C. Purpose of this Guideline
Supporting the Antimicrobial Resistance Strategy Framework and the Guidelines on Implementation of the Antimicrobial Strategy in South Africa: One Health Approach and Governance, 2018
These guidelines form part of efforts to institutionalise the prevention and containment of antimicrobial resistance (AMR) in health care facilities in South Africa, as outlined in the Antimicrobial Resistance Strategic Framework1 and Implementation Plan.2 The focus of these guidelines is on two interrelated aspects of prevention of healthcare associated infections (HAIs) and their spread; and the application of antimicrobial stewardship (AMS) practices at hospital level. They aim to serve as a practical, step-by-step or ‘how-to’ guide, addressing the infection prevention and AMS components of a robust response in a hospital. They draw on evidence from various international guidance documents and standards for interventions that have been shown to be successful in infection prevention and AMS programmes. 3, 4, 5, 6, 7
These interventions have been customised to the South African hospital setting based on local experiences in the public and private health sectors. This was done through a series of workshops and requests for comment involving country-level experts.
The focus of the guidelines will be on prevention of HAIs and stewardship of antibiotics used to treat bacterial infections other than tuberculosis, however the suggested interventions can be applied equally to antifungals as they share the same stewardship principles. National guidelines already exist for the management of multidrugresistant tuberculosis and HIV.
The guidelines are intended for use by a multidisciplinary cadre of healthcare professionals – doctors, nurses, pharmacists, microbiologists, and infection prevention and control (IPC) practitioners, in their day-to-day management of AMR in a hospital setting.
The guidelines should also be read in conjunction with the Guidelines on Implementation of the Antimicrobial Strategy in South Africa: One Health Approach and Governance, which provides direction on the governance structures within hospitals that should be established.
1 National Department of Health. South African Antimicrobial Resistance National Strategy Framework; A One Health Approach and Governance; 2017 – 2024; Pretoria 2014 (updated 2018)
2 National Department of Health. Implementation Plan for The Antimicrobial Resistance Strategy Framework in South Africa: 2014– 2019. Pretoria; 2015.
3 Centers for Disease Control and Prevention. Core elements of hospital antibiotic stewardship programs. Atlanta, GA: US Department of Health and Human services, CDC; 2014
4 Australian Commission on Safety and Quality in Health Care. Antimicrobial stewardship in Australian Hospitals; 2011.
5 Public Health England. Start Smart – Then Focus. antimicrobial stewardship toolkit for English Hospitals; 2015
6 Tonkin-Crine SKG, Tan PS, van Hecke O, Wang K, Roberts NW, McCullough A, Hansen MP, Butler CC, Del Mar CB. Clinician targeted interventions to influence antibiotic prescribing behaviour for acute respiratory infections in primary care: an overview of systematic reviews. Cochrane Database of Systematic Reviews 2017;9: CD012252.
7 T. F. Barlam et al. Implementing an Antibiotic Stewardship Program: Guidelines by the Infectious Diseases Society of America and the Society for Healthcare Epidemiology of America. Clinical Infectious Diseases, 2016;62(10):e51–e77