Antimicrobial resistance (AMR) is a serious public health threat that is gaining swift ground. The increase of multi-resistant bacteria associated to the lack of new antibiotics represents a threat to global health. Some patients are faced with no therapeutic solutions as some bacteria resist to all antibiotics. Moreover, “old” antibiotics and to some extent more “recent” ones are gradually removed from the market because they are not economically sustainable, albeit being still possibly efficient. The issue of antimicrobial resistance is a real challenge that decision-makers are well aware of and has gained a high priority among public health challenges.
A closely related challenge is the issue of Healthcare Associated Infections that shall not be considered separately. In fact, infection prevention and control strategies should go hand in hand with i) prudent use of antibiotics ii) appropriate tools for monitoring and surveillance and iii) accurate diagnostic tests to decide on the right therapy.
The various national, European and international initiatives that have emerged over the last decade have shown a great commitment to actively tackle these issues.It is essential that all actors in the field of AMR join forces so as to avoid duplication of efforts and ensure greater coherence. Moreover, it is essential that the strategies adopted extend beyond the sole human health domain and bring a global One Health response.
The overall objective of the AMR-HCAI JA is to ensure that policies for control of AMR and HCAI are adopted and implemented across EU MS in a coordinated way, ensuring national specificities are accounted for, in line with the ECDC and WHO guidelines and recommendations, and in conjunction with other European initiatives.This will be made possible by bringing together different networks of policy makers, experts and organizations on AMR and HCAI working in different European and International initiatives and projects relevant for policy decision.
The Joint Action EU-JAMRAI aims to bring together the participating EU member states and international organizations, institutes, universities to contribute to tackle Antimicrobial Resistance (AMR) and Healthcare- Associated Infections (HCAI). It will capitalize on existing initiatives and propose concrete steps to reduce the burden of AMR. This collaboration strives to foster behavioral change at individual and community level and tackle this pressing issue within a “One Health” approach, considering the prevention and control of AMR in humans, animals and environment.
AMR is a major public health problem that will cause 10 million deaths worldwide by 2050 unless action is taken. EU-JAMRAI is an EU-funded project that will contribute to face this problem, already responsible for an estimated 25,000 deaths per year in the European Union. Although AMR and HCAI (Health-Care Associated Infections) are often considered separately, the relationships between AMR and HCAI are well established, and both are dealt with by the same bodies in many organizations. Infection prevention and control strategies (IPC stewardship) should go hand in hand with i) prudent use of antibiotics (antibiotic stewardship), ii) appropriate tools for monitoring and surveillance and iii) accurate diagnostic tests to decide on the right therapy (diagnostic stewardship).
In line with the EU Action plan and the Council Conclusions on AMR (adopted on 17 June 2016) and the tripartite GAP, the Joint Action on AMR and HCAI will build on existing works and initiatives by Member States as well as international organizations (OECD, ECDC, WHO Europe, OIE and FAO). It will propose concrete steps enabling European countries to strengthen the implementation of efficient and evidence-based measures to tackle AMR and HCAI, for the benefit of Member States and overall public health in Europe.
Therefore, the overarching objective of the AMR-HCAI Joint Action is to support EU Member States develop and implement effective one health policies to combat AMR and reduce healthcare-associated infections.
The Joint Action will therefore contribute to:
• Identifying and testing evidence-based measures to address AMR and HCAI in different contexts and, based on the outcome of these tests, support capacity-building and provide recommendations to policy-makers (WP6, WP7, WP4);
• Bringing together different networks of policy makers, experts and organizations on AMR and HCAI working in different European and International initiatives and projects relevant for policy decision (WP1, WP2, WP4, WP5, WP8);
• Promoting (i) the One Health approach through a closer collaboration, understanding and trust between the animal health and human health sector, accounting for environmental issues, and (ii) the “One Health in all policies” concept (health policies should have an intersectoral dimension) in addition to the “Health in all policies” concept (all policies should have a health dimension) (WP5, WP7);
• Increase awareness and understanding of AMR across European member states (WP2, WP8)
• Producing concrete recommendations for a European contribution to international initiatives such as WHO, GHSA, G7…(WP2, WP4, WP9)
No less than 44 partners and more than 40 collaborating stakeholders from all over Europe participate in this JA. Key international organizations such as WHO Europe, OECD, OIE and FAO will take part in this project to fuel the debate with their expertise and ensure consistency with existing initiatives, including the WHO Global Action plan, the recently adopted EU action plan, the JPI AMR or the Council Conclusions on AMR. Additionally, representatives from health professionals, patients and industry will take part in EU-JAMRAI.
