BIA CSC Position Statement on the determination of Consultant Competence
We note that RCPath have also produced a position statement which was published on 10/07/2017. Both documents are entirely congruent. We hope that the BIA document provides additional specific advice on provision of evidence that would be acceptable to UKAS. We are sharing our document with UKAS this week.
ARK (Antibiotic Review Kit) - a research programme aiming to safely reduce antibiotic use in hospitals
Update June 2017:
ARK Feasibility Study
We started our feasibility assessment of ARK in Brighton in April and are just coming up to three months. We have had an amazing level of engagement from clinicians including medical staff, pharmacists and nurses. We have had over 150 people complete the online learning module so far. This is now embedded in our mandatory training and staff induction program. The decision aid is now embedded in our drug chart. Antibiotic stop rates at review have gone up from around 8% (using the ARK audit tool we have developed which is much more stringent than the tool we used for the CQUIN data) to over 30%. Clinician and patient feedback has been excellent.
Over the last few months we have secured endorsement of the ARK Hospital project from British Society for Antimicrobial Chemotherapy, the Society for Acute Medicine, the UK Clinical Pharmacy Network and the British Infection Association. The staff here in Brighton who have done the online module will be receiving their certificates over the next two weeks.
ARK pilot sites and full trial.
The pilot sites will open from September 2017 onwards. We are now starting monthly teleconferences with them as they get ready. Our aim if all goes well is to include data from some at least of these in the main trial and recruit the first sites to the main trial to start in Jan 2018. This means we want to start working with sites for the main trial in September 2017.
ARK on the web
We now have our website up and running. It is at www.arkstudy.ox.ac.uk
We have started putting updates on the news pages. Please be patient while we get better at uploading and formatting posts!
We have a twitter account which you can follow at @ARK_Hospital
In case you haven’t seen it, the wonderful FINGERTIPS resource http://fingertips.phe.org.uk/profile/amr-local-indicators now has Trust-level data for antibiotic prescription reviews. From these data, it looks like the median stop rate is 7.5%. Our experience suggests that Trusts are likely to be overestimating their true stop rate. We think our tool is better and just to repeat, our stop rates increased to over 30%. If you haven’t already, check out your own Trust’s data on Fingertips.
If you would like any further information please don’t hesitate to get in touch directly or through the website. I hope many of you will want to join the full ARK trial and be interested in getting set up for this in the autumn.
Martin Llewelyn PhD FRCP DTMH
Consultant, Department of Microbiology and Infection
Brighton and Sussex University Hospitals NHS Trust
Professor of Infectious Diseases
Brighton and Sussex Medical School
University of Sussex
Building independence through planning for transition: a quick guide for practitioners supporting young people
Transition to adults’ services can be a difficult time for young people. They need support and reassurance to help them move on to a more independent life. This new NICE/SCIE quick guide explains how early planning and access to the right information can help young people and their families to make the right choices. It is based on the guideline and quality standard for this topic and will be of interest to all practitioners in children’s and adults’ services who support young people at transition.
Sofosbuvir-velpatasvir-voxilaprevir for treating chronic hepatitis C [ID1055]
NICE is producing guidance and if anyone is interested in attending their committee meeting as a BIA representative on 23 November 2017 in Manchester, please contact us at BIA@hartleytaylor.co.uk by 17 July. Thank you.
ESCMID Trainee Association Survey
The Trainee Association of ESCMID (TAE) steering committee has launched a new survey that aims to explore the experience of trainees and young medical specialists on supervision, mentorship and management.
The survey should take around 10 minutes to complete. Your input is much appreciated.
M. chimaera - latest guidance
PHE has produced two new guidance documents on M. chimaera:
UKCPA non-member subscriber pack
The UKCPA would like to invite non members to register for their subscriber pack and updates
Included in the pack is:
- Access to three webinars, free of charge
- Our latest In Focus magazine (emailed quarterly)
- Details of forthcoming Masterclass events
- Details of our conferences
- What our members have told us about the value of our online networks
Subscribing is easy – just complete the form found here: http://bit.ly/1LfXvBU
In addition, we have now launched our NEW website, detailing information on all the education, training and resources that UKCPA provides, as well as further information on member benefits. Please feel free to take a look around: www.ukclinicalpharmacy.org
RCP New Specialty Service Planning Resource
The website rcpmedicalcare.org.uk will help those involved in the planning and provision of services get a clearer picture of the specialty services that need to be in place to provide great patient care.
