Transcript Document
IMPORTANT
DEVELOPMENTS for implementation of healthcare-associated infections and AMR prevention and control measures-Republic Bulgaria-2008 Assoc. Prof. R.VatchevaDobrevska,MD,PhD National Reference Centre for Nosocomial Infections, NCIPD, Sofia Ministry of Health, Republic Bulgaria
Republic Bulgaria
areas of health Member States.
supports the development of measures aiming to limit the spread of HAI and AMR considers that the objectives will be achieve real results through recovering the necessary aspects of the problem and offer options within the framework of cooperation between
First of all it should be noted that one of the most important decisions of the Bulgarian Ministry of Health, concerning coordination of the HAI control is Infections.
the creation of National Reference Center for Nosocomial
The National Reference Center for Nosocomial Infections (NRCNI) , a specialized unit at the National Center of Infectious and Parasitic Diseases (NCIPD),Director Academician Dr Bogdan Petrunov, DSc has been set up with the support of Government structures for HAI.
Bulgarian Ministry of Health, Swiss Confederation’s - Swiss Red Cross via Bulgarian Swiss Hospital Hygiene Programme and indicated as a competent local authorized
The main activities of NRCNI were in different fields as follow:
Implementation of adequate institutional and regulatory basis at all levels 1. A proposal of “NATIONAL PROGRAMME for PREVENTION AND CONTROL OF HAI and RESTRICTION of SPREAD of AMR 2009-2011” was developed The Programme was presented at the Ministry of health for financial support of the activities
The National HAI PROGRAMME is based on:
IPSE international documents “Recommendations for practical, standards and indicators for monitoring and control of HAI and AMR “ and “ Communication from the Commission to the European Parliament and the Council on Patient safety , including the prevention and control of HAI” (Brussels, 15.12.2008
, COM, 836, final) .
2. In order to harmonize the existing legislation with EU standards and make it relevant to the current level of medical science and good practice the MEDICAL STANDART on HAI developed.
was
3. An to the EXPERT COUNCIL for infection control to Health Minister has been created – higher decisions making level in the health care system.
Prevention and control policy
4.The final IPSE document “ Recommendations for practical, standards and indicators for monitoring and control of HAI and AMR “ was translated into Bulgarian language
and presented to a wide range of professionals: clinical microbiologists , hospital epidemiologists , Regional Inspectorate , infection and infection control specialists, nurses , and others, within the range of a Congress of the Bulgarian Association of Microbiologists (BAM) in 2008.
The ESCMID President, Professor Giuseppe Cornaglia was a special guest, during the BAM congress.
5. An inquiry investigation was provided in Health care Facilities (HCF) for hospital care in the country, by Survey Check ListWP2 of IPSE for assessment of the prevention and control of HAI system . We have got data analysis and written report with feedback with HCF.
“IPSE Working Party Two Consensus on EU Hospital Infection Control and Antimicrobial Resistance Standards and Performance Indicators” Prof. Barry Cookson, Ana Paula Coutinho
6. NATIONAL MEETING on HAI with a FOCUS on MRSA (methicillin-resistant Staphylococcus aureus ) was organized by NCIPD-NRC-NI- 19.06.2008 in Sofia.
It was supported by the Ministry of Health and it was under the patronage of Minister of Health Dr Eugeniy Gelev.
A wide range of specialists from the country clinical microbiologists, epidemiologists, infection and clinical specialists, managers of HCF and others were participated in the meeting.
6.1. A Survey of HCF for hospital care conducted by NRC-NI with the support of the Ministry of Health, to assess the was approaches and programs for limiting the spread of MRSA and preventing infections caused by them.
6.2. The processing and analysis of data, imminent conclusions and report presentation has been made.
6.3. A project of Guidelines NRC-NI.
for control and prevention of MRSA in HCF in the country is coming to be developed by
6.4. The topics of the Bulgarian and foreign experts’ presentations covered various aspects, including the approaches for patients and staff safety, corresponding to the World Alliance for Patient Safety established by the WHO in 2004.
6.5.Dr Bart Gordts, President of the Belgian national platform for infection control Brugge, Belgium- The was a special guest speaker during the meeting.
The guest MH shared experience of his country with Dr. T. Tenev, Chief of Medical Officers, at the time of round table in the Ministry of health. They also discussed the possibility of future consultations and collaboration in the process of development of the Bulgarian system.
Surveillance policy
7. The surveillance activities of HAI аt local and national level aims to achieve knowledge of the real range of the problem with the HAI in the public healthcare by organizing specific measures for change. According with the recommended practices in the final document of IPSE: a set of definitions approved by the EU are included in Medical standard of HAI.
