18138 WHO Competency Framework for...
Transcript of 18138 WHO Competency Framework for...
WHO/HIS/HWF/AMR/2018.1
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iii
Contents
Foreword . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . iv
Acknowledgements . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . v
Abbreviations and acronyms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . vii
Executive summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . viii
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
Objectives and application of the AMR competency framework . . . . . . . . 2
Methods . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
Structure of the AMR competency framework . . . . . . . . . . . . . . . . . . . . . 4
Statement of shared goal . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
Table 1. AMR competency framework . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
Glossary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15
James Campbell DirectorHealth Workforce Department
Marc SprengerDirectorAMR Secretariat
iv
Foreword
Antimicrobial resistance (AMR) represents a major health and socioeconomic threat, with the potential for devastating consequences to the health of millions of people globally if concrete steps are not taken to address it. The appropriate use of antimicrobial medicines for preventive and curative measures is vital to ensure continued success with common and complex medical interventions, and to slow or reverse the progress of resistance. Since the adoption of the WHO Global Action Plan on Antimicrobial Resistance by Member States in May 2015, remarkable progress has been made by all stakeholders to ensure that AMR is getting the attention it deserves and is a priority on the health action agenda in countries. Global programmes and events, such as the World Antibiotics Awareness Week, continue to help raise public awareness and understanding to scale up action.
The misuse and overuse of antimicrobials in human medicine and food production have contributed to the increase in the prevalence of AMR. In the human health sector, a major reason given by health workers and students for the misuse of antimicrobials is the lack of understanding and adequate expertise to address AMR. A key approach to address this challenge and ensure the appropriate use of antimicrobials is to ensure that health workers acquire, through their education and training, the competencies required to prevent and combat AMR, as stated in the first objective of the WHO Global Action Plan on AMR. Although most countries have a national action plan to address AMR, the variability in quality and uneven coverage of initiatives to strengthen education and training of health workers on AMR require a standardization of educational resources for AMR that reflects global evidence and best practices but can be adapted locally. Education and training capacity and resources are currently known to differ markedly across regions and settings. This WHO competency framework for education on AMR is strategic and timely, given the widespread perception among health workers of insufficient knowledge and expertise on the topic, resulting in inappropriate antimicrobial prescription and use practices. This competency framework is intended to serve as a reference for academic institutions, educators, accreditation bodies, regulatory agencies and other users to help ensure that pre-service education and in-service training equip health workers with the requisite competencies to address AMR. It complements other relevant existing WHO guidance on AMR and lays the foundation for the development of more in-depth educational resources and AMR curricula.
v
Acknowledgements
The development of the WHO competency framework for health workers’ education and training on antimicrobial resistance was coordinated by the WHO Health Workforce Department and the AMR Secretariat with inputs from the Service Delivery and Safety and Essential Medicines and Health Products departments. The following WHO staff were responsible for coordinating the development of the document: Onyema Ajuebor, James Campbell, Giorgio Cometto (Health Workforce Department); Marcus Sprenger, Elizabeth Tayler (AMR Secretariat). WHO staff from other departments also provided contributions: Nicola Magrini, Lorenzo Moja, Ingrid Smith (Essential Medicines and Health Products Department); Sergey Eremin, Breeda Hickey, Karen Mah (AMR Secretariat); Benedetta Allegranzi, Hiroki Saito, Sara Marie Tomczyk (Service Delivery and Safety Department); Andreas Reis (Information, Evidence and Research Department); Saskia Andrea Nahrgang, Danilo Lo Fo Wong (WHO Regional Office for Europe); Klara Tisocki (WHO South-East Asia Regional Office). Administrative assistance was provided by Beatrice Wamutitu (Health Workforce Department). The following WHO interns provided review support: Yumi Ishikawa (Health Workforce Department); Johannes Koehler (Information, Evidence and Research Department); Martin Plymoth (AMR Secretariat).
WHO is grateful to the following individuals for preparing the mapping analysis of AMR educational tools and resources ahead of the WHO expert consultation meeting on health workforce and AMR education held 23–24 March 2017: Steven Hoffman, Sara Jones, Susan Rogers Van Katwyk (Global Strategy Lab, University of Ottawa).
All participants at the WHO expert consultation meeting on 23–24 March 2017 are also acknowledged for their contribution to the conceptualization of the competency framework, the identification of relevant competencies, and for providing quality assurance and feedback on earlier drafts of the document: Israel Bimpe (International Pharmaceutical Students’ Federation), Edith Blondel-Hill (Interior Health Authority, British Columbia), Joana Carrasqueira (International Pharmaceutical Federation), Enrique Castro-Sánchez (Imperial College London), Sabiha Essack (University of Kwazulu-Natal, South Africa), Siobhan Fitzpatrick (World Federation of Medical Education), Lindsay Grayson (University of Melbourne and Monash University), Lauri Hicks (Centers for Disease Control and Prevention, Atlanta), Steven Hoffman (Global Strategy Lab, University of Ottawa), Alison Holmes (Imperial College London), Bijie Hu (Zhongshan Hospital of Fudan University), Frances Hughes (International Council of Nurses), Benedikt Huttner (University of Geneva Hospitals), Kumud Kumar Kafle (Tribhuvan University & Alliance for the Prudent Use of Antibiotics, Nepal), Zuzana Kusynova (International Pharmaceutical Federation), Gabriel Levy-Hara (Hospital Carlos G Durand, Argentina), Caline Mattar (Junior Doctors Network/World Medical Association), Marc Mendelson (University of Cape Town, South Africa), Dilip Nathwani (University of Dundee & British Society for Antimicrobial Chemotherapy), Leonardo Pagani (General Hospital of Bolzano, Italy & European Society of Clinical Microbiology and Infectious Disease), Barbara Potter (Public Health Agency of Canada), Céline Pulcini (Université de Lorraine, France), Susan Rogers Van Katwyk (Global Strategy Lab, University of Ottawa), Susie Sanderson (British Dental Association), Nandini Shetty (Public Health England), Neil Squires (Public Health England), Julia Tainijoki-Seyer (World Medical Association), Karin Thursky (National Centre for Antimicrobial Stewardship, University of Melbourne, Australia), Priit Tohver (International Federation of Medical Students’ Associations).
vi
WHO is also grateful to all individuals, partners and institutions involved in the consultation reviews at the various stages of development of this tool: Bojana Beović (University Medical Centre Ljubljana), Kelly Cairns (Alfred Health, Australia), Maciej Piotr Chlebicki (Singapore General Hospital, Singapore), Aubrey Clark, Jude Nwokike, Farouk Umaru (United States Pharmacopeial Convention), Oliver Dyar (Karolinska Institutet), Linus Ndegwa (Centers for Disease Control and Prevention, Kenya), Douglas Slain (West Virginia University, United States of America), Jorgen Stassijns (Institute of Tropical Medicine, Antwerp, Belgium), Evelina Tacconelli (University Hospital of Tübingen, Germany & European Society of Clinical Microbiology and Infectious Disease), Adrian M Viens (Centre for Health Ethics and Law, University of Southampton), Agnes Wechsler-Fördös (Hospital Rudolfstiftung Vienna & Alliance for the Prudent Use of Antibiotics, Austria).
WHO is grateful to the governments of Japan and the Federal Republic of Germany for their financial contributions to this project.
vii
Abbreviations and acronyms
AMR antimicrobial resistance
AMR GAP Global Action Plan on Antimicrobial Resistance (WHO)
AWaRE access, watch and reserve
EML/EMLc WHO Model List of Essential Medicines/for Children
GReVP good review practices
HAI health care-associated infection
IPC infection prevention and control
MDR multidrug-resistant
SDGs Sustainable Development Goals
WASH water, sanitation and hygiene
WHO World Health Organization
viii
Executive summary
In 2015, the World Health Organization (WHO) launched the global action plan to fight antimicrobial resistance (AMR). The first objective of the plan calls for measures to improve health workers’ education and training on AMR.
This WHO competency framework for health workers’ education and training on AMR provides foundational normative guidance to help countries ensure that health workers are properly equipped with the competencies they need to combat the spread of AMR. Target users of this document include pre-service and in-service health education and training institutions; accreditation and licensing bodies; and health policy- and decision-making authorities.
The framework is configured in a tabular matrix format, containing core and additional AMR competencies, which have been organized across four domain areas and four categories of health workers. The domain areas include: foundations that build awareness of antimicrobial resistance, appropriate use of antimicrobial agents, infection prevention and control (IPC), and diagnostic stewardship and surveillance. The four categories of health worker groupings identify competencies that are required for: all health workers, prescribers, non-prescribers and public health officers/health services managers. This framework provides users with a reference tool to guide the analysis, framing and adaptation of locally relevant education and training materials on AMR.
WHO COMPETENCY FRAMEWORK FOR HEALTH WORKERS’ EDUCATION AND TRAINING ON ANTIMICROBIAL RESISTANCE
1
Introduction
Addressing the issue of antimicrobial resistance is critical to achieving the Sustainable Development Goals (SDGs). Antimicrobial resistance is a significant public health and environmental threat. Left unchecked, common infections and minor injuries could once again become frequent killers. The scale of the AMR threat is such that no single country is free from its health and socioeconomic impact: efforts to tackle the problem will require collaboration across national and continental boundaries. AMR occurs when microbes become resistant to medicines to which they were initially susceptible. This risk is fuelled by the reduced availability of new and effective antimicrobials to treat resistant microbes (1,2). The development of drug-resistance applies to antimicrobials for a wide variety of diseases, including, among others, HIV and tuberculosis.