* Added value at EU level in the field of public health: The Joint Action will enhance cooperation between Member States, the European Commission and its agencies and other international organisations and will enable each tar
The aim of this JA is to join forces to define European common policies to fight AMR and to control HCAI in line with ongoing EU and international policies. The JA will look over the best programmes in each country to get the best for this JA and see how cooperation at EU level can improve national AMR-related policies. To efficiently implement concrete actions, the national specific political contexts of AMR and HCAI status (antibiotic prescription behaviour, AMR epidemiology, hygiene measures, variety of health-care systems, population size …) will be taken into account in all WPs. The JA will ensure that the key component of the Knoster modal (vision, skills, incentives, ressources and action plan) are used to foster change and ensure implementation at local level of JA recommendation.
By involving key stakeholders, the JA will capitalise on existing expertise derived from these various groups to elaborate and disseminate the JA outputs. Moreover, when appropriate, the stakeholders will be directly involved in the WPs. Besides stakeholders, HCW (general practitioners, hygienists, nurses,…), veterinarians and patient groups will be also highly involved. Only a coordinated action including all the partners at local and national levels and with a OneHealth approach will be decisive to successfully reduce AMR and prevent HCAI and have an impact on the overall public health in Europe.
There are nine work packages:
WP1: Coordination of the project: Leader: Inserm France. Actions undertaken to manage the project and to make sure that it is implemented as planned
WP2: Dissemination of the project. Leader: AEMPS Spain. Actions undertaken to ensure that the results and deliverables of the project will be made available to the target groups
WP3: Evaluation of the project. Leader: ISS Italy. Actions undertaken to verify if the project is being implemented as planned and reaches its objectives
WP4: Integration in National Policies and sustainability. Leader: Ministry of Social Affairs and Health (MoH-FR) France. Actions undertaken for integration of evidence-based policy initiatives and key recommendations issued from the JA into Member States policies, to support and improve national plans development, and to ensure the sustainability of the JA activities at national or on the local or regional level, based on the Knoster model.
WP5: Implementation of One Health national strategies and National Action Plans for AMR. Leader: Dutch Ministry of Health, Welfare and Sport (VWS) The Netherlands. Actions to support Member States (and other participant countries) on the implementation of some of the provisions laid down in the Council Conclusions on the next steps under a One Health approach to combat antimicrobial resistance
WP6: Policies for prevention of Health Care Associated Infections and their implementation co-leaders Hellenic Center for Disease Control and Prevention (HCDCP) Greece & Public Health Agency of Sweden (FOHM) Sweden. Actions to support the establishment of efficient and feasible infection control programs through the effective implementation of agreed key components for guidelines and/or other tools at national, regional and local level to prevent infections and thereby limit the use of antibiotics and spread of resistant bacteria in health-care settings.
WP7: Appropriate use of antimicrobials in human and animals. co-leaders: Norwegian Institute of Public Health Norway & AEMPS Spain: Actions to collate and organise into a useable database current guidelines for antibiotic stewardship at all levels of the European health system and to develop efficient tools and checklists for the implementation of guidelines for the proper use of antibiotics in all EU member states.
WP8: Awareness raising and Communication. Leader: AEMPS Spain. Actions to promote the responsible use of antibiotics and encourage best practices among the general public and healthcare professionals and through higher dialogue with young population a
- WP3: Development of an evaluation plan and progress monitoring and quality assessment of JA documentation and deliverables
- WP4: In the frame of the task of “Integration plan and sustainability strategy”, a survey for “prioritization of action to prevent and control AMR and HCAI” was set up with the aim to identify priority actions which are viewed by Members States and stakeholders as most relevant to tackle AMR and to control HCAI. It is launched and intended for the Advisory Committee members and stakeholders.
- WP 5: Mapping National Action Plans (NAPs) for AMR was carried out. The results were discussed during the workshop in the Netherlands on 22-23 Jan. 2018 and presented at the EU One Health Network on AMR meeting in Brussels on 5 Feb. 2018. Self-assessment tool of national strategies and NAPs for AMR, including the One Health approach was developed and sent to all countries participating in this JA. The results were discussed during the workshop in Warsaw on 3-4 Sept. 2018. Three pilot country to country visits took place in order to evaluate each other's NAPs and One Health strategies and to discuss future policy options, and plans: Germany to France; Slovenia to Czech Republic and Netherlands to Spain. The feedbacks were presented during the workshop in Vienna on 7 Nov. 2018.
