Antibiotic-smart organisations can help save lives

Many of our common medical treatments and surgical procedures - from urinary tract infections to cancer treatments and hip replacements - may require antibiotic treatment. But for many decades, antibiotics have been both misused and overused, leading to a rapid rise in antibiotic resistance.

National initiative to help communities and regions become 'antibiotic smart

"Antibiotic resistance is a very complex problem where people, organisations and sectors of society are part of the problem, but also part of the solution. We cannot rely on the development of new antibiotics fast enough to meet existing needs. We must also work to prevent infections and the spread of infections," says Camilla Björn, researcher at RISE and leader of Antibiotic-Smart Sweden.

Antibiotic-Smart Sweden is a national initiative led by the Swedish National Board of Health and RISE together with the national working group Strama and ReAct - Action on Antibiotic Resistance, as well as a number of municipalities and regions.

"In order to help municipalities, regions and their organisations understand their role and provide them with tools to ensure that antibiotics continue to work, we have developed several criteria to become 'antibiotic smart'," explains Camilla Björn.  

The criteria have been developed together with policy-makers and professionals in the target organisations. These currently include local government, schools, pre-schools, care for the elderly and disabled, water and sewage services, regional government, health centres and hospitals.  

For schools, the criteria include, for example, teaching students about antibiotics and antibiotic resistance. For nursing homes, the criteria include measuring healthcare-associated infections. Both pre-schools and nursing homes emphasise the importance of working systematically to prevent the spread and occurrence of infections. For water and wastewater operations, the focus is on reducing the release of antibiotics and bacteria from treatment plants.

Tanum takes action after citizens' initiative 

Tanum Municipality has been a partner in Antibiotic-Smart Sweden from the start. They have chosen to tackle the antibiotic problem at the municipal level. Public Health Strategist Lillan Fahlstedt explains:  

"At the end of 2017, a citizen's proposal was received that included the introduction of a theme day on antibiotic resistance and the annual reporting of antibiotic prescriptions. Shortly after the proposal was received, Antibiotic Smart Sweden was launched and it was decided that Tanum would participate."  

Tanum has been involved in the development of the municipal management criteria, which can now be used by municipalities throughout Sweden. These criteria include deciding on the municipality's commitment to the issue and spreading knowledge about the wise use of antibiotics among the population. It also includes creating the conditions for the municipality's activities to prevent infections and the spread of infections.  

"In addition to reporting on the use of antibiotics in the Sustainability Report, we have carried out communication activities on our website and social media in connection with the European Antibiotic Awareness Day. We have also publicised our involvement in Antibiotic-Smart Sweden in the municipality's information magazine, which is distributed free of charge. This shows that we are taking a stand on the issue," says Lillan Fahlstedt.  

Committed work in Köping 

About 35 kilometres to the east is the municipality of Köping, which has also decided to get involved in Antibiotic-Smart Sweden. After the pandemic subsided, the municipality wanted to find new ways of working with hygiene issues. Two specialist homes became the focus of the work.  

"As we had already appointed hygiene officers and carried out monthly infection registries, two things that were included in the criteria for Antibiotic-Smart Nursing Homes, we decided to test the criteria related to participation in Swedish HALT. This is a measure of healthcare-associated infections and antibiotic use in specialised housing. The municipality had worked with HALT before, but not in recent years," says Malin Svakko, a nurse in Köping, and continues:  

"We also chose to work with hygiene self-monitoring and decided that we would put an online hygiene training programme into an annual cycle so that the staff would do it every year. On the same topic, we organised a presentation for staff in cooperation with the region on the prevention of urinary tract infections, which are very common in elderly care."

Evaluated criteria predicted to be of great benefit 

In early 2024, Antibiotic Smart Sweden rolled out a final set of pilot-tested and evaluated criteria for municipal operations. Malin Svakko believes that these criteria will be of great use:

"The municipality is an important part of the chain to prevent the spread of infections and reduce unnecessary antibiotic prescriptions. It is important that all municipalities and regions look at what they can contribute. The criteria can be helpful to ensure that they do what they can."  

Camilla Björn agrees:  

"Being certified as antibiotic-smart is proof that you meet the criteria and are striving to improve in these areas. "We believe that being an antibiotic-smart organisation can be a source of pride for your own organisation, while at the same time inspiring other organisations and municipalities to get involved," she says:  

"We hope that the work in communities and regions will lead to important changes in the long term, including increased knowledge and awareness among children and adults about antibiotics and antibiotic resistance, a reduction in the spread of infections in healthcare and society, and the judicious use of antibiotics. In short, sustainable development where antibiotics continue to work and save lives."