Globally, major gaps still exist in knowledge and awareness of AMR, as well as in the availability of quality technical resources to address the challenge (3–6). In the case of health workers, a variety of factors can result in the misuse or overuse of antimicrobials, including: a lack of knowledge or up-to-date information, inability to identify the type of infection, yielding to patient pressure to prescribe antibiotics, and a preponderance of situations that allow for financial benefit from the supply of medicines. Inadequate hygiene, sanitation in community settings and IPC measures in health facilities also facilitate the spread of infections and increase the use of antimicrobials (7). Measures to tackle these challenges through a collaboration of various stakeholders are required to avert the increasing occurrence of resistance, particularly in resource-constrained settings (8). To address this challenge, the first objective of the WHO Global Action Plan on Antimicrobial Resistance (AMR GAP) calls for raising awareness and educating and training health workers to improve antimicrobial prescribing and dispensing behaviours (9). On a similar policy level, the Global Strategy on Human Resources for Health: Workforce 2030 (10) complements the AMR GAP by offering policy guidance options on broader policies and approaches to optimize health worker education and training. WHO’s role in collating and making available AMR education and training resources is crucial to support educators, decision-makers and health policy planners in implementing effective policies to guide actions on AMR control (11).
2
Objectives and application of the AMR competency frameworkThe main purpose of this document is to strengthen efforts at the country level to address AMR by outlining a set of core and additional competencies to guide the education and training of health workers.
The competency framework serves as a reference tool to be applied according to local priorities and needs. Given the comprehensive nature and interprofessional structure of the competency framework, certain competencies outlined in this document may not apply to some settings or work environments, depending on factors such as the availability of health workers with an advanced training or technological capacity. For users in such settings, the framework provides for a selective approach to implementation whilst allowing for scale up of health worker competencies whenever additional needs are identified and resources made available. The AMR competency framework is not a scope of practice for specific occupational groups and should not be interpreted as such; rather, the competencies that it identifies should be interpreted and applied in the context of the defined roles and responsibilities in a specific jurisdiction, according to local regulations and practices.
The competency framework is aimed primarily at pre-service and in-service health education and training institutions, accreditation and regulatory bodies and health policy- and decision-making authorities. It is structured to benefit all health workers, including both prescribers and non-prescribers of antimicrobials. It also includes public health and health services managers who lead institutions or have roles that influence decision- and policy-making to deliver AMR-related education and training, or have broader responsibilities through health services management and public health regulations with a bearing on antimicrobial prescription and use practices. The competency framework may be used to plan for AMR skills auditing and strengthening, and optimization of antimicrobial stewardship roles or functions.
WHO COMPETENCY FRAMEWORK FOR HEALTH WORKERS’ EDUCATION AND TRAINING ON ANTIMICROBIAL RESISTANCE
3
Methods
The development of this AMR competency framework has evolved through a combination of a review of AMR competencies obtained from a mapping of education and training resources around the world (12), and a series of refinement steps conducted through consultation exercises with a WHO expert consultation group (13), other AMR research topic experts and key health professional associations.
Building on the first objective of the WHO Global Action Plan on AMR, an informal meeting was held in March 2016 between WHO and health professional associations to describe the needs and challenges health workers face in addressing AMR (14). One of the outcomes from the meeting was an agreement to map existing AMR-related educational resources in order to identify currently available resources, provide information on needs and propose ways to address the gaps. A draft version of the AMR-education mapping report was subsequently prepared, serving as the main background document for the WHO expert consultation meeting on AMR and health workforce education and training held in March 2017.
Key findings of the report revealed a variance across settings in the availability, comprehensiveness, quality, standards and accessibility of currently available tools to address AMR education and training. The mapping report also highlighted best practice models to build upon (15). A recommendation was then made by the group on the basis of these findings to develop a global competency framework for AMR as part of measures to help address the situation of AMR education and training.
In developing the core material, evidence and guidance was extracted from the literature related to competency frameworks on appropriate prescribing and other AMR-related competency domains (16–29). The framework is adapted for human health and is holistic in approach as it brings together the different domains in complementary technical areas such as IPC, diagnostic stewardship and surveillance, leadership, and awareness and appropriate use of antimicrobials. It also features references to recent complementary policy frameworks on the appropriate use of antibiotics such as the AWaRE categorization described in the 2017 WHO Model List of Essential Medicines/for Children (EML/EMLc) (30). The WHO AWaRE system groups antibiotics into three categories – ACCESS, WATCH and RESERVE. The ACCESS group includes antibiotics recommended as empiric, first or second choice treatment options for common infectious syndromes and are listed in the EML/EMLc with the syndromes for which they are recommended. The WATCH group includes antibiotic classes that are considered generally to have higher resistance potential and that are still recommended as first or second choice treatments but for a limited number of indications. The RESERVE group includes antibiotics that should be treated as “last resort” options, or tailored to highly specific patients and settings, and when other alternatives would be inadequate or have already failed (e.g. serious life-threatening infections due to multi-drug resistant bacteria). The aim is to enhance treatment outcomes, reduce the development of drug-resistant bacteria, and preserve the effectiveness of “last resort” antibiotics by ensuring that the right antibiotics are available and prescribed for the right infections.
4
Structure of the AMR competency framework
The AMR competency framework is a tabular matrix of the AMR domains, health worker categories and the competencies (the knowledge, skills and attitudes) necessary to effectively address AMR in practice settings. The framework is organized across four broad categories of health workers and four domains of AMR-related competencies. For the purpose of this framework, the competencies are broadly divided into two types – core and additional. The core competencies are the essential knowledge, skills attitudes that a health worker in a particular category is expected to have. The additional competencies (see italic text in Table 1) are the desirable knowledge skills and attitudes that a health worker may have, depending on factors such as need, relevance to practice setting, and the availability of required resources and capacity to utilize the competency.
The framework adopts an interprofessional approach based on the principle that addressing AMR requires a shared understanding, and effective collaboration and communication among health workers. Given that a number of different health workers are involved in the sequence of events and scenarios leading to the prescription and use of antimicrobials, the categorization of health workers has been structured to reflect, in a comprehensive manner, the most significant roles impacting antimicrobial prescription and use.
As AMR is a complex public health and environmental issue, a systems approach combined with population and patient-centred strategies (including behavioural change elements) are vital to achieve the objectives of the competency framework. Essential competencies in cross-cutting areas, such as leadership, communication, law and ethics, are also important for adequately understanding, monitoring and responding to AMR. Where relevant, these competencies are embedded within related areas of the framework. A glossary is attached to help guide understanding, implementation and application.
WHO COMPETENCY FRAMEWORK FOR HEALTH WORKERS’ EDUCATION AND TRAINING ON ANTIMICROBIAL RESISTANCE
5
Statement of shared goal
Maintaining a shared commitment to address AMR and protect patients in practice settings can enhance action by health policy-makers and promote collaboration among health workers. The AMR competency framework provides foundational guidance that can be adapted to different health care and resource contexts to foster appropriate prescribing and other AMR-related competencies. The use of the competency framework in health worker education and training should be grounded in a shared commitment by all stakeholders, including health workers. Such commitments may be ingrained in practice through the use of joint vision statements, as exemplified in Box 1. Similar statements, adapted to local settings, may be used in national advocacy and communication activities to support the inclusion of relevant AMR elements in educational curricula or licensing and regulatory mechanisms to ensure greater compliance and a culture of collective responsibility.
Box 1.Sample joint vision statement for fighting AMR
We, the health care workers, accept the responsibility to improve patient care and health outcomes by protecting against the emergence and spread of antimicrobial resistance for patients and society, now and in the future. We shall achieve this goal by acquiring and maintaining the competencies related to AMR control including through improving leadership, awareness, knowledge, skills, attitudes and behavioural change regarding the appropriate prescription, dispensing and use of antimicrobials, and implementing better infection prevention and control and diagnostic stewardship.
6
Antim
icrob
ial r
esist
ance
do
mai
nsa
Cate
gory
1: A
ll he
alth
wor
kers
bCa
tego
ry 2:
Pre
scrib
ersc
Cate
gory
3: N
on-p
resc
riber
sd Ca
tego
ry 4:
Pub
lic h
ealth
office
rs/
heal
th se
rvice
s man
ager
se
Nurs
esPh
arm
acist
sLa
bora
tory
scie
ntist
s/te
chni
cians
Foun
datio
ns th
at
build
awar
enes
s of
antim
icrob
ial
resis
tanc
e Co
mpe
tenc
y sta
tem
ent:
Healt
h wor
ker d
emon
strat
es
that
they
have
the k
nowl
edge
an
d awa
rene
ss of
effec
tive
appr
oach
es to
cont
rol A
MR,
an
d has
the s
kills/
attit
udes
to
imple
men
t cha
nge a
ccord
ing
to ro
le an
d lev
el of
train
ing.
Rele
vanc
e: H
igh
Know
ledg
e:1.
Unde
rstan
d the
deve
lopm
ent a
nd
main
caus
es of
AMR.
2.
Unde
rstan
d the
basic
princ
iples
of
infec
tion p
reve
ntion
and c
ontro
l, i.e
. han
d hyg
iene t
o pre
vent
tra
nsm
ission
of in
fectio
ns.
3. Un
derst
and t
he im
pact
of re
sista
nce o
n cho
ice of
an
timicr
obial
ther
apy f
or tr
eatin
g inf
ectio
ns.
4. Un
derst
and t
he m
orbid
ity,
mor
talit
y and
econ
omic
thre
at of
AM
R to h
uman
healt
h.5.
Know
the i
mpo
rtanc
e of
optim
izing
use o
f ant
imicr
obial
s in
the h
uman
and a
nimal
secto
rs to
prev
ent d
evelo
pmen
t of
resis
tanc
e.
Skill
s:1.
Abilit
y to i
nter
pret
and
com
mun
icate
the u
se of
ap
prop
riate
polic
y guid
eline
s on
AMR.
Attit
udes
:1.
Prom
ote a
ware
ness
of AM
R and
ap
prop
riate
antim
icrob
ial us
e am
ongs
t all h
ealth
care
wor
kers,
pa
tient
com
mun
ities
and t
he
gene
ral p
ublic
.2.
Act t
o pro
tect
the e
ffecti
vene
ss of
antim
icrob
ials a
s an e
thica
l im
pera
tive a
nd a
publi
c goo
d.
