Annexure E: Hospital AMS Committee

Composition

It is critical that the highest-ranking member of each component of the AMS response represents the hospital on the Hospital Antimicrobial Steering Committee (HAMSC). This is to ensure translation of policy into action and is especially important in choosing the most senior level administrator.

The committee should consist of the following core members:

• Chairperson: should be the CEO or highest-ranking management representative of the hospital
• Senior Physician of the hospital
• Head of Pharmacy Services of the hospital
• IPC practitioner of the hospital
• Head of Nursing – or highest-ranking nurse manager, under whose brief AMS falls
• Medical Microbiologist - where not available, either the most experienced member of the NHLS that services the hospital, OR a seconded microbiologist from another NHLS laboratory or private laboratory.

Additional members who can be included, depending on the size of institution and their access to resources, include:

• Other clinicians representing each clinical department of the hospital or as a minimum the key departments consuming the most antibiotics – e.g. ICU, surgery, emergency medicine, gynaecology and/or obstetrics
• Adult infectious diseases specialist (where not available, a prescribing specialist clinician, family practitioner or equivalent with experience in AMS)
• Paediatric infectious diseases specialist if the hospital is a specialist paediatric hospital or has joint adult and paediatric services. Where a paediatric infectious  diseases specialist is not available, a prescribing specialist paediatrician with experience in AMS or similar at the level of family practitioner or equivalent should substitute
• Quality improvement/assurance practitioner
• Ward pharmacist or any pharmacist trained in AMS

Responsibilities of the HAMSC

• Surveillance – HAMSC must monitor and report on:
  • Antimicrobial usage data from pharmacy – ideally data from each hospital department should be presented in Defined Daily Doses per hundred patient days (DDD/100 patient days) for ward patients and as DDD for emergency unit and outpatients. However, the institutions should look at the data available and work with existing data constraints moving towards the ideal. The list of antibiotics for reporting will depend on their availability as per the STGs and EML for that facility level
  • Local antibiotic resistance profile data of microorganisms in each facility collected from the local NHLS laboratory. Some facilities refer to regional referral laboratory for processing and reports would be available at regional level. Hospital wide bug-drug combinations should be reviewed and reported annually to the PAMSC. Resistance profiles should also be fed back to all clinicians in the hospital on a 6 monthly basis and presented as part of the quality committee agenda to the management staff
  • Outbreaks of MDROs in the hospital should be reviewed by the HAMSC,  which should work with the hospital’s IPC team, the provincial outbreak response team, and NICD (when necessary) to control the outbreak according to the Health Act
  • Hospital-acquired infections – institutions must phase in the monitoring of rates for the number of CLABSI, CAUTI, SSI and/or VAP (if surgery and/or ICU services are provided at the hospital). Number of C. difficile infections per hospital should also be reported. 12-monthly data should be reported to the PAMSC. The IPC Practitioner plays a critical role in providing this information, along with the microbiologist or laboratory staff in the hospital
  • Volume of infection-related laboratory investigations (blood cultures, CRP, PCT, white blood cell count) from NHLS laboratories servicing the hospital
• Follow up with existing IPC structures that all clinical areas follow standard precautions and appropriate additional (transmission-based) precautions as required to reduce the risk of transfer of contagious and resistant pathogens to patients and staff. Supervise terminal cleaning of isolation facilities after patient discharge
• Coordinate the activities of the hospital’s antibiotic stewardship team/s. Identify clinical units in need of support
• Ensure that regular feedback is given to all prescribers on the status of AMR interventions and surveillance information as part of ongoing feedback and awareness. Consideration should be given to reporting systems for prescribers who consistently do not follow protocols and guidelines and should be dealt with through the HAMSC and the Management of the hospital
• Provide regular in-service training in AMS and IPC for clinicians, nurses, and allied health care professionals, through access to antibiotic stewardship ward rounds, web-based training materials and workshops at regional training centres
• Coordinate and publicise the hospital’s participation in awareness days related to AMS/IPC i.e. World Hand Hygiene day (5th May), Infection Control Week (September), Pharmacy Month (September), and World Antibiotics Awareness Week (November)

Role of HAMSC

• Surveillance
• Communicate with IPC and quality structures
• Coordinate AMR activities
• Feedback to prescribers
• Provide regular in-service training