hospital personnel might be a result of their implementation late in the epidemic, when the environment was heavily contaminated with spores.

The emergency department (ED) is the cornerstone between hospital and community, and represents a crucial setting for implementing antibiotic stewardship programmes, as another study indicates. Savoldi and Tacconelli et al undertook a four-year, non-restrictive, multi-faceted study within a general ED with the aim to evaluate the impact of a programme on antibiotic use and costs.18

The study also

focused on assessing the impact on length of hospital stay (LOS), CDI incidence rate, and mortality in the patients’ group admitted from ED to medical wards. The antibiotic stewardship implementation was associated with a reduction of antibiotic use and costs. In addition, a mild but sustained length of stay decrease was observed in all medical wards, along with a significant downward trend of CDI incidence rate. Mortality did not significantly change, however.18 Prof. Tacconelli went on to outline a number of priority areas that must be considered, when implementing a programme, advising delegates to: 1 Define the leadership, budget and personnel.

2 Collaborate with the microbiology department.

3 Define the targets. 4 Choose the setting. 5 Select the indicators (including side effects).

6 Gain the co-operation of an infection control practitioner.

7 Carefully revise national or regional guidelines.

8 Stay up to date with new studies on stewardship.

9 Ensure multidisciplinary collaboration. 10 Work closely with an IT expert.

Surveillance is also vital and Prof. Tacconelli highlighted the value of appropriate local data. For national benchmarking, EPI- Net, also provides data on the emergence and spread of antimicrobial resistance in humans and animals, as well as healthcare- associated infections (HCAIs). The data source lets users compare resistance rates across Europe in the form a heat map. The JPI-AMR funded ARCH Net (Bridging the gap between humAn and animal suRveillance data, antibiotic poliCy, and stewardsHip [ARCH]) has also been established to tackle the issue of effective surveillance. The ARCH Network brings together multisector specialists and networks in the field of animal and human surveillance to bridge the gap between surveillance data and antibiotic stewardship. Major goals of the ARCH Net are to: 1 Provide new tools to strengthen cooperation between surveillance and stewardship teams.

2 Facilitate the antibiotic stewardship teams enabling appropriate assessment of the AMR rates according to case-mix of patients and settings to develop antibiotic policy recommendations.

3 Reduce the heterogeneity of microbiological and sensitivity data reporting in surveillance systems.

4 Promote and harmonise reporting in animal surveillance and stewardship and to connect it with human recommendations.

The network has been tasked with developing four white papers offering practical guidance to link surveillance data to therapy recommendations, focusing on the hospital, long-term care facility, ambulatory and veterinary clinics. Considerations include: l Which resistant pathogens should be targeted?


l How should resistance be monitored? l Should non-clinical samples (screening and colonisation status) be monitored?

l Which time interval for reporting? l Report delivery. l Which stratification criteria should be adopted?

l Define thresholds to direct therapy decisions. l Establish criteria for ranking antibiotics. l Develop stewardship guidelines for specific sub-settings.

Checklists will be downloadable from December 2020. (https://archnet- Prof. Tacconelli went on to point out that infection prevention and control training among nurses and doctors varies greatly across European countries. With this in mind, EUCIC (the European Committee on Infection Control) was established within the European Society of Clinical Microbiology and Diseases, which aims to strengthen infection control and prevention measures in European countries to reduce HCAIs. This is achieved through a network offering resources and knowhow, as well as the organisation of training programmes and support structures. The EUCIC Training Programme in Infection Prevention and Control integrates international courses in selected EUCIC training centres, aiming to train a new generation of specialists in Infection Prevention and Control in Europe. The Training Programme consists of basic, advanced and local modules, observerships and e-learning modules. (https://www.

Beyond COVID-19

The COVID-19 pandemic has ushered the world into a new era and Prof. Tacconelli highlighted a paradigm shift in infection management. The population at risk of


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