Rele
vanc
e: H
igh
Know
ledg
e:
1. Un
derst
and t
he im
porta
nce o
f an
timicr
obial
choic
e, do
sage
, int
erva
l, dur
ation
, pre
para
tion a
nd
adm
inistr
ation
of an
timicr
obial
s. 2.
Know
the p
rincip
les of
m
icrob
iolog
y in i
dent
ifying
pa
thog
ens f
rom
clini
cal s
ample
s.3.
Know
the b
asic
diagn
ostic
role
of
the m
icrob
iolog
y lab
orat
ory.
4. Un
derst
and l
ocal
AMR
epide
miol
ogy,
resis
tanc
e and
su
scept
ibilit
y pat
tern
s and
use o
f gu
idelin
es.
5. Pa
tient
coun
sellin
g etiq
uette
s, dis
cussi
on te
chniq
ues a
nd
psyc
holog
y for
patie
nt
com
mun
icatio
n.6.
Unde
rstan
d the
princ
iples
of
empir
ic, sy
ndro
mic
or cu
lture-
base
d tre
atm
ent o
ption
s in r
elatio
n to t
he
selec
tion o
f ant
imicr
obial
s.
Skill
s:1.
Appr
opria
te us
e of a
ntim
icrob
ials
to tr
eat a
nd/o
r pre
vent
com
mon
inf
ectio
ns an
d syn
drom
es.
2. Ab
ility t
o com
mun
icate
with
pa
tient
s on t
he ap
prop
riate
use o
f an
tibiot
ics.
3. Ab
ility t
o coll
ect m
icrob
iolog
y sa
mple
s.
Attit
udes
:1.
Prom
ote a
stan
dard
for t
he
appr
opria
te us
e of a
ntim
icrob
ials
and m
anag
e pat
ient e
xpec
tatio
ns
and d
eman
ds es
pecia
lly w
hen
the u
se of
antim
icrob
ials i
s not
ind
icate
d.
Rele
vanc
e: H
igh
Know
ledg
e:1.
Unde
rstan
d the
role
of be
dside
nursi
ng in
an
timicr
obial
stew
ards
hip
prog
ram
mes
.
Skill
s:1.
Asse
ss th
e sou
rce of
infec
tion
and i
dent
ify ap
prop
riate
m
easu
res.
2. Ob
tain
aller
gy hi
story,
pe
rform
med
icatio
n re
conc
iliatio
n, an
d rec
ord t
his
in th
e med
ical re
cord
.
Attit
udes
:1.
Cont
ribut
e to a
patie
nt-
cent
red f
ocus
in th
e clin
ical
team
, and
mon
itor a
nd
com
mun
icate
daily
patie
nt
prog
ress.
2. Co
ntrib
ute t
o pub
lic he
alth
liter
acy a
nd ge
nera
l adv
ocac
y on
the i
mpo
rtanc
e of
infec
tion p
reve
ntion
.
Rele
vanc
e: H
igh
Know
ledg
e:1.
Unde
rstan
d the
sign
ifica
nce
of an
timicr
obial
choic
e, do
sage
, dur
ation
and
prep
arat
ion in
the t
reat
men
t of
infec
tions
.
Skill
s:1.
Advis
e pat
ients
and
pres
cribe
rs on
the a
ppro
priat
e us
e of a
ntim
icrob
ials.
2. Pr
actis
e safe
disp
osal
of
unus
ed an
timicr
obial
m
edici
nes.
Attit
udes
:1.
Advo
cate
for p
atien
t safe
ty
and c
ompli
ance
in th
e pr
escri
ption
and u
se of
an
timicr
obial
s in c
ompli
ance
wi
th fo
rmula
ry pr
otoc
ols.
2. Cr
itica
lly as
sess
infor
mat
ion
and p
harm
aceu
tical
prod
ucts
as pa
rt of
good
proc
urem
ent
prac
tices
.
Rele
vanc
e: H
igh
Know
ledg
e:
1. Un
derst
and t
he di
agno
stic
role
of th
e micr
obiol
ogy
labor
ator
y in d
etec
ting
infec
tions
, resis
tanc
e pa
ttern
s, gu
iding
patie
nt
man
agem
ent a
nd in
form
ing
AMR c
ontro
l stra
tegie
s.
Skill
s:1.
Colle
ct an
d rep
ort d
ata o
n an
timicr
obial
prod
uct q
ualit
y an
d sen
sitivi
ty to
natio
nal
drug
regis
tratio
n bod
ies.
2. Ad
vise p
rescr
ibers
on co
rrect
micr
obiol
ogica
l tes
ting
proc
edur
es.
3. Ab
ility t
o car
ry ou
t bac
terial
iso
lation
, iden
tifica
tion,
susce
ptibi
lity t
estin
g and
rep
ortin
g.4.
Prov
ide fa
cility
-spec
ific
cumu
lative
susce
ptibi
lity
repor
ts for
com
mon
bacte
rial
path
ogen
s aga
inst a
ntibi
otics
th
at ar
e rec
omm
ende
d in t
he
local
or na
tiona
l guid
eline
s.5.
Gene
rate
profi
les of
an
timicr
obial
resis
tanc
e for
iden
tified
antim
icrob
ial
micr
oorg
anism
for p
ublic
he
alth d
ecisi
on-m
aking
.
Attit
udes
:1.
Advo
cate
for a
nd co
mply
wi
th la
bora
tory
and p
ublic
he
alth g
uideli
nes r
egar
ding
antim
icrob
ial su
scept
ibilit
y te
sting
.
Rele
vanc
e: H
igh
Know
ledg
e:1.
Unde
rstan
d the
use o
f qua
lity
impr
ovem
ent f
ram
ewor
ks to
ad
dres
s gap
s in A
MR e
duca
tion.
2. Un
derst
and t
he po
tent
ial fo
r co
st sa
vings
and h
ealth
gains
as
socia
ted w
ith eff
ectiv
e inf
ectio
n con
trol a
nd ap
prop
riate
an
timicr
obial
use.
3. Un
derst
and t
he ro
les an
d res
pons
ibilit
ies of
diffe
rent
stake
holde
rs in
antim
icrob
ial
stewa
rdsh
ip tea
ms.
Mem
bers
of th
e tea
m co
uld in
clude
, but
ar
e not
limite
d to,
the r
oles o
f ph
ysici
ans,
phar
mac
ists,
infec
tion
prev
entio
nists,
micr
obiol
ogist
s, nu
rses a
nd ho
spita
l adm
inistr
ator
s or
othe
rs.
Skill
s:1.
Abilit
y to d
eter
mine
and
imple
men
t bes
t app
roac
hes
to an
timicr
obial
stew
ards
hip
inter
vent
ions o
n the
basis
of
cont
ext.
2. Ab
ility t
o car
ry ou
t res
ource
all
ocat
ion to
imple
men
t and
su
stain
antim
icrob
ial st
ewar
dship
pr
ogra
mm
es.
3. De
velop
polic
y adv
ocac
y and
en
force
men
t to m
anag
e AM
R pr
ogra
mm
es.
Attit
udes
:1.
Prom
ote A
MR a
ware
ness
at he
alth
syste
m, h
ospit
al an
d com
mun
ity
levels
.
Table
1. AM
R com
pete
ncy f
ram
ewor
k
WHO COMPETENCY FRAMEWORK FOR HEALTH WORKERS’ EDUCATION AND TRAINING ON ANTIMICROBIAL RESISTANCE
7
a This
fram
ewor
k assu
mes
that
know
ledge
cont
ents
are s
imila
r for
pre-
serv
ice ed
ucat
ion an
d in-
serv
ice tr
aining
thou
gh em
phas
is sh
ifts t
o im
prov
ing sk
ills an
d atti
tude
s for
in-se
rvice
train
ing.
b Den
otes
the b
asic
AMR c
ompe
tenc
ies th
at al
l hea
lth ca
re w
orke
rs sh
ould
have
. c In
clude
s med
ical d
octo
rs an
d den
tists.
Not
e tha
t pha
rmac
ists,
nurse
s and
midw
ives a
nd ot
her h
ealth
care
wor
kers
are a
lso in
clude
d in t
his ca
tego
ry in
setti
ngs w
here
they
are a
llowe
d to p
rescr
ibe an
timicr
obial
s by r
egula
tion.
The e
xten
t to
whic
h the
pres
cribin
g com
pete
ncies
are r
eleva
nt to
the d
iffer
ent c
adre
s may
vary
acco
rding
to sc
opes
of pr
actic
e and
loca
l regu
lation
.d N
on-p
rescr
ibers
includ
e hea
lth w
orke
rs th
at ar
e not
allow
ed by
regu
lation
to pr
escri
be an
timicr
obial
s. (N
ote t
hat i
n som
e set
tings
, pha
rmac
ists,
nurse
s and
midw
ives a
re al
lowed
by re
gulat
ion to
pres
cribe
antim
icrob
ials.)
e This
cate
gory
may
inclu
de pe
rsonn
el fro
m th
e pre
scribi
ng an
d non
-pre
scribi
ng oc
cupa
tiona
l gro
ups w
ho ha
ve a
leade
rship
role
or au
thor
ity in
man
aging
AMR c
ontro
l.
Antim
icrob
ial r
esist
ance
do
mai
nsa
Cate
gory
1: A
ll he
alth
wor
kers
bCa
tego
ry 2:
Pre
scrib
ersc
Cate
gory
3: N
on-p
resc
riber
sd Ca
tego
ry 4:
Pub
lic h
ealth
office
rs/
heal
th se
rvice
s man
ager
se
Nurs
esPh
arm
acist
sLa
bora
tory
scie
ntist
s/te
chni
cians
Foun
datio
ns th
at
build
awar
enes
s of
antim
icrob
ial
resis
tanc
e
2. Ac
cord
ing to
setti
ngs a
nd w
here
ap
prop
riate
, enc
oura
ge ad
here
nce
to an
timicr
obial
form
ulary
/pr
otoc
ol re
strict
ions.
