using healthcare associated infection data for...
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2016/LSIF/FOR/017
Using Healthcare Associated Infection Data for Action
Submitted by: Japan
Policy Forum on Strengthening Surveillance and Laboratory Capacity to Fight Healthcare Associated Infections and Antimicrobial
ResistanceHa Noi, Viet Nam
14-15 December 2016
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APEC Policy Forum; Strengthening Surveillance and Laboratory
Capacity to Fight HAI and AMR
Using Healthcare Associated Infection Data for Action
December 15, 2016
Go TANAKA, MD, MPH, PhD Councilor, Coordination Office of Measures on
Emerging Infectious Diseases, Cabinet Secretariat, Government of Japan 1
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Tokyo Meeting of Health Ministers on AMR in Asia, April 2016
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We, the Ministers of Health and representatives from countries in the Asia-Pacific region, namely, Australia, Bangladesh, China, India, Indonesia, Malaysia, Myanmar, Philippines, Republic of Korea, Thailand and Viet Nam, have come together on the occasion,,,
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Communiqué Strengthen capacities to conserve effectiveness of antimicrobials as a domestic, regional and global public good through: (1)Implementing domestic antimicrobial stewardship programmes that promote the appropriate and prudent use of antimicrobials in humans and animal health and agriculture;
(2) Using quality information generated from domestic AMR surveillance systems following standardized protocols to guide policies and clinical decision-making in human and veterinary medicine;
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Communiqué (3) Developing laboratory capacity to identify pathogens and their antimicrobial susceptibility in order to guide optimal use of antimicrobials in clinical practice; 4) Developing internationally agreed standards for collection of data and reporting on AMR in human health, animal health, and agriculture, and supporting domestic, regional and global laboratory networks to improve the quality of data gathered through AMR surveillance;
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0 5 10 15 20 25 30 35
JapanNetherlands
EstoniaLatvia
HungaryAustria
SwedenSlovenia
GermanyLithuaniaDenmark
NorwayCzech Republic
BulgariaFinlandPoland
SlovakiaUnited Kingdom
Spain (b)Croatia
Iceland (a)Malta
PortugalIreland
ItalyLuxembourg
Cyprus (a)France
BelgiumRomania (a)
Greece
Tetracyclines (J01A) Beta-lactams,penicillins(J01C) Other betalactam antibacterials (J01D)Sulfonamides and trimethoprim(J01E) Macrolides, Lincosamides and streptogramins(J01F) Quinolones (J01M)Other antibacterials(J01X) Sum(J01B, J01G,andJ01R)*
Antimicrobial drug usage for medical purposes (Comparison with EU countries) 2012
Source: Cited and graphed from ECDC AMR Surveillance report 2012 5
DDD(Defined Daily Dose) Average adult usage of antimicrobial drug/day/1000 persons
15.8
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※rheum, acute bronchitis, acute sinusitis, acute pharyngitis (except for those identified as bacterial), and acute pharyngolaryngitis
In outpatient care in Japan
Antimicrobial drugs are administered to 60% of upper respiratory inflammation patients.
– Third generation Cephem: 46%, Macrolide: 27%, Quinolone: 16%
Intern Med 2009;48:1369-1375.
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AMR control Action Plan
Ministerial Conference for internationally threatening infection control; April, 2016 Key Performance Indicator;
Cephem, Macrolide and Quinolone OPD use ~50% decrease
2016-20
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Field Goal
1 Public awareness/education Promote knowledge and understanding for drug-resistance and further education and training for specialists.
2 Surveillance/monitoring
Monitor drug-resistance and the usage of antimicrobial agents on a continuing basis to understand adequately prior warning for changes or expansion of drug-resistance.
3 Infection prevention/control Prevent expansion of drug-resistant microorganism by properly executing infection prevention/control.
4 Proper use of antimicrobial agents
Promote proper use of antimicrobial agents in the field of medicine and farming/fishery industries.
5 Research & development/drug development
Promote research on drug-resistance as well as R&D to ensure prevention/diagnosis/treatment measure for drug-resistant microorganism.