Through Medical Care doctors will be able to access support for:
- Designing services – this includes a short description of the specialty and the patient population, and a summary of the workforce needs to support service provision
- Developing physicians – includes information on the education, training and continuing professional development required for that specialty
- Exploring the latest ideas on how to develop physicians and teams in areas such as quality improvement and medical leadership.
Comments that have been received as part of the consultation process for the development of the UK SMI can be seen in the associated review of users’ comments document. Anyone who does not want their comment(s) to be in the RUC document should let the Standards Unit know.
NICE vaccine uptake in under 19's quality standard (QS 145)
The vaccine uptake in under 19’s quality standard (QS145) was published on the NICE website on 2 March 2017.. You can view the quality standard by following this link: Vaccine uptake in under 19’s quality standards (QS145)
All consultation comments were considered by the Quality Standards Advisory Committee (QSAC) and the minutes of this meeting are now available: https://www.nice.org.uk/guidance/QS145/documents/minutes-2. A summary of the consultation comments, prepared by the NICE quality standards team and the full set of consultation comments are also available:https://www.nice.org.uk/guidance/QS145/documents/consultation-summary-report
RCP Health Informatics Unit - BIA representation sought
Please respond to BIA@hartleytaylor.co.uk in the first instance if you are interested in participating in this opportunity
HIU want to ensure that all that they do is patient centred and of benefit to health care professionals across the NHS. It is, therefore, important that specialist societies have an opportunity to help shape what they do.
Developments in health informatics are progressing quickly and bring opportunities for safer and more effective care of patients through enabling information sharing to support integrated care, the use of clinical decision support tools to improve patient care and the potential to develop personalised precision medicine. In addition, clinical data can be used for secondary purposes such as clinical audit, service management, service development and research. Furthermore, new technologies such as health apps, can support the development of a more empowered and activated patient, and a person centred model of care. HIU seek to work collaboratively in our work to realise these opportunities.
HIU write to invite BIA to nominate someone from within the Membership who would be best placed to be the link person to us for this work. The HIU team has had links in the past with Albert Mifsud who provided valuable input into the development of clinical record headings that were published by the Academy of Royal Medical Colleges in 2013.
The first project that we would like help with is the development of standards for electronic outpatient letters, commissioned by the Professional Record Standards Body. Your representative would be asked to raise awareness of the project among your members, and to comment on our draft headings and definitions for the content and structure of outpatient letters. The timeframe for this project is from now until April 2017.
In the longer-term, we would like to engage your society in other projects in our work programme. These could include:
• providing clinical leadership for the development and implementation of other standards for the structure and content of care records to achieve interoperability between computer systems in different care settings
• advising on and promoting the implementation and use of safe and effective new technologies
• promoting the professionalisation of clinical informatics and the development of career pathways for those wanting to specialise in this field.
Thank you for your assistance,
John G. Williams
Director of Health Informatics Unit
Care Quality Improvement Department | Royal College of Physicians
Judicial ruling on Prep (Pre-exposure prophylaxis) for HIV
On Thursday 10th November 2016 the Court of Appeal ruled that NHE England has the responsibility for funding Prep for prevention of HIV infection in those at high risk of the disease. Studies including the PROUD study have indicated that Prep (with Tenofovir/Emtricitabine) was around 90% effective in preventing new HIV infection among discordant partners and has the potential to reduce the number of new cases of HIV, currently around 4,000 cases/annum. Around 14,000 people would be eligible for Prep. NHS England will now consider cost-effectiveness and whether to fund prep. The decision has been welcomed by campaigners, healthcare staff and patient support organisations.
