31/08/2017. Point Prevalence Survey for Antimicrobial Resistant Organisms in Canadian Long- Term Facilities. Overview

Transcription

1 Point Prevalence Survey for Antimicrobial Resistant Organisms in Canadian Long- Term Facilities IPAC Canada 2017 National Education Conference June 20, 2017 Denise Gravel and the PHAC-IPAC Canada LTC Working Group Overview Government of Canada response to antimicrobial resistance and rationale for the prevalence Preliminary results of the prevalence for antimicrobial resistant organisms (ARO) and antimicrobial (antibiotic) use (AMU) Next steps 2 Introduction Antimicrobial resistance (AMR) is considered a serious global threat to public health because it erodes the efficacy of these agents in treating and preventing a wide range of infectious diseases in humans. Residents of long-term care facilities (LTFC) have a higher risk of infection than the general population. Risk factors for infection in residents of LTCFs include a higher likelihood of immunocompromised status and co-morbidities, decreased mobility, and closeconfined living quarters. Studies have shown that many residents enter LTCFs colonized with antibioticresistant organisms (ARO) that were acquired in acute care. Various resident and facility factors, unique to LTCFs, contribute to persistent colonization and spread to other residents. Some P/T s have conducted pilot studies to get an estimate of the burden of AMR and AMU in LTCFs; however, there is no available information at the national level. Living arrangements of seniors. Census in briefs Analytical products, Statistics Canada. Moro, M. L., & Gagliotti, C. (2013). Future Microbiology, 8(8), doi: / Nicolle, L. (2000). Clinical Infectious Diseases, 31 (3): doi: /fmb

2 Key Milestones in Response to Antimicrobial Resistance April 2014: Health Portfolio Actions on Antimicrobial Resistance released October 2014: Release of Antimicrobial Resistance and Use in Canada: A Federal Framework for Action outlining objectives for the Government of Canada. Announced the creation of CARSS March 2015: Ministerial Roundtable on AMR; Launch of CARSS and the release of the first CARSS Report and the Action Plan on Antimicrobial Resistance and Use in Canada: Building on the Federal Framework for Action In the 2015 Spring Report of the Auditor General of Canada on AMR it was noted that the creation of CARSS would address the weaknesses in surveillance that were identified in the OAG report On September 21, 2016 the President of the UN General Assembly convened a High Level Meeting (HLM) of Member States on AMR September 2016: Second CARSS Report released Canada signed on to Global Antimicrobial Resistance Surveillance System (GLASS) Development of a Pan-Canadian Framework on AMR, 2017 A national approach to addressing AMR requires collaboration across federal, provincial and territorial governments and with stakeholders 4 F/P/T Governance Model on AMR Annex A Existing New 5 Identification of priority organisms for public health surveillance in Canada Top priority group of organisms 2 nd Priority group of organisms 3 rd priority group of organisms Clostridium difficile Aspergillus spp. Aeromonas spp. ESBL-producing organisms Bacteroides spp. Chlamydia pneumoniae Carbapenem-resistant organisms (Acinetobacter + Enterobacteriaceae spp) Candida albicans Cryptococcus neoformans Enterococcus spp. Chlamydia trachomatis Haemophilus influenza Nesisseria gonorrhoeae Helicobacter pylori Non-tuberculosis mycobacteria (pulmonary) Streptococcus pyogenes & Pseudomonas aeruginosa pneumoniae Salmonella spp Group B Streptococcus Staphylococcus aureus Shigella spp. Mycobacterium tuberculosis Campylobacter spp. Developed by the Communicable and Infectious Disease Steering Committee (CIDSC) AMR Surveillance Task Group and approved by CIDSC in December

3 AMR/AMU Information Gaps in Human Health* Surveillance gaps in is limiting the development of a comprehensive understanding of AMR/AMU in Canada and where/how to target efforts Gaps have been identified by PHAC, the Auditor General of Canada (May 2014 report), and the F/P/T Communicable and Infectious Disease Steering Committee (CIDSC) Task Group on Surveillance (December 2015) Current national surveillance systems more focused on infections than pathogens, very limited data on resistance None or very little data on several priority AMR pathogens of concern to the health of Canadians, i.e. resistant E.coli and K. pneumoniae Limited data on AMR/AMU in small, non-academic hospitals and no data for rural and Northern healthcare settings and First Nations No data on AMR in the community; non-traditional healthcare settings (e.g. long-term care facilities); physician and dental offices No information on the linkages between AMU practices and the observed patterns of resistance and spread of pathogens 7 Addressing the Gaps Leverage existing infrastructures to capture of C.difficile infections found in the community and community-associated MRSA skin and soft tissue infections Proof of concept phase Collect antibiogram data from community and provincial public health laboratories to determine proportion of resistance Feasibility stage with BC and PEI Conduct prevalence studies to assess the burden related to AMR in non- CNISP, rural and Northern acute-care hospitals and long-term care facilities (LTCF) Collaboration with IPAC Canada members 8 CARSS Acute Care Point Prevalence (2017) 33 hospitals in 12 provinces & territories Primarily outside urban centres AMR, both HAI and CAI and AMU Canadian Nosocomial Infection Surveillance Program 64 hospitals in 10 provinces 91% of all teaching hospitals in Canada, in large urban centres HAI-AMR 9 3

