Medische microbiologie in Suriname

Transcriptie

1 Medische microbiologie in Suriname Antibiotica resistentie bestrijden in Suriname Dr. Ed IJzerman, arts-microbioloog Academisch Ziekenhuis Paramaribo

2 Inhoud Wat weten we van Suriname? Organisatie Gezondheidszorg Medische Microbiologie algemeen MML AZP Nationaal Actieplan beheersing AMR Uitdagingen

3 Suriname

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7 Tot 1954 een kolonie van Nederland Van 1954 tot 1975 een deel van het Koninkrijk der Nederlanden Sinds 25 november 1975 een onafhankelijke republiek Oppervlak km 2 (ter vergelijking: Nederland km 2 ) Aantal inwoners (grootste deel in en rondom Paramaribo)

8 Gezondheidszorg

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10 Gebaseerd op oude Nederlandse systeem Verrichtingenvergoeding Ligdagvergoeding Ziekenfonds Particuliere verzekeraars

11 Ziekenhuizen Academisch Ziekenhuis Paramaribo RK Sint Vincentius Ziekenhuis Diakonessen Ziekenhuis s Lands Hospitaal Mungra Medisch Centrum Nickerie

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15 Medische Microbiologie Routine diagnostiek infectieziekten voor alle ziekenhuizen, overige zorginstellingen en huisartsen: MML AZP Referentielaboratorium: Centraal Laboratorium van het Bureau voor Openbare Gezondheidszorg (BOG) Research: laboratorium van het Medisch Wetenschappelijk Instituut (MWI)

16 BOG: tegenhanger RIVM

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18 MML AZP Suriname heeft één routine medisch microbiologisch laboratorium (MML), hetgeen gevestigd is in het AZP. Het MML is 30 jaar lang geleid door Sandra Hermelijn, de enige artsmicrobioloog van Suriname. In verband met het bereiken van de pensioengerechtigde leeftijd werd gezocht naar opvolging.

19 In verband met het ontbreken van opvolging heb ik vanaf 1 mei 2017 een overeenkomst met het AZP met als doel om zorg te dragen voor opvolging en in de interim periode leiding te geven aan het MML. Dat toe ik samen met enkele enthousiaste collegae! (Jan Sinnige, Jayant Kalpoe, Wouter Rozemeijer, Bartelt de Jong, Peter van Keulen, Janneke de Vries, Frans Verduyn)

20 Academisch Ziekenhuis Paramaribo Overheidsinstelling Valt onder de verantwoordelijkheid van het Ministerie voor Volksgezondheid

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22 Medisch Microbiologisch Laboratorium van het AZP: 24 FTE analisten 1 operational manager 1 arts-microbioloog 4 FTE centrale ontvangst voor KCL en MML

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40 Activiteiten A3-jaarplan Opleidingsplan afgestemd op richtlijnen NVMM (goedgekeurd door SRC Suriname) Kwaliteitshandboek conform ISO Start multidisciplinaire patiëntenbesprekingen (IC, NICU) Introductie WHONET Start Antimicrobial Stewardship

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42 Antimicrobial Stewardship in Suriname 2017 Nationaal Antibioticum boekje Nationale Antibiotica Commissie 2018 Nationale Infectiepreventie Commissie Dr. IJzerman door Minister benoemd als Focal point voor AMR in SUR

43 Website Landelijk Antibioticabeleid Suriname,

44 Antimicrobial Stewardship in Suriname Volgende stappen Versterken Diagnostic stewardship Capacity building microbiologie voor surveillance ICT infrastructuur op peil Symposium Antibiotica eerste lijn mei 2019 Symposium Stewardship Caribbean nov 2019

45 Audit PAHO/WHO (Pan American Health Organization)

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48 Huidige acties (A3 2019) Introductie LIS Formatie kwaliteitsteam Eigen applicatiebeheer Herberekening benodigde formatie voor MML Uitbreiding Moleculaire Diagnostiek Afronden kostprijsberekening en benodigd budget Onderhandeling over tarieven met zorgverzekeraars PLUS..

49 National Antimicrobial Resistance (AMR) action plan Suriname

50 Waarom AMR plan: Groeiend probleem van antimicrobiële resistentie wereldwijd. Behandeling van bepaalde patiënten moeilijk, kostbaar en zelfs onmogelijk.

51 Internationale committments om AMR aan te pakken: United Nations: Political declaration of the high-level meeting of the General Assembly on antimicrobial resistance Resolution adopted by the General Assembly 5 October /3 WHO: Global action plan for antimicrobial resistance (World Health Assembly document A68/20, 27 March 2015). WHO: FAO/OIE/WHO Tripartite Collaboration on AMR.

