Swedish situation. Workshop, Riga, May 6, Birgitta Lytsy, infection control physician, Uppsala University hospital

Transcription

1 Swedish situation Workshop, Riga, May 6, 2015 Birgitta Lytsy, infection control physician, Uppsala University hospital Olov Aspevall, physician, Swedish Public Health Agency, Stockholm

2 Swedish situation 2015 Surveillande of AMR Surveillance of antibiotic prescription Antimicrobial stewardship Infection Prevention and Control

3 Sweden Area 449,964 km 2 Population 9,7 million, density 215/km 2 21 regions and counties responsible for health care 290 municipalities responsible for elderly care, child care, schools Regions and counties Municipalities

4 Sweden 21 counties = Health care sectors 10 University hospitals 80 regional hospitals Regions and counties Municipalities

5 SE: Main stakeholders- human medicine National level Ministry of Health and Social Affairs The Public Health Agency of Sweden National Board of Health and Welfare Health and Social Care Inspectorate Professional and interest organizations Areas of responsibility Laws, regulations, and guidelines, systematic knowledge overviews, surveillance and process evaluation, dissemination of knowledge and information, improvement campaigns, supervision of health and medical care

6 SE: Main stakeholders- human medicine Regional level groups Microbiology lab Medical county officer IPC units Infectious disease department Areas of responsibility Local guidelines, local surveillance, process evaluation and feed back regarding antibiotic resistance, antibiotic prescription, and compliance to infection control practices, local dissemination of knowledge and information, local improvement campaigns

7 Strama-work in Sweden The Swedish Strategic Programme Against Antibiotic Resistance => Collaboration Against Antibiotic Resistance To preserve effective antibacterial therapy for the future wwwstramase

8 The Strama network Close collaboration with The Public Health Agency of Sweden Strama network: Local Strama groups in all counties of Sweden

9 Members of a local Strama group Depending on local circumstances, but ideally General practitoner Infectious diseases specialist Microbiologist Infection control/hospital hygiene Communicable diseases officer Pharmacist ENT, paediatrics, geriatrics Coordinate local activities

10 SE: History, national guidance 1959

11 National level Surveillance of AMR, AB-prescription, laws and guidelines

12 SWEDRES SVARM 2013 Yearly national report on antibiotic use and resistance in human and veterinary medicine

13 DDD/1000 inhabitants and day Outpatent care Hospital care Källa: Folkhälsomyndigheten 2014 Antibiotic sale DDD/1000 habitants and day

14 DDD/1000 inhabitants and day 4 3,5 3 2,5 2 1,5 1 0,5 0 Outpatient care Hospital care Källa: Folkhälsomyndigheten 2014 Antibiotic groups

15 Prescriptions Antibiotics commonly used to treat respiratory tract infections Antibiotics commonly used to treat skin and soft tissue infections Antibiotics commonly used to treat urinary tract infections Antibiotics commonly used to treat acne years 5-9 years years years years years years years years years years years years years years years years years years Källa: Folkhälsomyndigheten 2014 Indication by age groups

16 Children 0 6 years treated at least one AB course per year/1000 children

17 Mandatory to report MRSA VRE ESBL Pneumococci Pencillin resistant

18 Number of cases Domestic Imported Domestic/Imported Imported/Domestic No data Källa: Folkhälsomyndigheten 2014 Number of MRSA cases

19 Number of cases Domestic Imported Other/missing Källa: Folkhälsomyndigheten 2014 Number of ESBLcarba

20 Figure 411 Källa: Folkhälsomyndigheten 2014 Moxifloxacin-resistant C difficile

21 Total AB recipies at UUH

22 Feed back results to prescribers

23 Medical Protection Agency Care programmes to control prescription and AMR Examples: Antibiotic prophylaxis dental care Antibiotic use pregnancy Tonsillitis, mediaotitis children Pneumonia Urinary tract infection women and men STI

24 Swedish situation 2015 Infection Prevention and Control

25 Point-prevalence studies of HCAIs twice yearly 25 8,7% 9,0% 8,9% 8,9% 9,3% 9,2% 9,4% 9,6% 8,9% 11,0% 0% 1% 2% 3% 4% 5% 6% 7% 8% 9% 10% 11% 12% HT1 3 VT1 3 HT1 2 VT12 HT1 1 VT 11 HT 10 VT 10 HT 09 VT 09 9,7% HT0 8 8,9% VT14 Källa: PPM-VRI

26 Östergötland Gävleborg Uppsala Stockholm Örebro Västerbotten Västra Götaland RIKET Region Skåne Blekinge Kronoberg Kalmar Dalarna Västernorrland Sörmland Jämtland Jönköping Norrbotten Värmland Halland Gotland Västmanland Differences between counties - analysis 11,6 11,2 11,0 10,0 9,8 9,4 9,3 9,1 9,0 9,0-49% 9,0 8,9 8,7 8,1 7,9 7,4 7,3 7,3 6,9 6,8 6,7 5,9 8 sucess factors identified for counties with low prevalence Not: Inkluderar data från samtliga mätningar 2012 och 2013 Källa: PPM-VRI 26

27 National law on standard precautions since 2007 All staff shall during examination, care and treatment or other direct contact with patients observe this regulation Includes: Dresscode Handhygiene Gloves Apron

28 Point-prevalence on compliance to standards precautions national data

29 Incidence and type of HCAI Medical ward at UUH : [Vårdtillfällen] fördelat på [Infektion], avgränsad till [Tidsperiod: Förra året ( )], [Organisatorisk enhet: Medicinavdelning 30 E, Uppsala], [Infektion: Lunginflammation - vård, Urinvägsinfektion med feber - vård, ]

30 C difficile 2014 Uppsala Univ Hospital Infectious disease ward Medical ward

31 Compliance to standard precautions Uppsala University Hospital 3 1

32 Bundles

33 Swedish situation 2015 Summary Excellent surveillance process and result indicators Detailed guidelines Laws and regulations

34

35 SENIC 32 % reduction of HCAIs in 5 years Two main pillars (main activities) 1 Surveillance 2 Interventions

36 Swedish situation 2015 Areas of improvement Feed back results Interventions Bundles Projects

37 UUH