2016/LSIF/FOR/002 Strengthening Surveillance for Antimicrobial Resistance and Healthcare-Associated Infections

Transcription

1 2016/LSIF/FOR/002 Strengthening Surveillance for Antimicrobial Resistance and Healthcare-Associated Infections Submitted by: United States Policy Forum on Strengthening Surveillance and Laboratory Capacity to Fight Healthcare Associated Infections and Antimicrobial Resistance Ha Noi, Viet Nam December 2016

2 National Center for Emerging and Zoonotic Infectious Diseases Strengthening Surveillance for Antimicrobial Resistance and Healthcare-Associated Infections Neil Gupta, MD, MPH International Infection Control Program U.S. Centers for Disease Control and Prevention Asia-Pacific Economic Cooperation (APEC) Policy Forum Ha Noi, Viet Nam December 14, 2016

3 WHO Global Report on Surveillance 2014 Widespread high levels of AMR % of resistance among tested isolates Significant gaps No global system on surveillance of antimicrobial resistance (AMR) Lack of harmonized standards, data sharing, and coordination

4 WHO Global Report on Surveillance 2014 *Domestic data means data obtained from official sources, but not that data necessarily are representative for the population or country as a whole WHO: Antimicrobial Resistance. Global report on surveillance 2014

5 Healthcare-Associated Infections Healthcare-associated infections (HAIs) are a significant cause of morbidity and mortality in health care systems globally HAI incidence 1 European CDC: 7.1 per 100 patients US CDC: 4.5 per 100 patients Resource-limited settings: 15.5 per 100 patients 1 Lancet Jan 15;377(9761): Epub 2010 Dec 9.

6 AMR Surveillance

7 Global Action Plan on Antimicrobial Resistance Five strategic objectives 1. Improve awareness and understanding 2. Strengthen the knowledge and evidence base through surveillance and research Member States request WHO (2015 WHA Resolution) develop and implement an integrated global program for surveillance of antimicrobial resistance across all sectors 3. Reduce the incidence of infection 4. Optimize the use of antimicrobial medicines 5. Develop the economic case for sustainable investment

8 How Surveillance Can Improve Health Outcomes Source: The Review on Antimicrobial Resistance, May 2016

9 AMR Surveillance Is Dependent on Multiple Steps Clinicians obtain specimen Laboratory processes and tests specimen Public health authorities collect, compile, and report data

10 AMR Surveillance Is Dependent on Multiple Steps Clinicians obtain specimen Laboratory processes and tests specimen The culture of culturing: Clinician behavior Lab factors: costs, turn-around time, dependability Affects interpretation of surveillance data Public health authorities collect, compile, and report data

11 AMR Surveillance Is Dependent on Multiple Steps Clinicians obtain specimen Laboratory processes and tests specimen Public health authorities collect, compile, and report data Building laboratory capacity: Guidelines Training Equipment & reagents Quality assurance

12 AMR Surveillance Is Dependent on Multiple Steps Clinicians obtain specimen Laboratory processes and tests specimen Public health authorities collect, compile, and report data Public health engagement in surveillance: Engaging stakeholders Harmonizing data Analysis & reporting Policy development

13 Global Antimicrobial Resistance Surveillance System Fostering domestic AMR surveillance systems through harmonized global standards to: Monitor AMR trends Detect emerging resistance Estimate the extent and burden of AMR globally Inform targeted prevention interventions Assess impact of interventions.

14 Components of a Domestic AMR Surveillance System Domestic coordinating center Domestic reference laboratory Surveillance sites Epidemiological capacity Trained in collecting epidemiological, clinical, and lab data Reporting platform Laboratory capacity Appropriate standards, guidelines, and protocols Strong quality management systems, including EQAS Diagnostic stewardship

15 The Need for Surveillance Systems Despite challenges, imperfect surveillance is still needed Some data are better than no data Although sentinel networks may not be representative, population-based surveillance not likely Ultimately surveillance should inform public health action Data Action

16 Making the Most of Imperfect Surveillance Systems Start small We can focus on challenges better in smaller networks Lab, clinical practice, reporting Demonstrate the usefulness of data Link data to action Demonstrate interventions that can work Government should be stakeholders or even owners of the system Inform policy Influence big levers like accreditation, licensing, payments

17 HAI Surveillance: The U.S. Experience

18 CDC s National Healthcare Safety Network A secure, web-based system for monitoring healthcare-associated infections (HAIs) Facilities use the NHSN web portal to enter, analyze, and share data Data is used by a variety of stakeholders: Facility: inform local quality improvement efforts State health departments: identify/support low-performing facilities National: describe burden, financial bonus and/or penalties

19 Cumulative NHSN Hospital Enrollment by Year, Number of hospitals Year

20 Factors Influencing NHSN Growth Since 2005 Increasing state health department involvement in HAI prevention 2007: first state law requiring public reporting of HAI rates is passed 2009: all state health departments receive CDC funding to establish HAI programs 2010 national healthcare reform law contained many quality provisions 2011: all hospitals must report HAI data to NHSN to receive full insurance reimbursements ( pay for reporting ) 2013: bonuses and penalties for high and low performing hospitals ( pay for performance )

21 Use of NHSN Data Assessing National Progress Yearly domestic and state progress reports The most recent report found: A 50% reduction in CLABSIs between 2008 and 2014 An 18% reduction in SSIs following 10 common types of surgeries between 2008 and 2014 No change in CAUTIs between 2009 and

22 Use of NHSN Data Public Reporting of Hospital HAI Data As part of healthcare reform quality reporting programs, hospitalspecific NHSN data is posted on a public website for consumers

23 Use of NHSN Data Tracking Antimicrobial Resistant HAIs CDC s Patient Safety Atlas uses pathogen and antimicrobial susceptibility data from NHSN to assess domestic and regional AMR patterns in HAIs reported to CDC

24 Use of NHSN Data Identifying Areas for Improvement NHSN Data U.S. hospitals currently reporting CAUTI, CLABSI, and C. difficile data Targeting Target hospitals with highest number of excess infections Partnering for Prevention Prevention collaborative networks Health Departments Other partners

25 CDC s Work in Viet Nam

26 A Health Threat Anywhere Is a Health Threat Everywhere Source: The Lancet 380:9857, 1-7 Dec 2012, pp

27 This image cannot currently be displayed. This image cannot currently be displayed. This image cannot currently be displayed. Global Health Security Agenda Action Packages Antimicrobial Resistance Domestic Laboratory Systems Emergency Operations Centers Zoonotic Diseases Biosafety/Biosecurity Surveillance Reporting Linking Public Health with Law Enforcement and Multisectoral Rapid Response Immunization Workforce Development Medical Countermeasures and Personnel Deployment

28 U.S. National Strategy: International Need Goal 5: Improve international collaboration and capacities for antibiotic resistance prevention, surveillance, control, and antibiotic research and development

29 AMR and IPC Capacity Building in Viet Nam AMR surveillance among network of 16 laboratories Laboratory assessments, capacity building, quality assurance Domestic policy and technical documents Reporting platform and epidemiological support HAI surveillance among 6 model hospitals Surveillance technical documents Reporting platform and epidemiological support Infection prevention and control Domestic technical advisory group support; guideline development Facility-based improvement programs, outbreak support

30 Cảm ơn For more information, contact CDC CDC-INFO ( ) TTY: The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.