Sepsis Scoping Report
ON BEHALF OF PROFESSOR GED BYRNE, DEAN AND DIRECTOR OF EDUCATION & QUALITY (NORTH) AND JULIE SCREATON, DIRECTOR, LONDON AND SOUTH EAST
We are pleased to let you know that our work exploring the current state of sepsis education and training for healthcare staff across England is now available to access on our website.
Sepsis is a potentially life-threatening condition that affects an estimated 150,000 people per year in the UK and is a significant cause of preventable morbidity and mortality. Whilst there have been significant advances in defining best management of sepsis, reviews of practice and individual cases have identified failings in the healthcare system in identifying and intervening early when patients have sepsis. The standard of care received by patients with sepsis in England needs to improve.
In response to our Mandate from the Department of Health and on behalf of NHS England’s cross-system sepsis programme board, we have undertaken a scoping exercise of the current provision of sepsis education and training for healthcare staff in England. The full report and exec summary (below) outline the findings of this work.
Whilst there are numerous examples of good practice in relation to sepsis education and training, which we have highlighted in the report, there are clear gaps in the provision of sepsis education and training, particularly for healthcare staff working in community and primary care settings, management and executive staff within healthcare providers, and staff in permanent and non-training roles.
This report includes a summary of the work we have undertaken this year in response to these gaps, for example, the e-learning package “Think Sepsis: the identification and management of sepsis in primary care” and a film that signposts viewers to current learning material “Think Sepsis: Identifying and managing sepsis in paediatrics”.
There is still more work to be done however, to ensure that all healthcare staff in England can access up-to-date education and training about sepsis. This report includes recommendations to ourselves and other stakeholders in order to achieve this.
TARGET webinar series: How to optimise antibiotic prescribing in primary care
Public Health England (PHE) and the British Society for Antimicrobial Chemotherapy (BSAC) have worked with primary care colleagues to develop a series of 7 free TARGET antibiotics webinars highlighting key easy actions you can take to help improve your antibiotic prescribing, and at the same time improve the patient experience and their self-care, therefore freeing up your time.
The webinar series is now complete, but videos are available to view - click for TARGET website
Posted 19/10/16 (updated 03/01/17)
Trainee Association of ESCMID: Newsletter October 2016
TAE survey results
The Trainee Association of ESCMID (TAE) has recently published the results of a large survey among European trainees in clinical microbiology and infectious disease on training systems and training adequacy. This survey shows high heterogeneity in training conditions in European countries, identifies perceived gaps in training, and suggests areas for improvements. The results can be accessed via the following link below (Open Access Article): http://link.springer.com/article/10.1007/s10096-016-2791-9
The TAE steering committee is also working on the results of the second part of the survey, focusing on the balance between personal and professional life (work-life balance) among CM and ID trainees and young specialists in Europe, including parenthood, working conditions, quality of life, alcohol consumption and burnout.
2016 TAE steering committee election is open until 24 October
Please see e-mail below or our website for more information how to vote:
Updated UK SMI Bacteriology Documents
Please see below for updated UK SMI Bacteriology documents.
1. SMI B60: Detection of bacteria with carbapenem-hydrolysing β-lactamases (carbapenemases) (ISSUED) (Please note that this document supersedes P 8: Laboratory detection and reporting of bacteria with carbapenem hydrolysing beta lactamases (carbapenemases), which has been withdrawn)
3. SMI B 59: Detection of Enterobacteriaceae producing extended spectrum β lactamases(REISSUED) (Please note that this document supersedes P 2: Laboratory detection and reporting of bacteria with extended spectrum beta lactamases, which has been withdrawn).
AMPS Competencies Report
The Health Education England survey of higher education institutions about embedding national antimicrobial prescribing and stewardship competences into curricula is now available to access on our website.
The antimicrobial prescribing and stewardship (AMPS) competences, produced jointly by the Government's expert advisory group for antimicrobial resistance and healthcare acquired infections (ARHAI), and Public Health England were published in 2013. Implementing these competences forms a key aspect of ‘Key area 3’ of the Government's five year strategy for tackling antimicrobial resistance - improving professional education, training and public engagement to improve clinical practice and promote wider understanding of the need for more sustainable use of antimicrobials. The antimicrobial prescribing and stewardship (AMPS) competences can provide clarity for regulators, education providers and professional bodies to inform standards, guidance and the development of training.