4 Point Prevalence Surveillance for AMR in LTCF Objective: To assess the prevalence at one pre-determined point in time of antimicrobial resistant organisms (ARO) in residents residing in Canadian LTCF; Develop a proof concept proposal for ongoing surveillance of AMR in LTCF Methods: Voluntary participation by IPAC Canada members for whom the area of practice was LTC Residents were identified at each LTCF by the facility census at a predetermined time set by each facility on any day occurring between April 3 rd and May 15 th, 2017 Information was collected on all residents with documented infection or colonization or using at least one systemic antibiotic Data was entered into a web-based application via IPAC Canada website or submitted directly to PHAC (paper forms) 10 Preliminary Results: Web-based application closed on May 31 st ; data extracted and forwarded to PHAC on June 9 th As of June 15 th,data was available on 200 residents residing in 22 LTCF Ontario (n=115, 57.5%) Alberta (n=23, 11.5%) PEI (n=62, 31.0%) Mean age 82 ± 11 years (median = 84) 69% were female A little over half (55.8%) of the residents were in two bed rooms 11 Figure 1: Prevalence of infections among the residents, N =

5 Figure 2: Proportion of residents known to have been colonized or infected with an ARO in previous 24 months, N = (51.5%) residents were known to be infected or colonized in the previous 24 months 80 (40.2%) of the residents were on additional precautions on the day of the prevalence - 77, contact precautions; 3, droplet precautions 13 Antimicrobial use and stewarship: 52 (26.0%) of the residents were taking an antibiotic on the day of the prevalence 46.2% for treatment of the reported infection 28.8% for prophylaxis 25.0% for treatment of another infection, not reported All LTCF reported they conducted some form of AMU stewardship program in the past 12 months Consulted with experts for guidance on AMU Implementation of optimal AMU policies Monitored and reported a measure and an outcome of AMU Identified a lead for stewardship activities Educated staff and family on AMU 14 Discussion One in 7 residents had an infection on the day of the prevalence. UTI was the most prevalent infection, followed by SSTI and LRI. Four residents were found to have an infection caused by an ARO MRSA SSTI ESBL UTI Although all facilities reported having conducted some form stewardship program in the past 12 months, AMU is high among residents in LTCF (26.0%) Over a quarter (28.8%) of the AMU is for prevention of infection Over half of the residents were known to be infected or colonized with an ARO in the previous 24 months On the day of the prevalence, almost 40% of the residents were on contact precautions. Limitations: not all the data has been analyzed. 15 5

6 Next Steps Complete data entry and analysis. Report will be presented to IPAC Canada Evaluate the prevalence, report on the proof of concept Short timelines Insufficient staffing and resources Timing conflicted with other studies that were being conducted concurrently with other LTC prevalence as well as provincial realignment of health care services Lack of communication between project leads and LTC participants. Title was misleading ( selected ) Review the feasibility of repeating prevalence vs other surveillance methods Adapt CNISP model Work with IPAC Canada LTC Interest Group Collaboration with P/Ts on surveillance Determine if the use of administrative database is possible IMS Health as an example 16 Conclusion Residents in LTCFs are at high risk of infection. The emergence of AMR is a growing concern as treatment options are now limited. Currently there is a gap in AMR and AUM surveillance in Canadian LTCF. With an aging population, a third of seniors aged 85 and over living in LTCF enhanced surveillance in this population is needed. PHAC is committed to collaborating with P/T and external stakeholders such as IPAC Canada to identify and help address priority surveillance including surveillance in LTCFs 17 Acknowledgements IPAC Canada Jean Clark Revera LTC Cheryl Collins Macassa/Wentworth Lodges Alisa Cuff Lewisport Community Health Greg German Health PEI Kamyab Ghatan Sienna Senior Living Nicki Gill Interior Health Community Health Adeline Griffin Yukon Health & Social Services Lee Hanna St. Joseph Auxiliary Hospital Jennifer Happe Red Deer Hospital Allison McGeer Mt Sinai Hospital Sandi Noble West Park Healthcare Centre Tania Paolini The Perley and Rideau Veterans Health Centre Esther Rupnarai West Park Healthcare Centre Aurora Wilson Providence Health Care AIPI Nathalie Pigeon CIUSSS Centre-Sud de Montreal Zeke McMurray Centre intégré universitaire de santé et services sociaux de l Estrie PHAC Stephen Cule Marwa Ebraim Chris Houston Jayson Shurgold Olivia Varseneaux 18 6