View
9
Download
0
Category
Preview:
Citation preview
Medische microbiologie in Suriname
Antibiotica resistentie bestrijden in Suriname
Dr. Ed IJzerman, arts-microbioloog
Academisch Ziekenhuis Paramaribo
Inhoud
• Wat weten we van Suriname?
• Organisatie Gezondheidszorg
• Medische Microbiologie algemeen
• MML AZP
• Nationaal Actieplan beheersing AMR
• Uitdagingen
Suriname
• 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 163.820 km2 (ter vergelijking: Nederland 42.508 km2)
• Aantal inwoners 585.000 (grootste deel in en rondom Paramaribo)
Gezondheidszorg
Gebaseerd op oude Nederlandse systeem
• Verrichtingenvergoeding
• Ligdagvergoeding
• Ziekenfonds
• Particuliere verzekeraars
Ziekenhuizen
• Academisch Ziekenhuis Paramaribo
• RK Sint Vincentius Ziekenhuis
• Diakonessen Ziekenhuis
• ‘s Lands Hospitaal
• Mungra Medisch Centrum Nickerie
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)
BOG: tegenhanger RIVM
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 arts-microbioloog van Suriname.
In verband met het bereiken van de pensioengerechtigde leeftijd werd gezocht naar opvolging.
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)
Academisch Ziekenhuis Paramaribo
• Overheidsinstelling
• Valt onder de verantwoordelijkheid van het Ministerie voor Volksgezondheid
Medisch Microbiologisch Laboratorium van het AZP: 24 FTE analisten 1 operational manager 1 arts-microbioloog 4 FTE centrale ontvangst voor KCL en MML
Activiteiten
• A3-jaarplan
• Opleidingsplan afgestemd op richtlijnen NVMM (goedgekeurd door SRC Suriname)
• Kwaliteitshandboek conform ISO 15189
• Start multidisciplinaire patiëntenbesprekingen (IC, NICU)
• Introductie WHONET
• Start Antimicrobial Stewardship
Antimicrobial Stewardship in Suriname
2017 Nationaal Antibioticum boekje
www.antibiotica.sr
2018 Nationale Antibiotica Commissie 2018 Nationale Infectiepreventie Commissie
• Dr. IJzerman door Minister benoemd als Focal point voor AMR in SUR
http://www.antibiotica.sr/
Website Landelijk Antibioticabeleid Suriname, www.antibiotica.sr
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
Audit PAHO/WHO (Pan American Health Organization)
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………..
National
Antimicrobial Resistance (AMR) action plan
Suriname
2018-2021
Waarom AMR plan: Groeiend probleem van antimicrobiële resistentie wereldwijd. Behandeling van bepaalde patiënten moeilijk, kostbaar en zelfs onmogelijk.
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 2016. http://www.un.org/en/ga/search/view_doc.asp?symbol=A/RES/71/3 WHO: Global action plan for antimicrobial resistance (World Health Assembly document A68/20, 27 March 2015). http://www.who.int/drugresistance/global_action_plan/en/ WHO: FAO/OIE/WHO Tripartite Collaboration on AMR. http://www.who.int/foodsafety/areas_work/antimicrobial-resistance/tripartite/en/
http://www.un.org/en/ga/search/view_doc.asp?symbol=A/RES/71/3http://www.un.org/en/ga/search/view_doc.asp?symbol=A/RES/71/3http://www.who.int/drugresistance/global_action_plan/en/http://www.who.int/foodsafety/areas_work/antimicrobial-resistance/tripartite/en/http://www.who.int/foodsafety/areas_work/antimicrobial-resistance/tripartite/en/http://www.who.int/foodsafety/areas_work/antimicrobial-resistance/tripartite/en/
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.
Augustus 2018: Opdracht PAHO Suriname: Bijstellen en afronden Actieplan en toevoegen activiteiten en budget
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
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
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
AMR Action Plan
AMR Monitoring and evaluation framework, WHO
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
1.1.1-Develop a national AMR
communication plan for 2018-2021
AMR Focal Points MOH
and LVV
1.1.2 Develop radio, tv and social
media programs/infomercials
regarding antimicrobial resistance
containment in humans using WHO
materials amongst others
AMR focal point MOH
1.1.3-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
1.2 Improve
professional
knowledge of AMR
and related topics
Include AMR and related topics
in professional education and
continuing education programs
1.2.1-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
1.2.2-Adapt/Develop training
modules for the various training
institutions
National infection
prevention and control
committee.