Undergraduate students have expressed interest in receiving more education about antimicrobials, especially about their multidisciplinary use. This survey asked higher education institutions about their awareness of the competencies, and how they had embedded them into their courses.
SMI Quarterly Report (Summer Update) July 2016
This document is available to view here.
The use of SMIs is specifically mentioned as a requirement in the NHS England standard contract. This has particular implications for both the SMI team itself and for labs. UKAS is contemplating the implications.
NICE publication Preventing infective endocarditis - information for the public
This publication has been amended in line with changes recently made to CG64 Prophylaxis against Infective Endocarditis. An updated version of the publication can be found here https://www.nice.org.uk/guidance/CG64/ifp/chapter/About-this-information
PHE Patient Information Document - urinary tract infection
Based on the success of the TARGET Treating your infection leaflet, a UTI leaflet is currently being developed by PHE Primary Care Unit to be used during primary care patient consultations. The leaflet will facilitate dialogue between the health professional and patient during a consultation and also educate the patient on self-management, prevention and when to seek more advice. We hope the leaflet will reduce antibiotic prescribing rates, and admissions with bacteraemia. It is envisaged that the leaflet will be most valuable to women experiencing acute uncomplicated UTIs, those experiencing urinary symptoms, and women that experience recurrent acute uncomplicated UTI.
We are in the process of carrying out focus groups with women who have experienced recent urinary symptoms/ UTIs. We are exploring their attitudes to and experiences of self-caring for their urinary symptoms and women's needs from a GP consultation. Additionally we are carrying out telephone interviews with health professionals to explore their perception of the “UTI” in consultation, antibiotic resistance, information shared, guidelines used, and how and where the leaflet could be used. Furthermore, with all participants we are discussing the content and usability of the "TARGET antibiotics" UTI leaflet, to be shared with patients during consultation about possible urinary symptoms and UTIs.
It is envisaged that this collation of data will help inform the final UTI leaflet, which will be appropriate and suit the needs of patients consulting a range of health professionals about UTIs. We are still developing the leaflet and see your comments as supporting the development of the leaflet.
Dr Cliodna McNulty
Head of Primary Care Unit,
Consultant Medical Microbiologist and Honorary Visiting Professor for Cardiff University
Virtual Doctors is a small charity which provides email advice to rural health workers in Africa and is currently looking to recruit more volunteer doctors (especially infectious diseases) based in the UK. Anyone interested in helping - particularly trainees, as this may be a good learning opportunity - should refer to the Virtual Doctors website for more information.
Tackling antibiotic resistance - preventing the overuse of antibiotics in people and animals
Press release and Policy Statements from BSAC (12/05/16)
Supplementary guidance from RIPL about testing of partners of pregnant women for Zika
No doubt you are all receiving many queries regarding the testing of semen samples for men with either pregnant partners, or partners trying to conceive. You will be aware that there is no mention of semen testing in either the interim RCOG/PHE guidance or the RCGP/PHE guidance for primary care. However, we do have some capacity for Zika PCR testing of semen at RIPL. Therefore I am emailing to explain how we would like your help, as the local Infection specialists, in utilising that capacity most effectively.
Until further notice, please consider testing to be indicated as follows:
· For a man with current Zika-like symptoms (that began whilst in an affected country or within 2/52 of leaving) AND whose partner is pregnant
o Please send a urine sample in addition to the serum and EDTA plasma samples
o The rationale for this is that there is accumulating evidence that viral RNA remains detectable in urine for longer than in blood
o There is no need to contact RIPL to discuss such a case but please state on the request form that the patient’s partner is pregnant
· For a man with previous Zika-like symptoms (that began whilst in an affected country or within 2/52 of leaving) AND whose partner is pregnant
o Please contact RIPL (see below) to discuss the case
o If testing is agreed, then send semen only for PCR testing
· For asymptomatic partners of pregnant women
o Don’t test. Give guidance as below
For up to date travel advice for pregnant women (and their partners), please refer to guidance from NaTHNaC:http://travelhealthpro.org.uk/zika-virus-update-and-advice-for-travellers-including-pregnant-women/
In regard to current advice on avoidance of sexual transmission, please refer to the guidance on the main PHE Zika page: https://www.gov.uk/guidance/zika-virus
We would expect that you, the local Infection specialists, would be able to address most GP and local obstetric Zika queries, but for those you can’t, and to discuss semen testing as above, please contact the Zika registrar at RIPL on 01980 619 659 (9am – 5pm, Mon-Fri) rather than the usual RIPL contact number. As ever, for immediate management/diagnostic advice on an acutely sick patient, please use the IFS number.