6 International cooperation Work in cooperation on a multidisciplinary level from international perspectives to promote drug-resistance control. 8
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Japan Nosocomial Infections Surveillance National Institute of Infectious Diseases
Government led nationwide surveillance
Surveillance of AMR and HAI since 2000
Participation on voluntary basis; Independent from the mandatory surveillance conducted by infection control law Feedback to member hospitals and also to the public
Future Perspective
Inclusion of hospitals with < 200beds
Data stratification
Trends for introduction of genomic method
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Division Measurement
Clinical Laboratory (CL)
Prevalence of major antimicrobial-resistant bacterial
(isolates base)
AMR Bacterial Infections (ARBI)
Incidence of antimicrobial-resistant bacterial infections
(patients base)
Surgical Site Infections (SSI)
Incidence of surgical site infections
(patients base)
Intensive Care Unit (ICU)
Incidence of device-associated infections (CRBI, VAP, UTI) in ICU
(patients base)
Neonatal Intensive Care Unit (NICU)
Incidence of all infections in NICU (patients base)
The Five Divisions of JANIS
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Participating hospitals Approximately 1,300 hospitals with >200 beds are participating
Total
AMR Bacterial Infection
SSI ICU
NICU
Clinical Laboratory
New participants are recruited every year.
Reimbursement of infection control fee
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JANIS format data
Convert all electrical data to JANIS format
National Institute of Infectious Diseases
Compile data from all hospitals Analyze and publish information periodically
Clinical laboratory in participating hospitals
Data collection
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Numbers of isolates cultured at participating hospitals
Samples No of samples No of culture-positive samples
No of cultured isolates
Respiratory tract 1,293,727 841,064 1,784,976
Urine 504,552 265,950 409,324
Stool 357,340 185,070 372,037
Blood 1,166,599 153,348 173,355
Spinal fluid 54,308 3,155 3,638
Others 854,260 404,288 709,226
Total 4,230,786 1,852,875 3,452,556
Open report 2012, JANIS
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MRSA isolation Rate; 51% of all
S. aureus detected (118,539 / 231,909)
Open Report 2013, Clinical laboratory, JANIS
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Handling during an outbreak (Assuming multi-drug resistant microbe)
Infection Control Committee
Infection Control Team
Support Consultation with local specialists
Inter-institutional network
If an outbreak of nosocomial infection is suspected (If there are 3 or more total cases within 4 weeks of the initial case of multi-drug resistant microbe)
Report Instruction/advice
Public Health Center
New cases of infection are found
Request support from specialists in medical institutions participating in the local network to prevent the spread of infection
If many cases of infection due to a single causative microbe in the same medical institution occur (approximately 10 patients or more)
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Division Clinical Laboratory
Antimicrobial- Resistant
Bacterial Infections
Surgical Site
Infections
Intensive Care Unit
Neonatal Intensive Care Unit
Frequency of reporting monthly monthly half year half year annually
JANIS Open Report
(for public)
Monthly _ _ _ _ _
Quarterly/ Half year
○ ( Quarterly)
○ ( Quarterly)
○ ( Half year)
○ ( Half year)
_
Annual ○ ○ ○ ○ ○
JANIS Feedback
Report (for
member hospitals)
Monthly ○ ○ _ _ _
Quarterly/ Half year
○ ( Quarterly) _
○ ( Half year)
○ ( Half year)
_
Annual ○ ○ ○ ○ ○
Data submission and feedback
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Merit for each participating hospital Confidential feedback report Provision of summary of each hospital data Provision of benchmark data by comparison with other hospitals. Help map out strategies for infection control
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Feedback information for JANIS member hospitals
Inter-hospital comparison
From when?
In which ward?
Available within 48 hr after data submission
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Domestic data Hospital K
An example of an antibiogram of a hospital where an A. baumannii outbreak was reported
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JANIS Server (For Japanese hospitals)
JANIS Server (For foreign countries)
Convert data to JANIS format
Automated Analyzer
Hospitals (Japan)
Overseas hospitals
Disk diffusion
WHONET
Data submission
Automated Analyzer
JANIS: Development of global database for antimicrobial resistance
Data submission
Call for participating hospitals from APEC economies
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Viet Nam Indonesia Cambodia
,,,,, Contact;
Indian Embassy at Tokyo(April, 2016) MoU btw NIID and Indian Council of Medical Research
Way forward of JANIS