Antimicrobial stewardship in Scotland: impact of a national programme

Scottish Antimicrobial Prescribing Group has developed prescribing indicators for hospital and primary care, which are measured and reported in all 14 NHS board areas. Improvement in compliance with the indicators has been demonstrated with resultant reductions in CDI rates and no adverse effect on mortality or antimicrobial resistance patterns.The establishment of a Scottish national antimicrobial stewardship programme has made a significant contribution to the HAI agenda, particularly in relation to CDI. The programme is supported by local antimicrobial teams, a national framework for education, surveillance of antimicrobial use and resistance and sharing of data for improvement. Antimicrobial stewardship has been integrated with other national programmes on patient safety and quality improvement.The Scottish Antimicrobial Prescribing Group (SAPG) [1] was formed in March 2008 by the Scottish Government Health Department (SGHD) to implement the recommendations of the Scottish Management of Antimicrobial Resistance Action Plan (ScotMARAP) [2]. SAPG operates as a multidisciplinary national clinical forum and its primary objectives are to co-ordinate and deliver a national framework for antimicrobial stewardship to enhance the quality of antimicrobial prescribing and management in Scotland.SAPG was established to lead the first national initiative to actively address antimicrobial stewardship. Collaboration with key stakeholders at national level and development of local (NHS board level) leadership through Antimicrobial Management Teams has been essential to develop national consensus and implement key stewardship interventions. This has been combined with the development of national and local systems and a framework for collecting and disseminating data on antibiotic prescribing and resistance surveillance and a framework for educational material to support the healthcare professionals in the workplace.Healthcare associated infection (HAI) is a priority for the Scot