Note that, for now, the above testing indications are to be applied only to the partners of pregnant women and not to the partners of women who are trying to conceive. We may be able to extend this testing in the future. Note also that if the request form is inadequately completed or if a semen sample is submitted without prior discussion with RIPL, we may save the sample(s) without testing.
This supplementary guidance about testing of the partners of pregnant women is NOT going to be published more widely. If you have generic queries about it, please email our current Zika registrar: firstname.lastname@example.org (Patient identifying information must not be included.)
This information can also be downloaded as a pdf file - please click here
29th February 2016
Zika virus has been declared a global health emergency by the WHO. The infection has swept across South and Central America over the past 12 months and is carried by the Aedes mosquito which is also responsible for outbreaks of dengue and chikungunya virus infection. Adults affected by Zika generally have a mild or asymptomatic illness, but the potential link with foetal microcephaly is alarming and pregnant women have been advised not to travel to affected areas. Members of the BIA have been closely involved with tracking the epidemic and formulating public health policy and guidance on Zika virus. Further information can be obtained via the following links:-
Members of the public/patients should be directed to the NHS Choices website and, if appropriate, to the FAQs on the RCOG website. They should be advised to discuss with their GP or obstetric team as appropriate
GPs (and HPTs) should be directed to PHE’s guidance for GPs and, if appropriate, the RCOG interim guidance for pregnant women. If they need further help then they should be contacting you, their local Trust Microbiologist/Virologist/ID physician.
This information is also available for download [docx] - please click here
5th February 2016
NICE Guidelines on Hepatitis C treatments
At the end of November NICE approved three new treatment combinations for hepatitis which will allow oral treatment to be offered to many more patients with chronic hepatitis C including those with early liver disease. Patients in England and Wales will be able to have access to these new treatment combinations after a period of three months, although funding has yet to be agreed. The NHS England Early Access Programme for patients with cirrhosis continues to function well and hundreds of patents have now received oral treatment through the regional Operational Delivery Networks (ODN’s). The BIA welcomes the new NICE approvals which will extend the range of patients who can be offered the new treatments.
Ledipasvir–sofosbuvir for treating chronic hepatitis C (NICE 2015)
Daclatasvir for treating chronic hepatitis C (NICE 2015)
Ombitasvir–paritaprevir–ritonavir with or without dasabuvir for treating chronic hepatitis C (NICE 2015)
Letter from Chief Medical Officer
Risk of Ebola Virus Disease (EBV) transmission from Ebola Survivors
Click here to see letter dated 02/12/2015 from Professor Dame Sally Davies
E-learning programme on Antimicrobial Resistance
To coincide with World Antibiotic Awareness Week and European Antibiotics Awareness Day, Health Education England (HEE) is pleased to announce the launch of its latest e-learning programme on Antimicrobial Resistance.
The introductory level programme has been designed to support all health and social care staff – both clinical and non-clinical - in a variety of settings to understand the threats posed by antimicrobial resistance, and ways they can help to tackle this major health issue.
This module was designed by specialist antimicrobial pharmacist Dr Diane Ashiru-Oredope and is free to access from the following link http://www.e-lfh.org.uk/programmes/antimicrobial-resistance. It takes about 25 minutes to complete.
We hope this module will support your organisations in improving infection prevention and control practices and antimicrobial stewardship programmes to reduce health care associated infection and antimicrobial resistance.