52 Vanaf 2012 verschillende regionale (CARICOM) workshops tbv het opstellen van een AMR plan. In Oktober 2016: workshop in Trinidad and Tobago, om nationale actieplannen van de participerende landen te helpen opzetten. Vertegenwoordiging uit Suriname: MVG: drs. B. Jubithana en Ms K. Jharie LVV: drs. G. Karg. Verdere ondersteuning/input gegevens door Drs. Hermelijn, PAHO Trinidad en WHO.

53 Augustus 2018: Opdracht PAHO Suriname: Bijstellen en afronden Actieplan en toevoegen activiteiten en budget

54 Table of contents page Abbreviations and acronyms 3 Foreword 4 Introduction 5 Situational analysis in Suriname 9 Strategy and governance 15 Activities 17 Operational plan 21 Monitoring and evaluation 21 References 22 Annex 1: Operational plan: priority activities, timeline and budget

55 Human and Animal sector - Inappropriate treatment, lack of treatment compliance - Deficient guidelines - Lack of training - Deficient treatment monitoring - Deficient infection control practices - Deficient regulatory mechanisms Industry/ trade Patients - Irrational drug use -Poor quality monitoring - Poor adherence - -Unavailability of certain drugs -Drugs / Prescription sharing -Deficient storage conditions - Self-medication - Deficient regulatory mechanisms - Social and economic barriers -High costs medicines to health services

56 AMR Action Plan The strategic objectives are: Objective 1: Improve awareness and understanding of antimicrobial resistance through effective communication, education and training. Bewustwording Objective 2: Strengthen the knowledge and evidence base through surveillance and research. Kennisvergroting Objective 3: Reduce the incidence of infection through effective sanitation, hygiene and infection prevention measures. Infectiepreventie Objective 4: Optimize the use of antimicrobial medicines in human and animal health. Antimicrobial stewardship Objective 5: Develop the economic case for sustainable investment that takes account of the needs of all countries, and increase investment in new medicines, diagnostic tools, vaccines and other interventions. Terugverdienmodel

57 AMR Monitoring and evaluation framework, WHO

58 Strategic Objective 1: Improving awareness and understanding of antimicrobial resistance through effective communication education and training 1.1 Increase national awareness of AMR Strategic intervention Activities Coordination/Responsibility Establish a public communications program targeting audiences in human and animal health practice and establish regular AMR awareness campaigns Develop a national AMR communication plan for Develop radio, tv and social media programs/infomercials regarding antimicrobial resistance containment in humans using WHO materials amongst others AMR Focal Points MOH and LVV AMR focal point MOH Develop educational materials and execute awareness campaigns targeting the general public and animal owners regarding animal health including safe use antibiotics in husbandry AMR focal point LVV

59 1.2 Improve professional knowledge of AMR and related topics Include AMR and related topics in professional education and continuing education programs Assess feasibility of incorporation of AMR (including hygiene and infection prevention) in undergraduate curricula of medical, nursing, dentistry assistants, lab assistants, animal husbandry training institutions National infection prevention and control committee. AMR focal points Adapt/Develop training modules for the various training institutions National infection prevention and control committee. AMR focal points

60 2.1-Strengthen national AMR surveillance and use of electronic monitoring systems Strategic intervention Activities Coordination/Responsibilit y Establish national infection prevention and control committee with support of the leadership of the MOH Formalize national infection prevention and control committee with representation of various health institutions Leadership Ministry of Health Improve electronic surveillance of AMR isolates National infection prevention and control committee develops a new manual for health institution acquired infections making use of WHO guidelines including surveillance targets to monitor effectiveness of infection prevention and control strategies Committee organizes regular meetings of hospital and health institutions to discuss reporting of health institutions acquired infections and plans interventions Committee shares reports with health authorities Procure appropriate computer software (LIS) MOH AMR focal point National infection prevention and control committee National infection prevention and control committee National infection prevention and control committee Clinical microbiologist MOH AMR focal point Train users in LIS at different institutions Clinical microbiologist MOH AMR focal point Produce annual national AMR report Aggregate and analyze annual AMR microbial isolates in humans with the inclusion of specimen and National infection prevention and control committee