3. Un
derst
and b
asic
princ
iples
of
beha
viour
chan
ge in
the c
onte
xt
of pr
escri
bing a
ntim
icrob
ials a
nd
mod
el go
od pr
escri
bing b
ehav
iour
to co
lleag
ues.
2. Es
tabli
sh an
d enf
orce
com
plian
ce
with
antim
icrob
ial fo
rmula
ry/
prot
ocol
restr
iction
s at l
ocal
and n
ation
al lev
els ac
cord
ing to
co
untry
polic
ies.
3. To
geth
er w
ith ci
vil so
ciety,
ad
voca
te fo
r the
resp
onsib
le de
velop
men
t of n
ew
antim
icrob
ials a
nd en
sure
the
corre
ct pr
omot
ion of
exist
ing on
es.
8
Table
1. AM
R com
pete
ncy f
ram
ewor
k, co
ntinu
ed
Antim
icrob
ial r
esist
ance
do
mai
nsa
Cate
gory
1: A
ll he
alth
wor
kers
bCa
tego
ry 2:
Pre
scrib
ersc
Cate
gory
3: N
on-p
resc
riber
sd Ca
tego
ry 4:
Pub
lic h
ealth
office
rs/
heal
th se
rvice
s man
ager
se
Nurs
esPh
arm
acist
sLa
bora
tory
scie
ntist
s/te
chni
cians
Appr
opria
te u
se
of an
timicr
obia
l ag
ents
Com
pete
ncy s
tate
men
t: He
alth w
orke
r dem
onstr
ates
th
at th
ey ha
ve th
e kno
wled
ge
and u
nder
stand
ing, a
ccord
ing
to th
eir fie
ld an
d lev
el of
ex
perti
se, t
o fac
ilitat
e opt
imal
and s
afe us
e of a
ntim
icrob
ial
agen
ts fo
r man
agem
ent o
f inf
ectio
ns.
Rele
vanc
e: H
igh
Know
ledg
e:1.
Unde
rstan
d tha
t ant
imicr
obial
s ha
ve di
ffere
nt re
sista
nce p
oten
tial
(AW
aRE c
ateg
ories
). 2.
Unde
rstan
d the
spec
ific r
oles o
f ot
her h
ealth
care
wor
kers.
3.
Unde
rstan
d the
cons
eque
nces
(in
tend
ed an
d unin
tend
ed) o
f the
us
e of a
ntim
icrob
ial th
erap
y in
hum
ans.
Skill
s:1.
Ensu
re eff
ectiv
e man
agem
ent o
f an
timicr
obial
s (ac
cord
ing to
scop
e of
prac
tice)
in in
fectio
n the
rapy
.
Attit
udes
:1.
Enco
urag
e pat
ient a
nd pe
er
prof
essio
nal in
tera
ction
s on
antim
icrob
ial pr
escri
ption
and
ther
apy.
2. En
sure
tim
ely an
d app
ropr
iate
feedb
ack t
o pre
scribe
rs an
d oth
er
care
grou
ps.
3. W
illing
ness
to pa
rticip
ate i
n qu
ality
impr
ovem
ent p
rogr
amm
es
for a
ntim
icrob
ial us
e.4.
Willi
ngne
ss to
com
mun
icate
th
e risk
of de
velop
men
t and
tra
nsm
ission
of AM
R spr
ead w
ithin
and o
utsid
e of m
ultidi
scipli
nary
an
timicr
obial
team
s.
Rele
vanc
e: H
igh
Know
ledg
e:1.
Diag
nosis
of di
seas
e inc
luding
the
abilit
y to d
iscrim
inate
dise
ases
of
differ
ent i
nfec
tious
path
ology
.2.
Indic
ation
for a
ntim
icrob
ial
ther
apy,
includ
ing as
sessm
ent o
f th
e sev
erity
of th
e inf
ectio
n (se
psis
synd
rom
e rec
ognit
ion) t
o inf
orm
ur
genc
y for
ther
apy.
3. Un
derst
and t
hat t
rave
l, rec
ent
hosp
italiz
ation
or pr
eviou
s m
icrob
iolog
y find
ings o
f re
sista
nt ba
cteria
are f
acto
rs th
at pr
edisp
ose t
o colo
nizat
ion/
infec
tion w
ith a
resis
tant
pa
thog
en.
4. Un
derst
and c
omm
on dr
ug
inter
actio
ns be
twee
n an
timicr
obial
s and
othe
r th
erap
eutic
agen
ts, an
d be
twee
n ant
imicr
obial
s and
fo
od. U
nder
stand
their
clini
cal
signifi
canc
e and
the s
trate
gies t
o av
oid in
tera
ction
s.5.
Appr
eciat
e the
risk,
bene
fits a
nd
limita
tions
of th
e ant
imicr
obial
tre
atm
ent i
n the
cont
ext o
f the
pa
tient
and s
ettin
g. 6.
Unde
rstan
d the
conc
ept o
f bro
ad-
and n
arro
w-sp
ectru
m an
tibiot
ics
and t
he im
porta
nce o
f avo
iding
th
eir un
nece
ssary
use,
espe
cially
th
ose w
ith br
oad-
spec
trum
ac
tivity
.7.
Unde
rstan
d the
use o
f an
timicr
obial
s in s
pecia
l ca
re gr
oups
(e.g.
paed
iatric
s, pr
egna
ncy,
brea
stfee
ding,
rena
l dis
ease
s and
obes
e per
sons
).8.
Unde
rstan
d the
mec
hanis
ms
of ac
tions
of th
e diff
erent
an
timicr
obial
drug
s clas
ses.
9. Un
derst
and h
ow to
deve
lop a
hosp
ital fo
rmula
ry.
Rele
vanc
e: H
igh
Know
ledg
e:1.
Unde
rstan
d nur
ses’ r
ole in
the
ther
apeu
tic m
anag
emen
t of
infec
tious
dise
ases
.
Skill
s:1.
Adm
iniste
r and
reco
rd
antim
icrob
ial m
edici
nes u
se
includ
ing re
view
of do
se/ti
me
for a
ccur
acy.
2. Pe
rform
aller
gy ch
ecks
.3.
Upda
te cl
inica
l and
lab
orat
ory r
esult
s inc
luding
re
nal fu
nctio
n res
ults,
drug
lev
els, a
nd pr
elim
inary
/fina
l m
icrob
iolog
y res
ults.
4. M
onito
r and
repo
rt ad
verse
ev
ents
of an
timicr
obial
tre
atm
ent.
5. In
tera
ct wi
th ot
her m
embe
rs of
the s
tewa
rdsh
ip te
am
to pr
omot
e opt
imal
antim
icrob
ial tr
eatm
ent i
n pa
tient
s (te
amwo
rk).
Attit
udes
:1.
Educ
ate p
atien
ts an
d fam
ily,
and p
erfo
rm di
schar
ge
teac
hing.
Rele
vanc
e: H
igh
Know
ledg
e:1.
Unde
rstan
d the
sign
ifica
nce
of effi
cacy
data
for c
linica
l be
nefit
for e
ach i
ndica
tion
(mag
nitud
e of b
enefi
t es
timat
ed in
clini
cal t
rials)
.2.
Phar
mac
okine
tics:
rout
e of
ther
apy,
conc
ept o
f bio
avail
abilit
y, do
sing
frequ
ency
, the
rape
utic
drug
m
onito
ring a
nd cl
eara
nce.
3. Ph
arm
acod
ynam
ics: t
issue
/or
gan a
dver
se eff
ects
(e.g.
ab
norm
al liv
er fu
nctio
n tes
ts,
rena
l tox
icity
).4.
Aller
gy: im
med
iate,
non-
life
thre
aten
ing, s
ever
e adv
erse
dr
ug re
actio
ns (e
.g. St
even
Jo
hnso
n Syn
drom
e).
Skill
s: 1.
Asse
ss pr
escri
ption
s in
acco
rdan
ce w
ith lo
cal p
olicie
s fo
r ant
imicr
obial
use.
2. Re
view
antim
icrob
ial ch
oice,
dose
, inte
rval,
dura
tion a
nd
rout
e of a
dmini
strat
ion.
3. Gi
ve ad
vice o
n dos
age
form
, pre
para
tion a
nd
adm
inistr
ation
(esp
ecial
ly fo
r sp
ecial
patie
nt co
horts
such
as
child
ren)
.4.
Coun
sel in
dividu
als an
d po
pulat
ions o
n the
safe
and
ratio
nal u
se of
antim
icrob
ials
(inclu
ding t
he se
lectio
n, us
e, co
ntra
indica
tions
, sto
rage
, dr
ug in
tera
ction
s and
side
eff
ects)
.5.
Accu
rate
ly dis
pens
e pr
escri
bed a
ntim
icrob
ials f
or
majo
r and
mino
r infec
tions
.
Rele
vanc
e: Av
erag
e
Know
ledg
e:1.
Unde
rstan
d the
use o
f the
an
tibiog
ram
in de
tectin
g and
rep
ortin
g AMR
patte
rns i
n se
tting
s whe
re an
tibiog
ram
s ar
e com
mon
ly us
ed.
Skill
s:1.
Reco
gnize
com
mon
m
echa
nism
s of r
esist
ance
wi
thin
an in
stitu
tion f
or
differ
ent a
ntim
icrob
ial/
orga
nism
com
binat
ions.
Unde
rstan
d the
ir im
pact
on re
sista
nce t
o oth
er
antim
icrob
ials.
2. Co
nduc
t ant
ibiot
ics sp
ectru
m
of ac
tivity
analy
sis us
ing th
e an
tibiog
ram
to he
lp de
term
ine
the a
ntibi
otic
agen
t of h
ighes
t effi
cacy.
Attit
udes
:1.
Prov
ide la
bora
tory
user
s wi
th gu
idanc
e on t
he m
ost
appr
opria
te te
sts an
d the
ir lim
itatio
ns.
