Infection control and antimicrobial resistance in Republic of Moldova Riga, May 6-8, 2015
Republic of Moldova Population: 3.9 million Area: 33.7 sq. km Life expectancy: men 65.5 years women 73.3 years Population with income below subsistence minimum: 20.8 % GNI (gross national income) per capita: 1560 US $ Unemployed: 8.1% Migration: 25% of working-age people
General information of Health System in 2014 16 Republican hospitals 10 - Municipal hospitals 35 Rayonal hospitals 250 Primary Health Care Centres 37 Privat clinics 2014 Phisicians 10 357 Nurses 21 101 Total visits 17 746 817 Number of beds Hospitalized pacients 18 095 607 874 Outpatients 601 226 Average length of staing in hosptal days 8,9
Coordination at the National level Strategy for development of the Health System 2008-2017 and National plan for implementation approved by GD 1471/2007 - creating efficient mechanism for detection of the health problems, assessment, elaboration of indicators, implementation of prevention measures and progress monitoring; Law on State Surveillance in Public Health nr. 10-XVI/2009 implement surveillance of hygienic condition in health facility and infection control measures; Law on Pharmaceutical activity nr.1456/1993 evidence of import and distribution of antibiotics in national electronic data bases; National Immunization Program for 2011-2015 (GD nr.1192/2010) reducing/elimination morbidity and mortality for communicable diseases, immunization for 12 etiological entity, including: starting 2009 for Haemophilus influenzae tip b and starting 2014 - for Pneumococcal infections; Regulation on Public Health Surveillance Service (GD nr.384/2010) promote control of measures provided by health facilities in prevention of the nosocomial infection and resistance for microorganisms to antibiotics. Regulation concerning national surveillance system on transmisible diseases and health events. GD nr.951 / 2013) includes nosocomial infections and antimicrobial resistance to be monitored.
Legislation Regulations regarding hygiene in health care facilities GD 663/ 2010; Regulations regarding Pharmacies GD nr.504 / 2012; National strategy for waste (2013-2027 years), GD nr.248/ 2013; National Guidelines for surveillance and control of nosocomial infections ; National Guidelines for prevention of Ebola diseases MoH order 2015 Regulations for medical waste. MoH Decision nr. 5 din 14.12.2001
http://old.ms.md/_files/14514- PCN%2520Pneumonia%2520nosocomiala% 2520la%2520adult.pdf
http://old.ms.md/_files/14435- PCS_VAP_Pneumonia%25201.10.201 3.pdf
Notification of HCAI in the electronic reporting system of communicable diseases
la 1000 spitalizați Incidence of HCAI 1993-2014 years, to 1000 patients Order of MoH nr.140 / 30.04.1998 Defined criteria for nosocomial infections Order of MoH nr.51/2009 Include position of Hospital epidemiologist Mass media and public concern 3 2.5 2 1.5 1 0.5 0 2.4 1.8 1.3 1 0.8 0.8 0.9 1 1.2 0.7 0.7 0.8 0.8 1.1 1.4 1.5 0.7 0.7 0.8 0.9 1 1.1
Structure of HCAI (Health Care Associated Infection) in 2014 IN in perinatology 3,4% 1,4% 1,2% Surgical site infections 13,8% Infections in new borns Associate infections 39,7% VAP 17,3% Other Urinary tract infections 23,2%
Surveillance of the resistance to antibiotics in the Republic of Moldova There is an irrational use of antimicrobial medicines in the health care settings of the Republic of Moldova that provides favorable conditions for AMR to persist; Infection prevention and control in hospitals; surveillance on AMR and antimicrobial consumption in human medicines; awareness on the appropriate use of antimicrobials have to be improved to combat AMR in Moldova; The National Surveillance System collect data for AMR based national protocol not adapted to the WHO and EU requirement; The quality of the data need improvement and validation by external EQAP (External Quality Assessment Project).
Resistance profiles for pathogens in the Republic of Moldova, 2012/2013 Polirezistance: Shigella (<13 antibiotics), Salmonella (<12 antibiotics), Staphilococcus (<9 antibiotics), Patogens (<19 antibiotice)
The objectives of National Infection Control Programme Implementing IC system in all medical institution; Active, early identification and epidemiological surveillance of nosocomial infections; Microbiological support insurance; Improve antimicrobial resistance monitoring; HCW protection and patient safety; Education and training of the HCW; Monitoring of prevention and control measures;
International cooperation networks SEEHN network for antibiotic resistance CLIN-Net LAB-Net
BARN Workshop, November 5 7, 2014 Chisinau, Republic of Moldova
Va mulțumesc pentru atenție! Thanks for attention!