The rules for reporting were coordinated.
7.1. The data from the HAI surveillance for 2007 was collected by NRC-NI , imported and processed by electronic means. Their analysis and report are imminent.
7.2. The data from the National prevalent survey of HAI is being analysed and their publication is coming.
7.3. A Prevalence survey of HAI in regional hospitals in Sofia region Inspectorate- Sofia.
was conducted in 2008 by staff of the NRC-NI-and Regional
7.4. A study of some hospital outbreaks was completed. Molecular-typing of isolates caused infections was conducted, too.
The report was presented in May 2008 during the National meeting of Ministry of Health with participation of epidemiologists and Regional inspectorates Chiefs . Representatives from the ECDC, Stockholm and WHO took part in the Meeting.
Education and Training
8.1. A National training program for infection control doctors has been developed. Working group for discussions concerning the programme has been formed.
8.2. Measures for institutionalization training of infection control doctors (ICD) in the system of CME for acquisition of highly specialized activities have been taken at the level of Ministry of Health .
of the
8.3. It was finished an examination of State graduation of 50 nurses as “Infection Control Nurse” ( ICN ).
8.4. The training of the clinical staff responsible for HAI of medical and nurses level (link staff) is institutionalized and introduced on the system of CME;
8.5. Two training courses ”Contemporary aspects of the control and prevention of HAI” were been provided in NRC-NI :one for doctors , one for nurses from different HCF of the country. 8.6. A training course about diagnostic methods, risks and staff and patients safety the field of organ transplantation transplantation” has been provided in the “National Agency of in
Scientific-applied and objective investigations
9. In the IPSE document “Recommendations for practical, standards and indicators for monitoring and control of HAI and AMR in the chapter “Resources”, a special place is devoted to the development of the research investigations in this area.
In the Laboratory of Molecular typing of NRC-NI following activities have been developed:
9.1. In the NRC-NI standard protocols for epidemiological typing of certain indicator bacterial species with increasing epidemic meaning , by methods of molecular biology are developed. Protocols for typing of Pseudomonas aeruginosa, Serratia marcescens, Enterobacter spp., ESBL Enterobacteriaceae, Acinetobacter baumanii etc. have been developed.
9.2.
The following methods have been implemented for genes in nosocomial pathogens: PFGE, MLVA, ERIC, REP-PCR.
typing and detection of resistance
9.3. Typing of isolates , causing different outbreaks has been made. 9.4. Author’s Congress / team from the NRC-NI has participated in the scientific events: The Bulgarian Association of Microbiologists Plovdiv,2008 , The European Congress ECCMID / Barcelona, 2008, The European Congress of Micobacteriology/Report for ensures safety of patients and staff at health-care facility on TB/
9.5. NCIPD, in particulary and NRC-NI, was a host of the exclusive European Forum: TAIEX event: INT MARKT 30085: Seminar on communicable diseases prevention and control : 29/09/2008 - 02/10/2008, organized by Directorate General Enlargement European Commission.
The colleagues from the NRC-NI actively participated in the workshop organisation , with presentations for the laboratory work of 25 foreign participants workshops on also . NRC-NI was a host : lectures and practical work of 2 methods for molecular typing.
The key issues AMR 2009-2011. over next years are the practical implementation of Medical HAI Standard and Programme for HAI Prevention and Control and restriction of spread of The General Objective is to harmonise the practical standards standards.
for infection prevention and control in Bulgaria with European
The long term effect of National HAI Programme will rates of hospital acquired infections, restriction of spread of AMR overall quality improvement of the services provided comprise decreased establishments in Bulgaria.
, and an in the health care
The priorities will be as follows :
A. Practical implementation in the health-care establishments measure for improving patient, personnel and visitors safety by means of high quality health care , including containment of HAI and AMR
B. Development of the Bulgarian Post Graduate Education of training/retraining courses in the field of infections prevention and control. These training programmes shall target all infection control practitioners (ICP), such as epidemiologists, clinical microbiologists, nurses, and clinicians concerned as well as the specialists in the field of central sterilisation/Central Sterile Supply Department.
C. An increased effectiveness Bulgarian system for prevention and control of nosocomial infections. based on improved capacity, broader competences, and clear division of roles and responsibilities parties who plan, implement and account for the annual infection control plan in the hospital).
of the This should be within the system (e.g. the
D.To create awareness of the real scale
of the problem with HAI throughout the medical community. Improved recognition rates for HAI surveillance system methods and via establishing and strengthening active extent application of molecular biology
E. An enhanced surveillance and control of the spread of antimicrobial resistance.
This should support the formulation of an adequate national antibiotic strategy, respectively of cost-effective local antibiotic policies .