2. En
sure
read
y acce
ss to
the
tests
and c
omm
unica
tion
of re
sults
to cl
inicia
ns –
op
timize
clini
cal li
aison
. 3.
Ensu
re ti
meli
ness
in th
e ha
ndlin
g of m
icrob
iolog
y sa
mple
s and
com
mun
icatio
n of
susce
ptibi
lity r
esult
s.
Rele
vanc
e: Av
erag
e
Know
ledg
e:1.
Unde
rstan
d whe
re an
d how
to
sear
ch/re
triev
e bes
t scie
ntifi
c ev
idenc
e to s
uppo
rt op
timal
use
and t
hera
py.
2. Un
derst
and t
he im
porta
nce
of pr
omot
ing ap
prop
riate
an
timicr
obial
use a
ccord
ing to
th
eir AW
aRE c
ateg
ories
, in or
der
to im
plem
ent s
pecifi
c res
istan
ce-
prev
entio
n acti
ons f
or th
ese
antim
icrob
ials.
Skill
s:1.
Deve
lop a
syste
mat
ic ap
proa
ch
to an
timicr
obial
pres
cribin
g and
de
sign i
nter
vent
ions t
o add
ress
gaps
.2.
Asse
ss ne
eds a
nd re
spon
d to
antim
icrob
ial sh
orta
ges.
3. Ad
dres
s issu
es re
lated
to th
e av
ailab
ility o
f ant
imicr
obial
s inc
luding
the a
cceler
ated
re
gistra
tion o
f qua
lity,
cost-
effec
tive e
ssent
ial an
timicr
obial
s as
well
as th
e use
of go
od re
view
prac
tices
(GRe
VP).
Attit
udes
:1.
Advo
cate
for a
cond
ucive
en
viron
men
t and
man
agem
ent
struc
ture
that
prior
itize
s an
timicr
obial
stew
ards
hip an
d en
cour
ages
acco
unta
bility
for b
est
prac
tices
on ac
tions
to im
prov
e ap
prop
riate
antim
icrob
ial us
e in
hosp
itals
and c
omm
unity
setti
ngs.
2. En
sure
a re
gular
supp
ly of
es
sent
ial an
timicr
obial
s. 3.
Ensu
re th
e ava
ilabil
ity of
adeq
uate
hu
man
and m
ater
ial re
sour
ces f
or
deliv
ering
healt
h car
e.
WHO COMPETENCY FRAMEWORK FOR HEALTH WORKERS’ EDUCATION AND TRAINING ON ANTIMICROBIAL RESISTANCE
9
Antim
icrob
ial r
esist
ance
do
mai
nsa
Cate
gory
1: A
ll he
alth
wor
kers
bCa
tego
ry 2:
Pre
scrib
ersc
Cate
gory
3: N
on-p
resc
riber
sd Ca
tego
ry 4:
Pub
lic h
ealth
office
rs/
heal
th se
rvice
s man
ager
se
Nurs
esPh
arm
acist
sLa
bora
tory
scie
ntist
s/te
chni
cians
Appr
opria
te u
se
of an
timicr
obia
l ag
ents
10. U
nders
tand
the b
asics
of
antim
icrob
ial pr
oduc
t res
earch
, de
velop
men
t, reg
ulatio
n and
m
arke
ting.
Skill
s:1.
Selec
t and
pres
cribe
antim
icrob
ials
in ac
cord
ance
with
stan
dard
tre
atm
ent g
uideli
nes a
nd
asso
ciate
d esse
ntial
med
icine
s lis
ts (w
here
appli
cable
) kee
ping i
n m
ind th
e pat
hoge
n, do
se, d
urat
ion
and r
oute
of ad
mini
strat
ion.
2. Re
cogn
ize th
e im
med
iate a
nd
long-
term
patie
nt an
d eco
logica
l co
nseq
uenc
es of
inap
prop
riate
an
timicr
obial
pres
cript
ion.
Attit
udes
:1.
Prom
ote b
est p
racti
ce ap
proa
ches
to
pres
cribin
g ant
imicr
obial
s and
en
sure
adhe
renc
e to g
uideli
nes.
2. Pr
omot
e cap
acity
to se
arch
for
relia
ble so
urce
s of u
nbias
ed/
unco
nflict
ed in
form
ation
on be
st us
e of a
ntim
icrob
ials.
3. Be
ware
of m
arke
t inc
entiv
es
to pr
olifer
ate t
he pr
escri
ption
of
antim
icrob
ials a
gains
t the
un
derst
andin
g of p
rescr
ibing
gu
idelin
es an
d pra
ctica
l ap
plica
tion.
6. En
sure
tim
ely su
pply
of
appr
opria
te m
edici
nes.
7. En
sure
appr
opria
te
docu
men
tatio
n of
antim
icrob
ials d
ispen
sed
includ
ing ro
ute,
time,
dose
, th
erap
eutic
drug
mon
itorin
g an
d res
pons
e for
indiv
idual
patie
nts.
Attit
udes
: 1.
Prom
ote a
ppro
ache
s to
incre
ase i
ndivi
dual
or
com
mun
ity kn
owled
ge
of us
ing an
timicr
obial
s ap
prop
riate
ly.2.
Prom
ote t
he us
e of q
ualit
y as
sure
d ant
imicr
obial
s for
pa
tient
trea
tmen
t.3.
Prom
ote A
MR d
rug u
tiliza
tion
studie
s.4.
Prom
ote b
ette
r pat
ient
unde
rstan
ding o
f all
treat
men
t issu
es su
ch as
sa
fety c
once
rns i
nclud
ing
alerts
, and
adhe
renc
e.
4. En
cour
age t
he us
e of lo
cal a
nd
natio
nal m
etric
s to a
udit/
quali
ty
impr
ovem
ent a
nd ad
here
nce t
o gu
idelin
es.
5. Pr
ovide
clea
r mec
hanis
ms f
or
the g
over
nanc
e of a
ntim
icrob
ial
stewa
rdsh
ip inc
luding
addr
essin
g re
spon
sibilit
y and
acco
unta
bility
fo
r the
quali
ty an
d qua
ntity
of
antim
icrob
ials p
rescr
ibed w
ithin
a sy
stem
.6.
Prom
ote p
rodu
ct qu
ality.
7. Ad
opt a
shar
ed re
spon
sibilit
y for
m
ainta
ining
prod
uct q
ualit
y.
10
Table
1. AM
R com
pete
ncy f
ram
ewor
k, co
ntinu
ed
Antim
icrob
ial r
esist
ance
do
mai
nsa
Cate
gory
1: A
ll he
alth
wor
kers
bCa
tego
ry 2:
Pre
scrib
ersc
Cate
gory
3: N
on-p
resc
riber
sd Ca
tego
ry 4:
Pub
lic h
ealth
office
rs/
heal
th se
rvice
s man
ager
se
Nurs
esPh
arm
acist
sLa
bora
tory
scie
ntist
s/te
chni
cians
Infe
ctio
n pr
even
tion
and
cont
rol (
IPC)
Com
pete
ncy s
tate
men
t: He
alth w
orke
r und
ersta
nds
and i
mple
men
ts th
e prin
ciples
of
hygie
ne, s
anita
tion a
nd IP
C to
redu
ce th
e spr
ead o
f AM
R.
Rele
vanc
e: H
igh
Know
ledg
e:1.
Unde
rstan
ds th
e inf
ectio
n cha
in es
pecia
lly th
e fou
r com
pone
nts
requ
ired f
or tr
ansm
ission
of an
inf
ectio
n: (o
rgan
ism, s
ource
, rout
e of
tran
smiss
ion an
d sus
cept
ible
host)
. 2.
Unde
rstan
d the
role
of ha
nd
hygie
ne to
prev
ent t
rans
miss
ion of
pa
thog
ens.
3. Un
derst
and t
he pr
incipl
es of
pr
even
tion o
f hea
lth ca
re-
asso
ciate
d inf
ectio
ns (H
AI),
includ
ing su
rgica
l site
infec
tions
, ca
thet
er-a
ssocia
ted b
loods
tream
an
d urin
ary t
ract
infec
tions
.4.
Impo
rtanc
e of s
trate
gies t
o pr
even
t inf
ectio
n at c
omm
unity
an
d hea
lth fa
cility
leve
ls, e.
g. wa
ter, s
anita
tion a
nd hy
giene
(W
ASH)
, was
te m
anag
emen
t and
im
mun
izatio
n.5.
Intro
ducti
on to
infec
tious
dise
ases
an
d role
of th
e lab
orat
ory
in ide
ntific
ation
of m
icrob
es
and s
usce
ptibi
lity t
estin
g to
antim
icrob
ials.
Skill
s:1.
Prac
tise h
and h
ygien
e at t
he rig
ht
mom
ent a
nd w
ith ap
prop
riate
te
chniq
ue, a
ccord
ing to
WHO
re
com
men
datio
ns.
2. Co
ntrib
ute t
o the
desig
n and
im
plem
enta
tion o
f pro
cedu
res f
or
crisis
man
agem
ent i
n inf
ectio
n co
ntro
l: aler
t man
agem
ent,
patie
nt id
entifi
catio
n, re
call
of po
tent
ially
cont
amina
ted
equip
men
t and
supp
lies,
repo
rting
an
d exc
hang
e with
relev
ant h
ealth
ca
re pr
ofes
siona
ls.3.
Imple
men
t and
prac
tise u
nivers
al pr
ecau
tions
and t
rans
miss
ion-
base
d prec
autio
ns in
healt
h car
e.
Rele
vanc
e: H
igh
Know
ledg
e:1.
Unde
rstan
d tha
t pres
cribin
g an
timicr
obial
s to p
atien
ts co
lonize
d wi
th m
ultidr
ug re
sista
nt (M
DR)
path
ogen
s (e.g
. MDR
gram
ne
gativ
e pat
hoge
ns in
urine
or
GIT)
, will
not e
radic
ate t
he
path
ogen
s and
shou
ld th
erefor
e not
be
used
as a
prev
entiv
e mea
sure
to
stop t
rans
miss
ion of
the r
esist
ant
path
ogen
s to o
thers
.