61 2.2 Strengthen national laboratory capacity Strengthen national reference laboratory capacity Formalize and strengthen collaboration between AZP microbiological laboratory BOG laboratory and LVV laboratory Leadership MOH and LVV AMR focal point LVV Clinical microbiologist Complete construction of LVV laboratory, procure lab equipment and train lab personnel Leadership Ministry of LVV AMR focal point LVV Clinical microbiologist 2.3 Strengthen surveillance of AMR in animal husbandry Improve electronic surveillance system Establish Laboratory information system for animal husbandry which is compatible with the LIS for humans AMR focal point LVV AMR focal point MOH Design surveillance system for main microbiological food hazards, organize training workshops and purchase necessary reagents

62 3.1-Strengthen infection control and prevention in health institutions Strategic intervention Activities Coordination/Respon sibility Develop and disseminate infection control guidelines for hospitals and other health institutions Assess gaps in infection prevention and control (including sanitation and hand hygiene) in various health institutions MOH AMR focal point National infection prevention and control committee Develop plan of action and guidelines for strengthening health institutional infection prevention and control MOH AMR focal point National infection prevention and control committee Organize training sessions for health institutions in infection prevention and control guidelines using WHO protocols MOH AMR focal point National infection prevention and control committee

63 3.2-Strengthen safety regulations regarding animal husbandry Strategic intervention Activities Coordination/Responsibi lity -Update food safety legislation and regulations Update regulations on meat inspection and preparation of regulations for farm registration Organize information sessions with stakeholders regarding meat regulations and farm regulations Leadership Ministry of LVV Focal point AMR LVV -Implement food safety assurance systems -Implement registration and inspection system Review and update national Good Agricultural Practices standards in animal husbandry, agriculture and fisheries Organize training workshops for stakeholders Develop inspection procedures manuals Prepare and execute training and coaching for inspectors Leadership Ministry of LVV Focal point AMR LVV Leadership Ministry of LVV Focal point AMR LVV

64 3.2-Strengthen safety regulations regarding animal husbandry Strategic intervention Activities Coordination/Responsibi lity -Update food safety legislation and regulations Update regulations on meat inspection and preparation of regulations for farm registration Organize information sessions with stakeholders regarding meat regulations and farm regulations Leadership Ministry of LVV Focal point AMR LVV -Implement food safety assurance systems -Implement registration and inspection system Review and update national Good Agricultural Practices standards in animal husbandry, agriculture and fisheries Organize training workshops for stakeholders Develop inspection procedures manuals Prepare and execute training and coaching for inspectors Leadership Ministry of LVV Focal point AMR LVV Leadership Ministry of LVV Focal point AMR LVV

65 4.1-Rationalize the purchasing and prescription practices of antimicrobials Strategic intervention Activities Coordination/Respo nsibility Support the activities of the antibiotics working group and strengthen the use of online standard antimicrobial treatment guidelines Ensure the continuity of the functioning of the antibiotics working group Ensure the availability of essential antimicrobials Leadership MOH National Essential Medicines Formulary Commission Revise the online list and guidelines of essential antimicrobials Antibiotics working group Define antimicrobial medicine list for all hospitals Antibiotics working group Promote the use of online standard antibiotics treatment guidelines by instructing/training doctors Antibiotics working group MOH AMR focal point 4.2-Promote antimicrobial stewardship - Strengthen multidisciplinary collaboration Organize workshop involving stakeholders including those in veterinary medicine and animal husbandry MOH and LVV focal points

66 5.1 Develop a costeffectiveness model for investing in diagnostics Strategic intervention Activities Coordination/Responsi bility -Strengthen investments in AMR diagnostic capacity Assess the current capacity in the microbiology laboratory and propose a list of necessary investments Clinical microbiologist

67 Operational plan: priority activities, timeline and budget Looptijd: oktober 2018-oktober 2021 Estimated Budget (in USD) Budget MOH: Ondersteuning vragen bij de PAHO; Niet geincorporeerd: noodzakelijke investeringen in het microbiologisch lab Budget LVV: Onderdeel van het IDB project

68 Global AMR action plan The goal: To ensure, for as long as possible, continuity of successful treatment and prevention of infectious diseases with effective and safe medicines that are quality-assured, used in a responsible way, and accessible to all who need them.

69 Uitdagingen voor 2019 en verder Medisch microbiologisch laboratorium van het AZP op niveau brengen Verdere ontwikkeling klinische microbiologie Artsen-microbioloog opleiden om het stokje over te nemen Uitvoering geven aan het Nationaal actieplan AMR (helpende hand wordt zeer op prijs gesteld )

70 Tot slot: Dank aan Sandra Hermelijn 27 jaar MML AZP opgebouwd ANALISTEN MML INFECTIEPREVENTIE