Contact Mohamed Sadak, HEE Clinical Lead and Programme Manager, Antimicrobial Resistance and Sepsis for further information or feedback email@example.com
Pathogen Genomics into Practice
The PHG Foundation (an independent health policy think-tank focusing on how genomics and other emerging health technologies can provide more effective, personalised healthcare) has recently completed a major project to assess the potential impact of microbial genomics on public health and health services, and to develop policy to support implementation.
Pathogen Genomics Into Practice is a comprehensive report into the current state of play within the exciting field of pathogen genomic sequencing. In the report we examine the key areas where pathogen genomics is having, or could have, a significant impact. And we ask what are the actions needed to be taken to maximise the benefits of this powerful technology. In the final section we present our roadmap to advancing those actions.
Please see PHG foundation website for full report and further information.
NHS England approves treatment for Hepatitis C with significant liver disease
The British Infection Association (BIA) welcomes the recent announcement by NHS England that they will approve treatment with new directly acting oral agents for patients with chronic hepatitis C and significant liver disease. This follows on from the successful Emergency Access Programme for patients with decompensated liver disease which began in 2014. Several thousand patients will now have access to the new drugs which are extremely effective and well-tolerated.
Treatment for hepatitis C will be accessed through new Operational Delivery Networks (ODNs). Nominations have recently been received for Regional centres bidding to host ODN’s which are expected to be in place by August 2015. Important information will be collected about patients receiving treatment for hepatitis C through the HCV-UK clinical research network.
The BIA has played a crucial part in decision making for Hepatitis C with Ex-President Dr Peter Moss chairing the ID and Hepatitis Clinical Reference Groups (CRG’s) and helping to write and implement the new guidance.
The NHS England Policy Statement can be accessed on
Technical engagement on the draft ‘Toolkit for Managing Carbapenemase-producing Enterobacteriaceae in Non-acute and Community Settings’
PHE would value comments on the attached draft 'Toolkit for Managing Carbapenemase- producing Enterobacteriaceae in Non-acute and Community Settings.’ Please note that there are 8 attachments (below): the core toolkit and 7 annexes (A-G).
In the UK, over the last seven years or more, we have seen a rapid increase in the incidence of infection and colonisation by multi-drug resistant carbapenemase-producing organisms which reflects similar problems internationally. This increase identified an urgent need for guidance, particularly on infection prevention and control management aspects. You may be aware that, in December 2013, we published guidance for acute trusts. This was formally launched in March 2014, after which we received many requests for a non-acute/community version. We recognise that it is as important in the community as it is in hospital for colleagues to understand what carbapenemase-producing Enterobacteriaceae are and know how to manage individuals who are carriers or have an infection.
The Public Health England ‘Toolkit for Managing Carbapenemase-producing Enterobacteriaceae in Non-acute and Community Settings’ has been written to provide expert advice on the management of carbapenemase-producing Enterobacteriaceae in England, to prevent or reduce the spread of the bacteria into (and within) health and residential care settings. The work has been undertaken in consultation with a wide group of experts and community colleagues.
The toolkit provides practical advice for healthcare professionals and carers in non-acute settings with additional information for service users and their families. We have made the main body of the guidance intentionally short by providing ‘stand-alone’ documents for ease of use. As care provided and care settings in the community are many and varied, it would be impossible to provide ‘tailored’ advice for each situation. Therefore, we have provided a care matrix and a number of scenarios in the document to assist in assessing what is needed for your setting and service user.
PHE Briefing Note on Scarlet Fever - Feb 2015
Scarlet fever seasonal activity has remained elevated across England, following the widespread
increases in notifications seen last year. Since the start of 2015 there has been a rapid and higher than
expected increase in notifications compared to this time last year.
Please click here to see the PHE Briefing Note [PDF]
Please click here for PHE Press Release - Scarlet fever notifications continue to increase
Please click here for PHE publication - Group A streptococcal infections: activity during the 2014 to 2015 season
UK SMI Quarterly Report - Winter 2015
This report for UK Standards for Microbiology Investigations contains updates from November 2014 - January 2015.