Swedish situation Workshop, Riga, May 6, 2015 Birgitta Lytsy, infection control physician, Uppsala University hospital Olov Aspevall, physician, Swedish Public Health Agency, Stockholm
Swedish situation 2015 Surveillande of AMR Surveillance of antibiotic prescription Antimicrobial stewardship Infection Prevention and Control
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
Sweden 21 counties = Health care sectors 10 University hospitals 80 regional hospitals Regions and counties Municipalities
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
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
Strama-work in Sweden The Swedish Strategic Programme Against Antibiotic Resistance => Collaboration Against Antibiotic Resistance To preserve effective antibacterial therapy for the future wwwstramase
The Strama network Close collaboration with The Public Health Agency of Sweden Strama network: Local Strama groups in all counties of Sweden
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
SE: History, national guidance 1959
National level Surveillance of AMR, AB-prescription, laws and guidelines
SWEDRES SVARM 2013 Yearly national report on antibiotic use and resistance in human and veterinary medicine
DDD/1000 inhabitants and day 18 16 14 12 10 8 6 4 2 0 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 Outpatent care Hospital care Källa: Folkhälsomyndigheten 2014 Antibiotic sale DDD/1000 habitants and day
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
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 300000 250000 200000 150000 100000 50000 0 0-4 years 5-9 years 10-14 years 15-19 years 20-24 years 25-29 years 30-34 years 35-39 years 40-44 years 45-49 years 50-54 years 55-59 years 60-64 years 65-69 years 70-74 75-79 80-84 85-89 90 - years years years years years Källa: Folkhälsomyndigheten 2014 Indication by age groups
2011 2012 2013 Children 0 6 years treated at least one AB course per year/1000 children
Mandatory to report MRSA VRE ESBL Pneumococci Pencillin resistant
Number of cases Domestic Imported Domestic/Imported Imported/Domestic No data 3000 2500 2000 1500 1000 500 0 2006 2007 2008 2009 2010 2011 2012 2013 Källa: Folkhälsomyndigheten 2014 Number of MRSA cases
Number of cases Domestic Imported Other/missing 45 40 35 30 25 20 15 10 5 0 2007 2008 2009 2010 2011 2012 2013 Källa: Folkhälsomyndigheten 2014 Number of ESBLcarba
Figure 411 Källa: Folkhälsomyndigheten 2014 Moxifloxacin-resistant C difficile
Total AB recipies at UUH
Feed back results to prescribers
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
Swedish situation 2015 Infection Prevention and Control
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
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
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
Point-prevalence on compliance to standards precautions national data
Incidence and type of HCAI Medical ward at UUH : [Vårdtillfällen] fördelat på [Infektion], avgränsad till [Tidsperiod: Förra året (2014-01-01-2014-12-31)], [Organisatorisk enhet: Medicinavdelning 30 E, Uppsala], [Infektion: Lunginflammation - vård, Urinvägsinfektion med feber - vård, ]
C difficile 2014 Uppsala Univ Hospital Infectious disease ward Medical ward
Compliance to standard precautions Uppsala University Hospital 3 1
Bundles
Swedish situation 2015 Summary Excellent surveillance process and result indicators Detailed guidelines Laws and regulations
SENIC 32 % reduction of HCAIs in 5 years Two main pillars (main activities) 1 Surveillance 2 Interventions
Swedish situation 2015 Areas of improvement Feed back results Interventions Bundles Projects
UUH 2008-2009 3 7