorate
- supported C. auris outbreak response by providing epidemiological reports to incident management teams, health protection teams, NHS stakeholders and the public
Global reference microbiology
The division works closely with the Antimicrobial Resistance and Mechanisms Service and the wider Antimicrobial Resistance and Healthcare-Associated Infections (AMRHAI) Reference Unit within the Public Health Microbiology Division (PHM), serving as the WHO Collaborating Centre for Reference and Research on AMR and HCAI. They support the WHO by providing reference laboratory services for antimicrobial susceptibility and characterisation of healthcare-associated bacteria, and by developing laboratory capacity standards and procedures.
AMRHAI is also an ESCMID Collaborative Centre, receiving overseas visitors to learn laboratory best practices for antimicrobial susceptibility and characterisation of healthcare-associated bacteria.
For more information, see Specialist and reference microbiology: laboratory tests and services.
Gram-positive Surveillance
Streptococcal and staphylococcal infections
UKHSA is an internationally renowned centre for research into streptococcal infections. Through the prestigious WHO Collaborating Centre for Streptococcal Diseases, the agency has improved standards in the diagnosis and characterisation of streptococcal strains and generated an impressive evidence base to inform prevention strategies.
The development of surveillance infrastructure and novel use of data linkage methodology has allowed us to identify, quantify and track risk factors and outcomes. Additionally, the development of both genomic and spatio-temporal statistical methods has improved early detection of outbreaks.
Through nationwide outbreak investigation, we have developed internationally recognised expertise in controlling streptococcal infections.
Gram-positive Surveillance: important outputs
On Gram-positive Surveillance, the team has:
- co-ordinated national incident response for the 2022 surge in paediatric invasive Group A
- contributed to the evidence base for streptococcal infection prevention, leading to revised national public guidelines for managing iGAS
- conducted research on iGAS transmission in schools and nurseries
- investigating human genetic risk for iGAS infection
- used whole genome sequencing (WGS) to quantify cross-infection in late-onset infant Group B streptococcal (GBS) disease and define SNP thresholds for genomic clustering
Surgical site infections
UKHSA lead the Surgical Site Infection Surveillance Service (SSISS), which provides the infrastructure for hospitals to monitor surgical wound infections for a range of procedures, enabling comparison of rates between hospitals, identifying trends and ultimately improving patient safety. The team produce an annual report of surgical site infection (SSI) data collected by NHS Hospitals and independent sector NHS treatment centres.
The team also support local and national investigations of incidents relating to SSI. Through analysis of national data, the team derives new findings of importance in evaluating the impact of surveillance, identifying and quantifying patient and surgical risk factors, assessing patient outcomes associate with SSI and highlighting inequalities in risk according to wider socioeconomic factors.
The SSI team plays an important role in teaching and training in IPC and healthcare epidemiology through a range of postgraduate courses and supervision of public health, microbiology, field epidemiology and paediatric trainees on placement and masters student projects.
SSI: important outputs
The SSI team has:
- facilitated and supported hospitals in reducing SSI risk across various surgical procedures
- participated in national and international research to establish an evidence base for SSI prevention
- provided bespoke multivariable analyses and support to hospitals with high SSI rates for targeted public health action
- developed and delivered online training in surveillance methodology
Gram-negative surveillance
The HCAI division manages the national mandatory surveillance programme to collect data on healthcare-associated infections covering Clostridioides difficile infection, Staphylococcus aureus (MRSA and MSSA) and key Gram-negative bacteraemia including Escherichia coli, Klebsiella species and Pseudomonas aeruginosa.
Monthly counts of important microorganisms are published, along with quarterly and annual epidemiological commentaries. UKHSA works closely with partners and stakeholders to monitor and address concerns in incidence.
We also run a national surveillance programme on bloodstream infections (BSI) in critical care. The aim of the programme is to monitor BSI rates in critical care units in England, particularly in relation to central venous catheter (CVC) use, and inform quality improvement efforts in this area.
Gram-negative surveillance: important outputs
The HCAI division has:
- developed innovative analytical tools for large datasets via the Unified Infection Dataset
- launched our first public-facing ‘Mandatory bacteraemia and CDI’ dashboard, hosting monthly national statistics
- including additional data on health equity, specifically ethnicity and IMD, into our annual epidemiology
- initiated and rolled out several stakeholder engagement and training programmes at regional and national levels
AMR PROGRESS
Launched in 2024, AMR PROGRESS (AMR PROGRamme, ESPAUR, Stewardship, infection burden and sepsis, coinfections and AMR evaluation) is a cross-divisional initiative designed to strengthen collaboration and impact across UKHSA. This programme unites multiple teams and functions from the AMR and HCAI Division and other areas, integrating expertise in surveillance, stewardship, programme delivery, and evaluation.
The initiative brings together both established and newly created teams: ESPAUR and AMS (formerly part of IOIG), the AMR Programme (previously within Business Operations), coinfections and Gram-negative teams, and new units focused on infection burden, sepsis, and AMR evaluation. By aligning these diverse capabilities, AMR PROGRESS delivers a coordinated approach to tackling antimicrobial resistance and improving patient outcomes.