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Home News centre National Press Releases 2012 Press Releases ›  Survey shows use of antimicrobial stewardship toolkit leads to reduction in inappropriate prescribing in hospitals

Survey shows use of antimicrobial stewardship toolkit leads to reduction in inappropriate prescribing in hospitals

15 November 2012

A recent survey has shown that the Start Smart Then Focus (SSTF) antimicrobial stewardship resource has helped improve prescribing practice in hospitals. Having effective leadership from hospital pharmacist and microbiologist to champion an antimicrobial stewardship programme are two of the main elements that ensure its success.

These results have been launched ahead of European Antibiotic Awareness Day which takes place on Sunday 18 November. This annual European public health initiative aims to raise awareness of the risks associated with the inappropriate use of antibiotics and how to use them responsibly.

The Start Smart Then Focus toolkit was published last November by the Department of Health in association with the Advisory Committee on Antimicrobial Resistance and Healthcare Associated Infection (ARHAI) as a guide for evidence-based antimicrobial stewardship within the hospital setting.

Seventy-five Acute Hospital Trusts responded to a survey on the implementation of the Start Smart then Focus toolkit. Of those who had formally or informally assessed the programme between 65 and 75 per cent said it had led to a reduction in the use of broad spectrum agents and between 77 and 85 per cent a reduction in inappropriate prescribing.

When asked what was seen to successfully facilitate the programme not only was adequate pharmacist time a factor but also an enthusiastic pharmacist (79 per cent). Similar qualities were needed in the hospital microbiologist with 80 per cent saying that enthusiasm for the programme was more important than just having adequate time (43 per cent). Those that had an established antimicrobial strategy group found this to be very beneficial in taking action on the use and type of antibiotics used (63 per cent).

Conversely, lack of pharmacist time (63 per cent), lack of the hospital microbiologists’ time (60 per cent) and lack of management interest (27 per cent) were cited as being the three main barriers to the effective implementation of the SSTF programme.

Dr Cliodna McNulty, the HPA’s head of primary care, who helped to develop the survey, said: “These results are very encouraging. Clearly there is room for improvement but the tool does work in getting medical staff to think about what antibiotics they are prescribing and for how long. Too often we get used to doing things a certain way and so this toolkit has been very useful to getting people to reassess previous conceptions of what they thought would be appropriate.

“Of course the care of the patient is always paramount and these evidence-based guidelines have been very carefully developed to help those who prescribe make the right choices based on actual findings about what has been seen to work. We all know that resistance is a growing problem so by using this toolkit we can really help to reduce the amount of last-resort antibiotics that are being used to hopefully preserve their effectiveness for years to come.”

Phil Howard, Consultant Antimicrobial Pharmacist at Leeds Teaching Hospital, who led the survey, said: “Our survey shows that Start Smart then Focus can make a very positive difference to what hospitals can achieve by using this tool. It has helped to shape what they choose to prescribe which can be seen to directly reduce antimicrobial consumption across the board as well as specifically the use of broad spectrum antibiotics which is a great achievement.

“Through a combination of antimicrobial stewardship and infection control measures we can really make a difference to the global priority of reducing resistance.”

The Start Smart the Focus survey was a collaboration between the UK Clinical Pharmacy Association, The British Infection Association and Health Protection Agency. The first Global Antimicrobial Stewardship Survey was carried out by a jointly by European Society of Clinical Microbiology & Infectious Diseases and International Society of Chemotherapy.


Notes for editors:

  1. A link to the Start Smart then Focus toolkit can be found here:  
  2. More information about EAAD can be found here:  
  3. The Health Protection Agency is an independent UK organisation that was set up by the government in 2003 to protect the public from threats to their health from infectious diseases and environmental hazards. In April 2013 the Health Protection Agency will become part of a new organisation called Public Health England, an executive agency of the Department of Health. To find out more, visit our website: or follow us on Twitter @HPAuk or ‘Like’ us on Facebook at
  4. 4. For more information please contact the national HPA press office at Colindale on 0208 327 7901 or email Out of hours the duty press officer can be contacted on 0208 200 4400.

Last reviewed: 15 November 2012