Skill
s:1.
Apply
meth
ods a
nd st
rateg
ies
to pr
even
t and
cont
rol H
AIs,
includ
ing su
rgica
l site
infec
tions
, ca
thete
r-asso
ciated
bloo
dstre
am
and u
rinar
y tra
ct inf
ectio
ns,
healt
h car
e-ac
quire
d pne
umon
ia,
gastr
oent
eritis
.2.
Ident
ify an
d man
age t
he sp
ecific
loc
al fa
ctors
respo
nsibl
e for
inc
rease
d risk
of H
AI an
d AMR
ac
cord
ing to
prac
tice s
etting
s.3.
Imple
men
t a pl
an th
at is
focu
sed
on lim
iting
cros
s-inf
ectio
n and
co
ntam
inatio
n to r
educ
e HAI
and
AMR i
n hos
pitals
and c
ommu
nity
setti
ngs.
Attit
udes
:1.
Prom
ote p
rincip
les of
HAI
pr
even
tion a
nd co
ntro
l.2.
Enco
urag
e the
deco
ntam
inatio
n an
d ste
riliza
tion o
f hos
pital
equip
men
t and
patie
nt ar
eas.
Rele
vanc
e: H
igh
Know
ledg
e:1.
Unde
rstan
d the
role
of
nursi
ng in
IPC.
Skill
s:1.
Mon
itor p
atien
t res
pons
e and
ini
tiate
appr
opria
te ch
ange
s in
isolat
ion pr
ecau
tions
.2.
Prov
ide pa
tient
s and
fam
ilies
with
evide
nce-
base
d, ac
cura
te an
d non
-judg
men
tal
infor
mat
ion on
the
bene
fits a
nd im
porta
nce
of im
mun
izatio
n for
healt
h ou
tcom
es.
Attit
udes
:1.
Prom
ote h
ygien
e bes
t pr
actic
es in
healt
h car
e fac
ilities
. 2.
Prom
ote a
nd m
onito
r co
mpli
ance
with
IPC a
nd
patie
nt sa
fety m
easu
res.
Rele
vanc
e: H
igh
Know
ledg
e:1.
Unde
rstan
d the
link b
etwe
en
antim
icrob
ial st
ewar
dship
an
d IPC
.2.
Unde
rstan
ds th
e diff
eren
ce
and t
he im
pact
of no
soco
mial
inf
ectio
ns co
mpa
red w
ith
com
mun
ity-a
cquir
ed
infec
tions
.
Skill
s:1.
Abilit
y to f
ollow
phar
mac
y inf
ectio
n con
trol g
uideli
nes.
2. Us
e hyg
ienic
and s
afety
pr
actic
es to
cont
rol c
ross-
trans
miss
ion.
3. Cle
an an
d disi
nfec
t eq
uipm
ent a
nd su
rface
s.
Attit
udes
:1.
Prom
ote t
he lin
k bet
ween
an
timicr
obial
stew
ards
hip
and I
PC.
2. En
cour
age e
ngag
emen
t with
ot
her h
ealth
prof
essio
nals
to
redu
ce H
AI an
d AM
R.
Rele
vanc
e: H
igh
Know
ledg
e:1.
Unde
rstan
d the
role
of th
e lab
orat
ory (
i.e. id
entifi
catio
n of
micr
obes
, sus
cept
ibilit
y tes
ting,
strain
typin
g and
tim
ely co
mmu
nicat
ion of
res
ults)
in en
ablin
g IPC
m
easu
res.
Skill
s:1.
Prov
ide ac
cura
te an
d tim
ely
labor
ator
y inf
orm
ation
, us
ing cl
ear p
roto
cols,
fo
r IPC
plan
ning a
nd
imple
men
tatio
n, in
cludin
g in
outb
reak
setti
ngs.
2. Co
ntrib
ute t
o alig
nmen
t of
antim
icrob
ial st
ewar
dship
, dia
gnos
tic st
ewar
dship
an
d IPC
plan
ning a
nd
imple
men
tatio
n effo
rts.
3. Pr
actis
e app
ropr
iate I
PC
mea
sure
s in t
he la
bora
tory.
Attit
udes
:1.
Prom
ote t
he im
porta
nt ro
le of
the l
abor
ator
y in I
PC.
Rele
vanc
e: H
igh
Know
ledg
e:1.
Unde
rstan
d the
relat
ionsh
ips
betw
een p
atien
t safe
ty, IP
C, HA
I an
d AM
R.
Skill
s:1.
Supp
ort t
he im
plem
enta
tion
of m
ulti-m
odal
strat
egies
to
achie
ve be
havio
ural
chan
ge in
IP
C pra
ctice
s inc
luding
nece
ssary
re
sour
ces,
mon
itorin
g, au
dit an
d fee
dbac
k.2.
Prop
ose a
ppro
priat
e inf
ectio
n co
ntro
l mea
sure
s for
the
man
agem
ent o
f was
te, a
ir, wa
ter,
laund
ry an
d foo
d.3.
Deve
lop an
d upd
ate p
roce
dure
s re
lated
to de
cont
amina
tion
and s
teril
izatio
n guid
eline
s and
sta
ndar
ds.
Attit
udes
:1.
Prom
ote t
he im
porta
nce o
f pr
even
tion a
nd co
ntro
l of H
AI an
d AM
R.
2. Hi
ghlig
ht th
e hum
an, e
cono
mic
and w
ider p
ublic
healt
h con
cern
s of
HAI
and A
MR.
Use
data
to
illustr
ate t
he pr
oblem
and
com
mun
icate
it to
decis
ion-
mak
ers a
nd th
e affe
cted
com
mun
ities
.3.
Take
an ac
tive r
ole in
risk r
educ
tion
durin
g plan
ning o
f ren
ovat
ions
and n
ew co
nstru
ction
s in t
he
healt
h car
e org
aniza
tion.
WHO COMPETENCY FRAMEWORK FOR HEALTH WORKERS’ EDUCATION AND TRAINING ON ANTIMICROBIAL RESISTANCE
11
Antim
icrob
ial r
esist
ance
do
mai
nsa
Cate
gory
1: A
ll he
alth
wor
kers
bCa
tego
ry 2:
Pre
scrib
ersc
Cate
gory
3: N
on-p
resc
riber
sd Ca
tego
ry 4:
Pub
lic h
ealth
office
rs/
heal
th se
rvice
s man
ager
se
Nurs
esPh
arm
acist
sLa
bora
tory
scie
ntist
s/te
chni
cians
Infe
ctio
n pr
even
tion
and
cont
rol (
IPC)
Attit
udes
:1.
Advo
cate
and d
emon
strat
e ac
tion a
nd ac
coun
tabil
ity fo
r th
e im
plem
enta
tion o
f IPC
and h
ygien
e and
sanit
ation
be
st pr
actic
es in
healt
h car
e fac
ilities
and c
omm
unity
setti
ngs
resp
ectiv
ely.
2. Ad
voca
te fo
r WAS
H an
d for
sc
aling
up va
ccine
s aga
inst
com
mon
infec
tions
caus
ed
by m
icroo
rgan
isms s
uch a
s pn
eum
ococ
cus,
rota
virus
and
Haem
ophil
us in
fluen
zae t
ype b
.3.
Unde
rstan
d how
and w
hen t
o co
ntac
t the
infec
tion c
ontro
l pr
ofes
siona
l for t
heir f
acilit
y or
area
.4.
Prom
ote p
rope
r hea
lth ca
re w
aste
m
anag
emen
t.5.
Prom
ote i
njec
tion s
afety
aw
aren
ess a
nd te
chniq
ues.
12
Table
1. AM
R com
pete
ncy f
ram
ewor
k, co
ntinu
ed
Antim
icrob
ial r
esist
ance
do
mai
nsa
Cate
gory
1: A
ll he
alth
wor
kers
bCa
tego
ry 2:
Pre
scrib
ersc
Cate
gory
3: N
on-p
resc
riber
sd Ca
tego
ry 4:
Pub
lic h
ealth
office
rs/
heal
th se
rvice
s man
ager
se
Nurs
esPh
arm
acist
sLa
bora
tory
scie
ntist
s/te
chni
cians
Diag
nost
ic st
ewar
dshi
p an
d su
rvei
llanc
e Co
mpe
tenc
y sta
tem
ent:
The h
ealth
wor
ker
dem
onstr
ates
an
unde
rstan
ding,
relev
ant
to th
eir fie
ld an
d lev
el of
ex
perti
se, o
f the
prin
ciples
an
d pro
cesse
s of d
iagno
stic
stewa
rdsh
ip, su
rveil
lance
of
AMR a
nd an
timicr
obial
ste
ward
ship
that
unde
rpin
prop
hylax
is an
d tre
atm
ent
guide
lines
and A
MR c
ontro
l str
ateg
ies.
Rele
vanc
e: H
igh
Know
ledg
e:1.
Unde
rstan
d the
role
of na
tiona
l m
edici
ne re
gulat
ory a
utho
rities
in
the r
egula
tion o
f med
icine
s: law
s and
regu
lation
s, re
gistra
tion,
m
anuf
actu
ring,
licen
sing,
inspe
ction
and e
nfor
cem
ent,
phar
mac
ovigi
lance
, pos
t-mar
ket
surv
eillan
ce, q
ualit
y con
trol,
clinic
al tri
als, d
rug i
nfor
mat
ion.
2. Un
derst
and t
he im
porta
nce
of re
porti
ng su
spec
ted p
oor
quali
ty pr
oduc
ts, th
erap
eutic
ine
ffecti
vene
ss, an
d adv
erse
ev
ents
as th
ey m
ay ge
nera
te
signa
ls on
the c
ompr
omise
d qu
ality
of th
e ant
imicr
obial
pr
oduc
ts.3.
