Kerala government issues guidelines for antibiotic-smart certification of hospitals, LSGs

The State government, as part of its initiative to tackle antimicrobial resistance (AMR), has formulated an innovative accreditation system for certifying health-care institutions and community as “Antibiotic-Smart” and “Antibiotic-Literate.”

The accreditation system has been developed by identifying key performance indicators and giving weightages to each to arrive at a performance score for certification as Antibiotic Smart Hospitals, Antimicrobial Stewardship-Compliant Hospitals, Antibiotic Literate Local Self-Government (LSG) and Antimicrobial Stewardship-Compliant Local Self-Government.

Comprehensive operational guidelines detailing the revised criteria for certification and assessment of health-care institutions at primary, secondary and tertiary care levels and panchayats were brought out as a government order (GO) on Thursday.

These guidelines are part of the Antibiotic Literate Kerala initiative, a broad framework of which had been released earlier. The State is pioneering the concept at community level, and panchayats which take up AMR awareness works and activities intended to reduce AMR will be given the Antibiotic Literate Panchayat certification, thus taking AMR awareness to the grassroots.

Antibiotic Smart Hospitals (ASH) are health-care institutions which implement a pragmatic model of antimicrobial and diagnostic stewardship while ensuring compliance with standard infection prevention and control (IPC) practices. These hospitals act as a source of continuous Information, Education, and Communication (IEC) activities to health care workers and the public thereby fostering participatory stewardship.

The criteria for becoming ASH are different for primary, secondary and tertiary care institutions based on the patient profile to which they cater and available resources.

Some of the criteria include display of posters on AMR in Malayalam, posters on AwaRe (Access, Watch, Reserve) classification of antibiotics which guide rational use of antibiotics, regular awareness sessions for public and quarterly prescription audits.

About 95% of antibiotics used in outpatient department (OPD) in primary care hospitals should be from access category (broad-spectrum antibiotics used for common infections with lower resistance risk), whereas for secondary care it is 90% and tertiary care 85%. In all levels of hospitals, out of the total antibiotics prescribed, 60% should be from the access category.

In secondary and tertiary care hospitals, functional infection control committee and antimicrobial stewardship committee are a must. If more than two antibiotics are combined or if antibiotics are continued for more than 7 days, the reason for the same has to be documented. Hospital infection control committee should perform surveillance with regard to Healthcare Associated Infections (HAIs)

To be an Antibiotic-Literate panchayat, the health-care institutions in the panchayat should satisfy nine out of the 10 criteria for the ASH. All AMR hotspots under the LSGs—poultry farms, pig farms, duck farms, aquaculture, dairy farms, butcheries, slaughter houses etc — should be mapped. Sale of antibiotics without prescription on the human side should be zero in the panchayat

Colour coding is also being introduced for all hospitals in Kerala as part of the certification process. Now that the guidelines have been issued, all institutions under the Health department and the Medical Education department must complete colour coding as per the prescribed standards within three months. District and block-level AMR committees must ensure that all private hospitals under their jurisdiction are also colour coded.

Under the tagline “My Kerala, Antibiotic Smart Kerala”, ten key messages on AMR prevention are being disseminated to the public through various platforms.

The guidelines also clearly spell out the recommended structure of Antimicrobial Stewardship Committees at different levels of health-care institutions.