AMR focal points
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
2.1.1- Formalize national infection
prevention and control committee
with representation of various health
institutions
Leadership Ministry of
Health
2.1.2-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
MOH AMR focal point
National infection
prevention and control
committee
2.1.3-Committee organizes regular
meetings of hospital and health
institutions to discuss reporting of
health institutions acquired infections
and plans interventions
National infection
prevention and control
committee
2.1.4-Committee shares reports with
health authorities
National infection
prevention and control
committee
Improve electronic surveillance of
AMR isolates
2.1.5-Procure appropriate computer
software (LIS)
Clinical microbiologist
MOH AMR focal point
2.1.6-Train users in LIS at different
institutions
Clinical microbiologist
MOH AMR focal point
Produce annual national AMR report 2.1.7-Aggregate and analyze annual
AMR microbial isolates in humans
with the inclusion of specimen and
patients demographics
National infection
prevention and control
committee
2.2 Strengthen
national
laboratory
capacity
Strengthen national reference
laboratory capacity
2.2.1-Formalize and strengthen
collaboration between AZP
microbiological laboratory BOG
laboratory and LVV laboratory
Leadership MOH and
LVV
AMR focal point LVV
Clinical microbiologist
2.2.2-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
2.3.1-Establish Laboratory
information system for animal
husbandry which is compatible with
the LIS for humans
AMR focal point LVV
AMR focal point MOH
2.3.2-Design surveillance system for
main microbiological food hazards,
organize training workshops and
purchase necessary reagents
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
3.1.1-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
3.1.2-Develop plan of action
and guidelines for
strengthening health
institutional infection
prevention and control
MOH AMR focal
point
National infection
prevention and
control committee
3.1.3-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
3.2-Strengthen
safety regulations
regarding animal
husbandry
Strategic intervention Activities Coordination/Responsibi
lity
-Update food safety legislation
and regulations
3.2.1-Update regulations on meat
inspection and preparation of
regulations for farm registration
Leadership Ministry of
LVV
Focal point AMR LVV
3.2.2-Organize information sessions
with stakeholders regarding meat
regulations and farm regulations
-Implement food safety
assurance systems
3.2.3-Review and update national
Good Agricultural Practices
standards in animal husbandry,
agriculture and fisheries
Leadership Ministry of
LVV
Focal point AMR LVV
3.2.4-Organize training workshops
for stakeholders
-Implement registration and
inspection system
3.2.5-Develop inspection procedures
manuals
Leadership Ministry of
LVV
Focal point AMR LVV 3.2.6-Prepare and execute training and coaching for inspectors
3.2-Strengthen
safety regulations
regarding animal
husbandry
Strategic intervention Activities Coordination/Responsibi
lity
-Update food safety legislation
and regulations
3.2.1-Update regulations on meat
inspection and preparation of
regulations for farm registration
Leadership Ministry of
LVV
Focal point AMR LVV
3.2.2-Organize information sessions
with stakeholders regarding meat
regulations and farm regulations
-Implement food safety
assurance systems
3.2.3-Review and update national
Good Agricultural Practices
standards in animal husbandry,
agriculture and fisheries
Leadership Ministry of
LVV
Focal point AMR LVV
3.2.4-Organize training workshops
for stakeholders
-Implement registration and
inspection system
3.2.5-Develop inspection procedures
manuals
Leadership Ministry of
LVV
Focal point AMR LVV 3.2.6-Prepare and execute training and coaching for inspectors
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
4.1.1-Ensure the continuity of
the functioning of the
antibiotics working group
Leadership MOH
National Essential
Medicines
Formulary
Commission
4.1.2-Ensure the availability
of essential antimicrobials
4.1.3-Revise the online list
and guidelines of essential
antimicrobials
Antibiotics working
group
4.1.4-Define antimicrobial
medicine list for all hospitals
Antibiotics working
group
4.1.5-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
4.2.1-Organize workshop
involving stakeholders
including those in veterinary
medicine and animal
husbandry
MOH and LVV focal
points
5.1 Develop a cost-
effectiveness model for
investing in diagnostics
Strategic intervention Activities Coordination/Responsi
bility
-Strengthen investments in AMR
diagnostic capacity
5.1.1 –Assess the current capacity
in the microbiology laboratory
and propose a list of necessary
investments
Clinical microbiologist
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
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”.
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 )
Tot slot: Dank aan Sandra Hermelijn
27 jaar MML AZP opgebouwd
ANALISTEN MML INFECTIEPREVENTIE
Recommended