- WP 6: Two surveys were developed in the frame of the task “Promoting a top-down approach for preventing HCAIs through the implementation of agreed infection control programs (ICP) and institutional behavior change”:
Survey A: for the key components of ICP based on the ECDC and WHO guidances and the requirements of the updated EU Action Plan for AMR regarding the hospital sector;
Survey B: related to barriers for an effective ICP implementation, linked to institutional policy & organizational behavior.
Both Surveys had large participation (more than 2600 responders from 8 countries), resulting in having a useful and essential insight into the clinical reality of hospitals regarding ICP implementation from 4 different perspectives: ICCs, HAs, HCWs and PHAs. Results depict not only the necessary institutional structures and resources for an effective ICP implementation, but also the limiting barriers that required to overcome as well as the behavioral change needed.
The topic - Catheter associated urinary tract infection (CAUTI) - was selected for the task “Promoting a bottom-up approach from clinical practice to policy level by implementing evidence- based guidelines and existing policies using a structured implementation model and working in country teams”. Identification and comparison with national/local guidelines were done. The preparation phase and prework is achieved
- WP 7: Guidelines, tools and implementation methods for antibiotic stewardship for both human and animal health were developed and discussed during the workshop in Vienna on 7 Nov. 2018. In the frame of the task dedicated to facilitate implementation of antimicrobial stewardship and surveillance of resistance in both human & animal, questionnaire for associations, vets, farmers and other professionals related to Animal Health, and survey to map the antimicrobial stewardship in primary care, long-term and hospitals in Europe were set up with 522 responders from 26 countries and 95 responders from 28 countries, respectively. The results were discussed during the workshop in Vienna on 7 Nov. 2018.
- WP 2 and 8: A communication Plan entitled “A Social Behaviour Change Communication strategy to tackle AMR and reduce HCAIs in Europe” as well as an awareness campaign are developed and presented around a dedicated roundtable at the Stakeholder Forum in Vienna on 9 Nov. 2018. EU-JAMRAI activities were presented at 16 conferences and events including a EU-JAMRAI stand founded by CHAFEA during the European Congress of Clinical Microbiology and Infectious Diseases (ECCMID) in Madrid on 21-24 April 2018.
- WP 9: In the frame of the prioritization of researc
The involvement of key collaborating stakeholders to elaborate concrete recommendations and implementable measures to tackle AMR and HCAI. They disseminate the output of the EU-JAMRAI Joint Action to its own network
• We are working on the development and implementation of national strategies and action plans on AMR and HCAI in order to support Member States and ensure a common approach at European level on the implementation of the Global Action Plan. Mapping Questionnaire was developed in consultation with participating countries and the collaborating stakeholders and subsequently sent to participating countries. 13 participating countries and 5 non-participating countries returned the questionnaire. The results were discussed during the workshop organized on 22-23 January 2018 in The Hague, The Netherlands.
• The collaborating stakeholders and the participating partners are working hand in hand to fight AMR within the “One Health” approach.
• The Stakeholder Forum were organized on 9 Nov. 2018 in Vienna at the Federal Ministry of Labour, Social Affairs, Health and Consumer Protection in Vienna, where key international organizations such as WHO Europe and ECDC, as well as representatives from health professionals, patients and industry provided recommendations based on their experience. It was structured in three roundtables. The first one was focused on evidence informed public health policies and practices related to combating AMR and HCAI. The second roundtable, was about “Training and Education”, strengthen the importance of putting evidence into understandable packages of communication. To finish the forum, EU-JAMRAI team presented the JA “Awareness raising and communication strategy”.
• In this first period, the priority was first to set up the communication and dissemination tools for the joint action such as a logo representing the project, the website and a leaflet. Press releases were published at the start of the project and send for dissemination/appropriation to all partners and following the General Assembly meeting and Stakeholder Forum organised on 8-9 November 2018 in Vienna.
• A communication Plan entitled “A Social Behaviour Change Communication strategy to tackle AMR and reduce HCAIs in Europe” as well as an awareness campaign are developed and presented around a dedicated roundtable at the Stakeholder Forum in Vienna on 9 Nov. 2018. EU-JAMRAI activities were presented at 16 conferences and events including a EU-JAMRAI stand founded by CHAFEA during the European Congress of Clinical Microbiology and Infectious Diseases (ECCMID) in Madrid on 21-24 April 2018.
• For wider public information and dissemination, social media channels and Tweeter account have been created. An article on EU-JAMRAI was published in the magazine AMR Control 2018
• Participation of the Joint action in about 16 events
• An “evaluation questionnaire” was submitted in order to evaluate the General Assembly meeting which was held on 8 November 2018 in Vienna.
• Development of an evaluation plan and progress monitoring and quality assessment of JA documentation and deliverables