Unde
rstan
d the
impo
rtanc
e of
prop
er re
cord
keep
ing an
d use
of
drug
code
s (ac
cord
ing to
setti
ngs)
for t
race
abilit
y of m
edici
nes.
4. Un
derst
and i
mpo
rtanc
e of A
MR
surv
eillan
ce fo
r cha
racte
rizat
ion of
res
istan
ce tr
ends
and m
easu
ring
impa
ct an
d bur
den o
f AMR
to
guide
polic
y-m
akers
in de
velop
ing
treat
men
t rec
omm
enda
tions
.
Skill
s:1.
Act a
s first
line o
f sur
veilla
nce
to ac
cura
tely
ident
ify an
d rep
ort
susp
iciou
s, ine
ffecti
ve, a
nd
subs
tand
ard a
ntim
icrob
ials t
o the
ap
prop
riate
auth
oriti
es.
Attit
udes
:1.
Resp
ect a
nd pr
otec
t the
priva
cy
and i
dent
ity of
indiv
iduals
in
supp
ortin
g or c
arry
ing ou
t su
rveil
lance
activ
ities
for A
MR
cont
rol.
Rele
vanc
e: H
igh
Know
ledg
e:1.
Unde
rstan
d the
basic
princ
iples
of
antib
iogra
ms a
nd ot
her r
epor
ting
tools
and t
heir i
nter
pret
ation
.2.
Unde
rstan
d prin
ciples
of
surv
eillan
ce of
AMR a
nd
antim
icrob
ial us
e and
the u
se of
su
rveil
lance
data
.
Skill
s:1.
Abilit
y to i
nter
pret
and u
se
antim
icrob
ial su
scept
ibilit
y tes
ting
resu
lts (i
n set
tings
whe
re th
ey
are c
omm
only
used
) and
othe
r m
icrob
iolog
y tes
ting t
ools.
2. Fo
r infec
tious
dise
ases
expe
rts,
deve
lop in
dicat
ors f
or th
e rat
ional
use o
f ant
imicr
obial
s. 3.
Abilit
y to i
nterp
ret an
d use
AMR
surv
eillan
ce da
ta.
4. Ab
ility t
o app
ly pr
actic
e and
pr
oced
ures
for s
pecim
en se
lectio
n an
d coll
ectio
n and
the c
omple
tion
of cl
inica
l, dem
ogra
phic
and o
ther
epide
miol
ogica
l dat
a tha
t mus
t ac
com
pany
each
spec
imen
, cor
rect
stora
ge an
d tra
nspo
rtatio
n of
spec
imen
s to t
he la
bora
tory.
Attit
udes
:1.
Prom
ote t
he ge
nera
tion o
f re
levan
t clin
ical, e
pidem
iolog
ical
and m
icrob
iolog
ical d
ata t
o su
ppor
t AM
R sur
veilla
nce.
Rele
vanc
e: Av
erag
e
Know
ledg
e:1.
Unde
rstan
d the
role
of
nursi
ng in
the i
dent
ifica
tion,
co
llecti
on, t
rans
porta
tion a
nd
repo
rting
of m
icrob
iolog
ical
sam
ples a
nd te
st re
sults
.
Skill
s:1.
Obta
in cu
ltures
and s
ends
the
cultu
res to
the m
icrob
iolog
y lab
orat
ory.
2. Mo
nitor
cultu
re res
ults a
nd
repor
t res
ults t
o the
phys
ician
.
Attit
udes
:1.
Prom
ote t
he w
elfar
e of
patie
nts’ p
ost-d
ischa
rge
by en
surin
g opt
imal
com
mun
icatio
n of f
or
disch
arge
or re
ferra
l ser
vices
.
Rele
vanc
e: Lo
w
Know
ledg
e:
1. Un
derst
and m
etho
ds fo
r the
ide
ntifi
catio
n of s
ubsta
ndar
d an
d fals
ified
med
ical
prod
ucts.
2. Un
derst
and t
he
mea
sure
men
t of
antim
icrob
ial co
nsum
ption
, qu
ality
and a
ssocia
ted c
osts
in he
alth c
are s
ettin
gs an
d co
mm
uniti
es.
Skill
s:1.
Carry
out m
onito
ring o
f an
timicr
obial
use t
hrou
gh
point
prev
alenc
e sur
veys
etc.
2. Ac
cura
tely
repo
rt de
fectiv
e or
subs
tand
ard a
ntim
icrob
ial
med
icine
s to t
he ap
prop
riate
au
thor
ities
.
Attit
udes
:1.
Ensu
re a
cultu
re of
ris
k awa
rene
ss an
d et
hical
beha
viour
in th
e ide
ntifi
catio
n and
repo
rting
of
AMR d
ata.
Rele
vanc
e: H
igh
Know
ledg
e:1.
Unde
rstan
d the
princ
iples
an
d pra
ctice
of di
agno
stic
stewa
rdsh
ip.2.
Unde
rstan
d the
relev
ant
tech
nique
s and
data
requ
ired
for e
ffecti
ve su
rveil
lance
of
antim
icrob
ial us
e and
AMR i
n ho
spita
l and
com
mun
ity.
3. Un
derst
and t
he us
e of
diagn
ostic
data
in AM
R su
rveil
lance
.
Skill
s:1.
Supp
ort i
mple
men
tatio
n of
diagn
ostic
stew
ards
hip.
2. Ac
t as fi
rst lin
e of s
urve
illanc
e in
the c
orre
ct us
e and
re
porti
ng of
micr
obiol
ogica
l te
sts an
d diag
nosti
c too
ls.3.
Cont
ribut
e to h
ospit
al-sp
ecific
an
timicr
obial
susce
ptibi
lity
data
.
Attit
udes
:1.
Embe
d a su
rveil
lance
cultu
re
in th
eory
and p
racti
ce.
2. Em
brac
e the
use o
f ap
prop
riate
tech
nolog
y in
AMR t
estin
g.3.
Main
tain
effec
tive
com
mun
icatio
n and
co
llabo
rativ
e wor
k with
cli
nician
s, IP
C pro
fessio
nals,
ho
spita
l epid
emiol
ogist
s, an
d ot
her h
ealth
care
wor
kers
involv
ed in
stew
ards
hip
activ
ities
.
Rele
vanc
e: H
igh
Know
ledg
e:1.
Unde
rstan
d inf
ectio
us di
seas
es
epide
miol
ogy.
2. Un
derst
and p
rincip
les an
d m
etho
ds of
publi
c hea
lth
surv
eillan
ce.
3. Un
derst
and A
MR s
urve
illanc
e an
d dat
a ana
lysis
met
hods
and
asse
ssmen
t of t
rend
s to i
nfor
m
inter
vent
ions.
4. Un
derst
and t
he im
porta
nce
of in
corp
orat
ing an
timicr
obial
pr
oduc
t qua
lity a
ssura
nce t
opics
int
o rele
vant
natio
nal p
olicie
s and
re
gulat
ions i
nclud
ing th
e nat
ional
actio
n plan
for A
MR a
nd na
tiona
l re
gulat
ions o
n ant
imicr
obial
pr
escri
ption
sche
dulin
g, co
nsum
ption
, and
trac
eabil
ity.
5. Im
porta
nce o
f ado
pting
stan
dard
te
rmino
logies
such
as th
e AW
aRE c
ateg
ories
to de
velop
dr
ug st
atist
ics fo
r in-c
ount
ry
and i
nter
-cou
ntry
com
paris
on
of an
timicr
obial
utiliz
ation
and
outco
mes
.6.
The b
enefi
t of r
isk as
sessm
ent
and r
isk m
anag
emen
t stra
tegie
s fo
r iden
tifyin
g and
cont
aining
re
sista
nce.
Skill
s:1.
Abilit
y to m
onito
r and
repo
rt on
the p
erfo
rman
ce of
hosp
ital
and/
or co
mm
unity
AMR a
nd
relat
ed an
timicr
obial
stew
ards
hip
prog
ram
mes
. 2.
Iden
tify a
nd re
port
of su
bsta
ndar
d an
d fals
ified
med
icine
s.3.
Audit
the q
ualit
y of a
ntim
icrob
ial
use t
hrou
gh ba
sic sc
ientifi
c m
ethod
s.
WHO COMPETENCY FRAMEWORK FOR HEALTH WORKERS’ EDUCATION AND TRAINING ON ANTIMICROBIAL RESISTANCE
13
Antim
icrob
ial r
esist
ance
do
mai
nsa
Cate
gory
1: A
ll he
alth
wor
kers
bCa
tego
ry 2:
Pre
scrib
ersc
Cate
gory
3: N
on-p
resc
riber
sd Ca
tego
ry 4:
Pub
lic h
ealth
office
rs/
heal
th se
rvice
s man
ager
se
Nurs
esPh
arm
acist
sLa
bora
tory
scie
ntist
s/te
chni
cians
Diag
nost
ic st
ewar
dshi
p an
d su
rvei
llanc
e
Attit
udes
:1.
Ensu
re ad
equa
te pr
otec
tion
includ
ing a
safe
and c
ondu
cive
work
ing en
viron
men
t for
healt
h ca
re w
orke
rs ca
rrying
out A
MR
surv
eillan
ce ac
tiviti
es.
14
Antimicrobials: An agent or substance, derived from any source (microorganisms, plants, animals, synthetic or semisynthetic) that acts against any type of microorganism such as bacteria (antibacterial), mycobacteria (antimycobacterial), fungi (antifungal), parasite (antiparasitic) and viruses (antiviral). All antibiotics are antimicrobials, but not all antimicrobials are antibiotics (31).
Antimicrobial resistance: The ability of microorganisms (such as bacteria, fungi, viruses and parasites) to multiply or persist in the presence of an increased level of an antimicrobial agent (such as antibiotics, antifungals, antivirals, antimalarials and antihelmintics) relative to the susceptible counterpart of the same species.
