Vloga Ministrstva za zdravje pri evropski pobudi Eno zdravje
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1 Vloga Ministrstva za zdravje pri evropski pobudi Eno zdravje Eva Murko, dr. med Ministrstvo za zdravje Evropski dan antibiotikov,
2 Dejstva in podatki SZO - Napačna raba antibiotikov je glavni pospeševalec odpornosti - Antibiotiki so čudež moderne znanosti (skupaj s cepljenjem dodajo 20 let k pričakovanemu trajanju življenja) - Naraščajoča odpornost proti antibiotikom zmanjša učinkovito zdravljenje (odpornost proti abt. je naraven fenomen, pospešuje jo prekomerna in napačna raba abt., nobenih novih razredov abt. odkritih v zadnjih 25 letih). Vir: prezentacija WHO - European Antibiotic Awareness Day 2013, Joining efforts to avoid a post-antibiotic era
3 Dejstva in podatki SZO, nad. Alarmantno stanje v EU: % hospitaliziranih pacientov pridobi okužbo v H pacientov dobi rezistenten sev vsako leto pacientov umre - Odpornost na antibiotike ne spoštuje meja - Sklep št. 1082/2013/EU E Parlamenta in Sveta o resnih čezmejnih nevarnostih za zdravje prvič navaja tudi protimikrobno odpornost Vir: prezentacija WHO - European Antibiotic Awareness Day 2013, Joining efforts to avoid a post-antibiotic era
4 Vloga MZ: 1. Regulatorni vidik 2. Zakonodajni vidik 3. Finančni vidik 4. Promocijski vidik
5 1. Regulatorna vloga Upoštevanje EU dokumentov na tem področju in implementacija le teh: 1. Sklepi Sveta iz junija 2012 o posledicah protimikrobne odpornosti v zdravstvenem in veterinarskem sektorju pobuda Eno zdravje 2. Priporočilo Sveta iz junija 2009 o varnosti pacientov, vključno s preprečevanjem in obvladovanjem okužb, povezanih z zdravstveno oskrbo. 3. Priporočilo Sveta iz leta 2001 o preudarni rabi protimikrobnih zdravil v humani medicini (izvajanje strategij o smiselni rabi PZ) 4. Itd.
6 1. Regulatorna vloga, nad. Dokument Eno zdravje - opozarja na protimikrobno odpornost - priznava, da pretirana in neprimerna raba PZ pospešuje nastanek protimikrobne odpornosti - poziva DČ, naj izvedejo nacionalne strategije, ki naj med drugim vsebujejo: 1. Priprava nacionalnih smernic za zdravljenje ljudi in živali s PZ 2. Izvajanje programov komuniciranja za izobraževanje delavcev v zdravstvu in veterini glede primerne uporabe PZ 3. Omejitev profilaktične uporabe PZ na primere z izraženimi kliničnimi potrebami 4. Prehod na nadzorne sisteme, ki vsebujejo podatke o predpisovanju in /ali prodaji vseh PZ v humani medicini
7 1. Regulatorna vloga, nad. 1. Ustanovitev NKSRPZ v letu 2005 in prestrukturiranje komisije z namenom medresorskega sodelovanja s strokovnjaki na področju veterine v letu 2013 (Eno zdravje). Ustanovitev NAKOBO v letu Priprava nacionalne strategije za smiselno rabo protimikrobnih učinkovin in obvladovanje okužb, povezanih z zdravstveno oskrbo nadgradnja 3. Poročanje podatkov o porabi antibiotikov za ECDC (EU center za preprečevanje in obvladovanje bolezni) - ESAC mreža (prof. Čižman) 4. EARSS (iz leta 2000) se je v ECDC priključila 2009; RS pošilja podatke o odpornosti bakterij po standardizirani metodologiji EARS mreža (dr. Kolman, IVZ)
8 2. Zakonodajna vloga 1. Zakon o nalezljivih boleznih (Uradni list, 69/95) 2. Pravilnik o pogojih za pripravo in izvajanje programa preprečevanja in obvladovanja bolnišničnih okužb (Uradni list, št. 74/99, 10/2011) 3. Pravilnik o strokovnem nadzoru izvajanja programa preprečevanja in obvladovanja bolnišničnih okužb (Uradni list št. 10/11), na podlagi katerega bodo v letošnjem letu izvedeni strokovni nadzor izvajanja programa preprečevanja in obvladovanja bolnišničnih okužb in o izvedbi strokovnega nadzora izvajanja smotrne rabe protimikrobnih zdravil v treh bolnišnicah
9 3. Finančna vloga 1. Financiranje letnega spremljanja porabe ambulantnih in bolnišničnih protimikrobnih zdravil 2. Financiranje priprave poročil za ECDC 3. Financiranje NKSRPZ in NAKOBO
10 4. Promocija 18. november je evropski dan antibiotikov (European Antibiotic Awareness Day), obeležujemo ga od leta Cilj je povečati ozaveščenost prebivalstva (stroke in laikov) o tveganjih, ki so povezana z nesmotrno rabo ABT in izboljšati preudarno jemanje. 1. MZ organizira novinarsko konferenco in simpozij/okroglo mizo, dopis za zdravstvene ustanove 2. Aktivnosti, ki jih izvede NKSRPZ: članki v strokovnih revijah 3. Aktivnosti IVZ (vključevanje mednarodnih gradiv - ECDC in WHO) in ZZV-jev Neprimerna raba antibiotikov je pomemben javno zdravstveni problem, tako za strokovno medicinsko in splošno javnost kot tudi za posameznika, saj vsak po svoje lahko prispeva k ohranitvi antibiotične učinkovitosti.
11 Načrti za prihodnost 1. Vzpostavitev sporočanja podatkov ambulantnih antibiotikov (tudi parenteralnih) na sistemski ravni 2. Okrepitev dejavnosti regijskih zavodov za zdravstveno varstvo (bodočih enot NIJZ) v smislu izobraževanja strokovne in laične javnosti 3. Nadgradnja strategije (uveljavitev pristopa Eno zdravje ) 4. Izboljšanje sodelovanja z veterinarsko stroko 5. Aktivnosti NKSRPZ in NAKOBO: strokovna priporočila, smernice, povezovanje, nov KK higiena rok
12 Uporabne strani 1. WHO (WHO Collaborating centre for drug statistics methodology 2. IVZ, podatki o odpornosti bakterij (kri, likvor) - podatki mreže EARS-Net za leto 2011, npr. podatki o odpornosti E.coli, Klebsielle pneumoniae proti cefalosporinom 3. generacije
13 Podatki dostopni na spletni strani WHO European Drug Utilisation Research Group European Pharmaceutical Market Research Association International Society for Pharmacoepidemiology Norwegian Institute of Public Health The Nordic Pharmaco Epidemiological Network WHO Collaborating Centre for International Drug - Norwegian Prescription Database Drug consumption in Norway Australia Denmark Finland Nordic countries (Nomesco) OECD countries Sweden
14 Use of antibiotics for systemic use (J01) in men and women >65year in primary care (i.e. living outside institutions) Antibiotics for UTI (pivampicilin, primethoprim, sulfametoxazole and trimethopim, nitrofurantoin Penicillins (JOIC), excl. pivmecillinam All other antibiotics in JOl, exd.methenamine Vir: The Norwegian prescription database
15 ZAHVALJUJEM SE VAM ZA POZORNOST
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