Overview of Canada's Federal Actions to Address Antimicrobial Resistance and Antibiotic Stewardship Jacqueline Arthur, RN, BScN Centre for Communicable Diseases and Infection Control Commonwealth Laboratory Twinning Workshop: Combating Antimicrobial Resistance in the Caribbean December 10, 2014 1
Purpose To provide an overview of the Government of Canada s Federal Framework for Action on AMR-AMU. To highlight the Public Health Agency of Canada s knowledge translation, exchange and awareness activities for infection prevention and control (IPC) and AMU stewardship. 2
Healthcare System Structure Federated System Health care service delivery is primarily a provincial responsibility Public health responsibility shared across jurisdictions 3
Governments and Stakeholders importance of collaboration Federal Government Departments and Agencies (Public Health Agency of Canada, Health Canada, Canadian Food Inspection Agency, Canadian Institutes of Health Research and Agriculture and Agri-Food Canada as well as Environment and Industry ministries ) Provincial and Territorial Governments Professional Organizations Infectious Disease Experts/Healthcare providers (human and animal) Private Sector/Industry/Food Producers 4
Canada s Federal AMR Related Policies, Acts, Regulations Food & Drugs Act http://laws-lois.justice.gc.ca/eng/acts/f-27/ Health of Animals Act http://laws-lois.justice.gc.ca/eng/acts/h-3.3/ Feeds Act http://laws-lois.justice.gc.ca/eng/acts/f-9/ Meat Inspections Act http://laws-lois.justice.gc.ca/eng/acts/m-3.2/ 5
Canada s Federal AMR Related Initiatives Antimicrobial Resistance and Use in Canada: A Federal Framework for Action F/P/T Pathogen Reduction Initiative Food Safety Recognition Program http://healthycanadians.gc.ca/drugs-products-medicaments-produits/antibioticresistance-antibiotique/antimicrobial-framework-cadre-antimicrobiens-eng.php http://www.inspection.gc.ca/food/meat-and-poultry-products/programchanges/pathogen-reduction/eng/1338819927004/1338819992816 http://www.inspection.gc.ca/food/safe-food-production-systems/food-safetyenhancement-program/recognitionprogram/eng/1299860970026/1299861042890 Canadian Institutes of Health Research Antimicrobial Resistance Initiatives http://www.cihr-irsc.gc.ca/e/40485.html 6
SURVEILLANCE Action 1: Establish and strengthen surveillance systems to identify new threats or changing patterns in antimicrobial resistance and use, in human and animal settings. Current systems will be expanded to support the identification of emerging threats, disease trends, and provide the information required to deal with known problems. The Canadian Antimicrobial Resistance Surveillance System (CARSS) will be created to;» integrate available antimicrobial resistance data,» clearly articulate and track antimicrobial resistance at a national level, and» expand surveillance activities at the hospital and community level. Canadian Food Inspection Agency and Agriculture and Agri-food Canada are planning increased surveillance on antimicrobial use in animal settings to ensure that a comprehensive data set is available through CIPARS. 8
STEWARDSHIP Action 2: Strengthen the promotion of the appropriate use of antimicrobials in human and veterinary medicine. Enhance guidance, education, tools and industry-sponsored initiatives to promote the responsible use of antibiotics in humans and animals. Increase veterinary oversight of the use of medically important antimicrobials in food animal production. Continue efforts to phase out growth promotion claims on medically important antimicrobials. Action 3: Work with the animal agriculture sector partners to strengthen the regulatory framework on veterinary medicines and medicated feeds, including facilitating access to alternatives and encourage the adoption of practices in order to reduce the use of antimicrobials. Engage with those who must comply with new regulations to identify innovative approaches to facilitate access to alternatives. 9
INNOVATION Action 4: Promote innovation through funding collaborative research and development efforts on antimicrobial resistance both domestically and internationally Canada will work through the Canadian Institutes for Health Research (CIHR) on developing research priorities for funding. Strengthened international collaboration via a wide range of governmental and non-governmental organizations and international regulatory bodies will contribute to innovation on a global scale. 10
The Agency s Key Knowledge Translation and Exchange Activities Public health guidance» To inform the responsible use of antimicrobials and infection control» Develop and improve evidence-based guidelines on infection prevention and control practices Examples include infection control guidance for hospitals and human vaccination guidance Public awareness» To inform the public about antimicrobial resistance so that individuals can protect their own health. Webinars, educational tools, outreach campaigns aimed at health professionals, Canadian families, and the media Specific campaigns in Aboriginal and northern communities (e.g. drug-resistant tuberculosis and methicillin-resistant Staphylococcus aureus) Work with stakeholders, provinces and territories during Antibiotic Awareness Week in November 11
Hand Hygiene in Healthcare Setting http://publications.gc.ca/collections/collection_2012/aspc -phac/hp40-74-2012-eng.pdf 12
Routine Practices and Additional Precautions (RPAP) http://www.phac-aspc.gc.ca/noissinp/guide/summary-sommaire/tihs-tims-eng.php Companion Document: RPAP Assessment and Educational Tools http://www.phac-aspc.gc.ca/noissinp/guide/summary-sommaire/et-pa-eng.php 13
Canadian Tuberculosis Standards, 7th Edition http://www.respiratoryguidelines.ca/tb-standards-2013 14
Clostridium Difficile Infection - Infection Prevention and Control Guidance for Management in Acute Care Settings Clostridium Difficile Infection - Infection Prevention and Control Guidance for Management in Long-term Care Facilities http://www.phac-aspc.gc.ca/nois-sinp/guide/c-difltc-sld/index-eng.php http://www.phac-aspc.gc.ca/nois-sinp/guide/c-difacs-esa/index-eng.php 15
