NHS update: Antimicrobial resistance

01 December 2022

One of the biggest threats to public health is antimicrobial resistance. The latest dentistry and oral health update from Jason Wong, deputy chief dental officer, and Ali Sparke, director for dentistry, opened by focusing on the lessons from world antimicrobial awareness week (November 18-24, 2022).

Reflecting on the latest data from the UK Health Security Agency (UKHSA), they explain, “the estimated total number of serious antibiotic resistant infections in England rose by 2.2 per cent in 2021 compared to 2020. This is the equivalent of 148 severe antibiotic resistant infections a day in 2021.”

In light of this, NHS England has published a letter for dental practices detailing actions to “improve infection prevention, diagnosis, and treatment across primary, community and secondary care.”

Antimicrobial resistance

This year’s World Antimicrobial Awareness Week (WAAW) and the European Antibiotic Awareness Day (November 18) have provided an opportunity to contemplate what can be done to reduce the “emergence and spread of drug-resistant infections.” Antimicrobial resistance (AMR) can result in antimicrobial medicines becoming “ineffective,” therefore making them “increasingly difficult or impossible to treat”.

Urging dentists to be cautious when prescribing, the authors said professionals “must use their clinical judgement when applying antimicrobial guidance to the care of patients. We noted last year that during 2020, dentistry was the only discipline within the NHS to see an increase (rising by 22.1 per cent between 2019-20) in prescriptions for antibiotics. This was possibly, as a result of services being restricted to urgent dental care during the Covid-19 pandemic, and a consequential increase in the use of antibiotics for patients presenting with acute conditions.

“The latest English surveillance programme for antimicrobial utilisation and resistance (ESPAUR) report published on November 21, 2022, is promising: in 2021, consumption of antibiotics in dental practices was reduced by 7.1 per cent. However, this is still above the pre-2019 levels, and a slight year-on-year decline had been observed up to this point.”

The theme of WAAW for 2022 was ‘Preventing antimicrobial resistance together’. Linking to this theme, the World Health Organization called on all sectors of the medical community to “encourage the prudent use of antimicrobials” and work together through the One Health approach.

The writers explained the approach, “One Health is an integrated, unifying approach that aims to sustainably balance and optimise the health of people, animals and ecosystems.” Using a cooperative approach across sectors and disciplines, the One Health approach “contributes to protect health, address health challenges such as the emergence of infectious diseases, antimicrobial resistance, and food safety, and promote the health and integrity of our ecosystems.”

Antimicrobial prescribing in dentistry – a synopsis of guidelines

The 2020 Antimicrobial Prescribing in Dentistry: Good Practice Guidelines from the Faculty of General Dental Practice and Faculty of Dental Surgery of the Royal College of Surgeons of England in provide clear, concise and practical guidance on antimicrobials management in oral and dental infections.

A new one-page summary of the guidance is now available free of charge.

Ali and Jason also invite readers to “review the comprehensive November 2021 edition of the NHS dentistry and oral health update bulletin, which focuses on dentistry and AMR.” Which included resources and tools to ensure best practices on prescription for antibiotics is followed.

Launch of Core20PLUS5 for children and young people

To support the reduction of health inequalities for children and young people, the NHS has launched the Core20PLUS.

At its launch Core20PLUS5  was focused on adults. But the new version will focus on clinical areas related to children and young people. Five areas have been identified as the focus: asthma, epilepsy, diabetes, oral health and mental health.

Keeping your NHSmail active – use it or lose it

Email accounts that have not been proactively used currently have 90 days before being “classified as inactive”. After an additional 90 days, the account is deleted.

As of December 1, 2022, inactive and active periods will be reduced to 30 days. As a result, accounts which are not used for 60 days will be deleted.

To keep your NHSmail account active, one item from the below list must be completed:

  • Log into the NHSmail portal
  • Log into O365 application
  • Use O365 applications (i.e., Outlook with cached credentials)
  • Send an email

Domestic abuse

The FIFA World Cup has caused the author to consider “the link between sporting events and domestic abuse.”

Following the Euro 2020 tournament, the National Centre for Domestic Violence (NCDV) noted a rise in domestic abuse against women in England. During the five weeks of the event NCDV “referred 400 more people for protective court orders compared with the five weeks before the tournament.”

Dental professionals may become aware of signs of abuse to the head, eyes, ears, neck, face, mouth and teeth. The authors suggest that if “something doesn’t feel right, having a local plan in place will help you to help patients sensitively and effectively.”

For specific advice, the update suggests consulting February 2021’s NHS dentistry and oral health update which focused on domestic violence.

Also included in the bulletin:

Patient safety webinar: Jason Wong will be hosting a webinar on January 10, 2023, on the topic. Watch the webinar here P127 Creating a Positive Patient Safety Culture in Dentistry | ProDental CPD

Getting started with large scale change – enrolling now: Running from January 9 to February 19, 2023, the new course from NHS England will introduce the “fundamentals of large-scale change”. For more information visit www.england.nhs.uk/sustainableimprovement/leading-large-scale-change/getting-started/