Antimicrobial stewardship: Refers to how the appropriate use of antimicrobials can maximize both their current efficacy and the chances of their being efficacious for future generations. It embodies an organizational or health care system-wide approach to promoting and monitoring judicious use of antimicrobials to preserve their future effectiveness.
Diagnostic stewardship: Coordinated guidance and interventions to improve appropriate use of microbiological diagnostics to guide therapeutic decisions. It should promote appropriate, timely diagnostic testing, including specimen collection, and pathogen identification and accurate, timely reporting of results to guide patient treatment (32).
Drug-resistant infections: Describes infections caused by organisms that are resistant to treatment, including those caused by bacteria that do not respond to antibiotics (33).
Competencies: A “combination of knowledge, skills, motives and personal traits”, development of which should help individuals to continually improve their performance and to work more effectively.
Curriculum: A set of learning goals articulated across different health care workers that outline the intended content and process goals at particular points in time and throughout their professional career. These goals in the context of AMR, are relevant at a personal and societal level.
Infection prevention and control: A pragmatic scientific approach designed to prevent harm caused by infections to patients and health workers.
Interprofessional collaboration: Collaborative practice happens when multiple health workers from different professional backgrounds work together with patients, families, carers and communities to deliver the highest quality of care (34).
Prescribers: All health care professionals qualified to prescribe antimicrobials. In addition to physicians of all specialties and dental practitioners, the term may refer to inter alia prescribing nurses, pharmacists (in some jurisdictions), clinical microbiologists, midwives, optometrists, podiatrists and other health care professionals, depending on local regulations.
Principle: Defined as “an accepted or professed rule of action or conduct or a fundamental, primary, or general truth from which others are derived,” or “a fundamental doctrine or truth.” Principles are core tenets that should be acceptable to all.
Surveillance of AMR and antimicrobial use: Collection, validation, analyses and reporting of relevant clinical, microbiological and epidemiological data on AMR in targeted pathogens from different sources (e.g. humans, animals, food, environment), and on relevant antimicrobial use in humans and animals, and then applying the results to slow down or halt the development of resistance.
Significant and common infections: Refers to a collection of commonly and widely recognized infections occurring in the community or in a hospital setting.
Glossary
WHO COMPETENCY FRAMEWORK FOR HEALTH WORKERS’ EDUCATION AND TRAINING ON ANTIMICROBIAL RESISTANCE
15
1 Carlet J, Jarlier V, Harbarth S, Goossens H, Pittet D. Ready for a world without antibiotics? The Pensières Antibiotic Resistance Call to Action. Antimicrob Resist Infect Control. 2012;1:11.
2 Antimicrobial resistance: Global report on surveillance 2014. Geneva: World Health Organization; 2014.
3 Dyar OJ, Pulcini C, Howard P, Nathwani D. European medical students: A first multicentre study of knowledge, attitudes and perceptions of antibiotic prescribing and antibiotic resistance. Antimicrob Chemother. 2014;69(3):842–6. doi: 10.1093/jac/dkt440.
4 Dyar OJ, Howard P, Nathwani D, Pulcini C. Knowledge, attitudes, and beliefs of French medical students about antibiotic prescribing and resistance. Med Mal Infect. 2013;43(10):423–30. doi: 10.1016/j.medmal.2013.07.010.
5 Minen MT, Duquaine D, Marx MA, Weiss D. A survey of knowledge, attitudes, and beliefs of medical students concerning antimicrobial use and resistance. Microb Drug Resist. 2010;16(4):285–9. doi: 10.1089/mdr.2010.0009.
6 Abbo LM, Cosgrove SE, Pottinger PS, Pereyra M, Sinkowitz-Cochran R, Srinivasan A, et al. Medical students’ perceptions and knowledge about antimicrobial stewardship: How are we educating our future prescribers? Clinical Infectious Diseases. 2013;57(5):631–8.
7 Global action plan on antimicrobial resistance. Geneva: World Health Organization; 2015.
8 World Bank. Drug-resistant infections: A threat to our economic future. Washington (DC): World Bank; 2017 (http://documents.worldbank.org/curated/en/323311493396993758/final-report, accessed 27 April 2018).
9 Global action plan on antimicrobial resistance. Geneva: World Health Organization; 2015 (http://apps.who.int/iris/bitstream/10665/193736/1/9789241509763_eng.pdf?ua=1, accessed 27 April 2018).
10 Global strategy on human resources for health: Workforce 2030. Geneva: World Health Organization; 2016 (http://apps.who.int/iris/bitstream/10665/250368/1/9789241511131-eng.pdf?ua=1, accessed 27 April 2018).
11 WHO fact sheet on antimicrobial resistance [website]. Geneva: World Health Organization; 2018 (http://www.who.int/mediacentre/factsheets/fs194/en/, accessed 27 April 2018).
12 Mapping educational opportunities and resources for health-care workers to learn about antimicrobial resistance and stewardship. Human Resources for Health Observer Series No. 21. Geneva: World Health Organization; 2017.
13 WHO expert consultation meeting report on health workforce education and AMR control. Geneva: World Health Organization; 2017 (http://www.who.int/hrh/news/2017/expert_consultation_workforce_education_amr/en/, accessed 27 April 2017).
14 WHO meeting on health education and antimicrobial resistance. Internal report. Geneva: World Health Organization; 2016.
15 Antimicrobial prescribing and stewardship competencies. London: Public Health England; 2013 (https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/253094/ARHAIprescrcompetencies__2_.pdf, accessed 27 April 2017).
16 Patient safety curriculum guide. Multi-professional edition. Geneva: World Health Organization; 2011 (http://apps.who.int/iris/bitstream/10665/44641/1/9789241501958_eng.pdf, accessed 27 April 2017).
17 Training framework for antimicrobial stewardship program implementation for the Western Pacific Region. Melbourne: National Centre for Antimicrobial Stewardship; June 2016.
18 Cosgrove SE, Hermsen ED, Rybak MJ, File TM, Parker SK, Barlam TF. Guidance for the knowledge and skills required for antimicrobial stewardship leaders. Infect Control Hosp Epidemiol. 2014;35(12):1444–51.
References
16
19 A competency framework for all prescribers. London: Royal Pharmaceutical Society; 2016 (https://www.rpharms.com/Portals/0/RPS%20document%20library/Open%20access/Professional%20standards/Prescribing%20competency%20framework/prescribing-competency-framework.pdf, accessed 27 April 2017).
20 WFME global standards for quality improvement. The 2015 revision. Ferney-Voltaire, France and Copenhagen, Denmark: World Federation for Medical Education (http://wfme.org/standards/bme/78-new-version-2012-quality-improvement-in-basic-medical-education-english/file, accessed 27 April 2017).
21 Proposals for EU guidelines on the prudent use of antimicrobials in humans. Stockholm: European Centre for Disease Prevention and Control; 2017.
22 Pharmacy Education Taskforce: A global competency framework (Version 1). The Hague: International Pharmaceutical Federation; 2012 (https://www.fip.org/files/fip/PharmacyEducation/GbCF_v1.pdf, accessed 27 April 2017).
23 ESCMID competencies for antimicrobial prescribing and stewardship (forthcoming).
24 Core competencies for infection control and hospital hygiene professionals in the European Union. Stockholm: European Centre for Disease Prevention and Control; 2013.
25 Infection prevention and control core competencies for health care workers: A consensus document. November 2016. Winnipeg: Infection Prevention and Control Canada (https://ipac-canada.org/photos/custom/pdf/HCW_Core_Competency_Category_Table-2016November(2).pdf, accessed 27 April 2017).
26 SIRCINF001 - Use pharmacy practices for infection control (Release 1) [website]. Australian Government Department of Education and Training; 2018 (https://training.gov.au/Training/Details/SIRCINF001#, accessed 27 April 2017).
27 Identifying and defining competencies – A clear map for scientific and professional competencies as applied to hospital pharmacy. WP4 final report. Pharmine: Pharmacy Education in Europe; 2011 (https://www.pharmine.org/wp-content/uploads/2014/05/WP4-Final-report-identifying-and-defining-competences-for-hospital-pharmacists.pdf, accessed 27 April 2017).
28 Redefining the antibiotic stewardship team: Recommendations from the American Nurses Association/Centers for Disease Control and Prevention Workgroup on the Role of Registered Nurses in Hospital Antibiotic Stewardship Practices. American Association of Nurses; 2017 (https://www.cdc.gov/getsmart/healthcare/pdfs/ANA-CDC-whitepaper.pdf, accessed 27 April 2017).
29 ICN position statement on AMR. Geneva: International Council of Nurses, 2009 (http://www.icn.ch/images/stories/documents/publications/position_statements/ICN_PS_Antimicrobial_resistance.pdf, accessed 27 April 2017).
30 WHO model list of essential medicines – 20th list. Geneva: World Health Organization; 2017 (http://www.who.int/medicines/publications/essentialmedicines/20th_EML2017_FINAL_amendedAug2017.pdf?ua=1, accessed 27 April 2017).
31 Critically important antimicrobials for human medicine. 5th revision. Geneva: World Health Organization; 2017 (http://apps.who.int/iris/bitstream/10665/255027/1/9789241512220-eng.pdf?ua=1, accessed 27 April 2017).
32 Diagnostic stewardship: A guide to implementation in antimicrobial resistance surveillance sites. Geneva: World Health Organization; 2016 (http://apps.who.int/iris/bitstream/10665/251553/1/WHO-DGO-AMR-2016.3-eng.pdf, accessed 27 April 2017).
33 Mendelson M, Balasegaram M, Jinks T, Pulcini C, Sharland M. Antibiotics resistance has a language problem. Nature. 2017;545(7652):23–25. doi: 10.1038/545023a.
34 Framework for action on interprofessional education and collaborative practice. Geneva: World Health Organization; 2010.
World Health OrganizationAvenue Appia 201211 GenevaSwitzerlandwww.who.int/hrh WHO/HIS/HWF/AMR/2018.1