Infection Prevention and Control Patient Safety Survey (2014) Conducted by the Public Health Agency of Canada (Agency) in collaboration with Canada Patient Safety Institute Objective: to identify factors that may influence IPC best practices and outcomes, within the context of patient safety using an online self-administered survey These results are intended to help inform future planning related to advancing IPC in Canada and healthcare-associated infections (HAI) events. 16
Environmental Scan Presents the results of a survey, and literature search Summarizes and highlights Canadian and International infection prevention and control initiatives and approaches 17
Literature Results: Core Elements of Effective Infection Prevention and Control Programs for Healthcare Settings 1» Administrative/Organizational Leadership and Support» Antimicrobial Stewardship» Auditing of Performance and Practices» Communication and Information Sharing» Education and Training of HCWs on IPC» Facility Design and Construction» Microbiology Laboratory» Outbreak Detection and Management» Policies and Guidelines» Product Review and Evaluation» Reprocessing of Equipment» Routine Practices (which includes hand hygiene programs, aseptic technique, education of patients, families and visitors, PPE, source control, etc.)» Surveillance Programs 1 Routine Practices and Additional Precautions (RPAP) for Preventing the Transmission of Infection in Healthcare Settings (2013) 18
Human Antibiotic Drug Use The Public Health Agency of Canada analyses and interprets antibiotic use by Canadians by tracking:» antibiotics provided through pharmacies; antibiotics purchased by hospitals for patient treatments; and reasons for physician recommendations of antibiotics. http://publications.gc.ca/collections/collection_2014/aspc-phac/hp37-20-2013-eng.pdf 19 Highlights from the 2012/2013 report include:» In 2013, office-based physicians made 23.8 million antibiotic recommendations (approximately 1/12 diagnoses resulted in an antibiotic recommendation). Majority of recommendations were for upper respiratory infections, lower urinary tract infections and ear infections.» Between 2012 and 2013, a slight reduction was seen in the total amount of antibiotics provided through pharmacies (2 per cent), while a large increase was seen in the antibiotics purchased by hospitals (19 per cent).» Antibiotic use was highest in the community among the youngest and oldest age groups (0-5 and 65+ years old). However, the percent of diagnoses with antibiotic recommendations was much higher in children than in the 65+ age group.» Differences in antibiotic use by communities and hospitals were observed among provinces.
2014 Pilot Public Awareness Campaign www.canada.ca/antibiotics Objective: Improve knowledge and awareness of AMR and promote the prudent use of antibiotics among Canadian families and health professionals. The campaign featured communications and marketing activities designed to improve the general public s interactions with health-care professionals about AMR & AMU. The campaign messages and approach were informed by:» Baseline knowledge, awareness and behaviour assessments with Canadian public and physicians» Surveillance Data» Public Opinion Research 20
Overview of Promotional Tactics Advertising Web resources Social Media Canadian Families Health Professionals Public/Media Relations Partnerships Outreach 21
New AMR web content: Canada.ca/antibiotics 22
Campaign Products The suite of campaign products included: Campaign poster When you really need them, will antibiotics work? Educational brochure Antibiotic Resistance: Questions & Answers Infographics Antibiotic Resistance: Facts & Figures (adults) Help reduce antibiotic resistance (adults) Germs & Antibiotics (Children aged 8-12) Electronic Postcard Sometimes the right prescription, is no prescription. Parent Letter Whiteboard video When you really need them, will antibiotics work? Public Notices 23
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The Germs & Antibiotics infographic was developed for children between the ages of 8 &12 and will also be available online 25
An electronic postcard to help promote the campaign via email to health professionals in advance of the campaign A parent or guardian letter that physicians can use with parents to explain why an antibiotic was not prescribed for their child s illness 26
Continuing Professional Development Module for Antimicrobial Resistance (AMR) Awareness A one-hour long Continuing Professional Development (CPD) module has been developed for physicians and pharmacists The module will be accredited by:» Royal College of Physicians and Surgeons of Canada (RCPSC), Maintenance of Certification» College of Family Physicians of Canada (CFPC), Mainpro-M1» Canadian Pharmacists Association (CPhA) 27
Campaign Evaluation Post-campaign knowledge, awareness and behaviour assessments to take place in Jan/Feb 2015 for each target audience: prescribing physicians and general public. Other lines of evidence include: Web site metrics and analytics (visits, time spent) Uptake of printed and on-line materials (web button downloads, resource downloads) Social media Analytics Facebook (likes, shares, comments on posts) Twitter (re-tweets) Video views on YouTube 28
Moving Forward Canada s approach Implement Federal Framework actions Develop a national (pan-canadian) strategy on AMR and AMU Continue monitoring and reporting from our national surveillance programs; Evolve public health guidance for preventing and combating antibiotic resistant infections; Continue to collaborate with our national and international partners to advance research, policy and legislation work; Promote research in and development of alternatives to the use of antimicrobials in human and veterinary medicine; Work with the healthcare, agriculture and aquaculture sectors to ensure the judicious use of antimicrobials; and Engage provincial and territorial agricultural departments regarding the use of antimicrobials in farmed animal production. 29
ACKNOWLEDGEMENTS Centre for Communicable Diseases and Infection Control National Microbiology Laboratory Centre for Food-borne, Environmental and Zoonotic Infectious Diseases PHAC AMR Tiger Team 30
THANK YOU --------- Jacqueline Arthur Manager, Strategic Issues AMR Centre for Communicable Diseases and Infection Control Infectious Disease Prevention and Control Branch Public Health Agency of Canada jacqueline.arthur@phac-aspc.gc.ca 31