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2016/LSIF/FOR/017

Using Healthcare Associated Infection Data for Action

Submitted by: Japan

Policy Forum on Strengthening Surveillance and Laboratory Capacity to Fight Healthcare Associated Infections and Antimicrobial

ResistanceHa Noi, Viet Nam

14-15 December 2016

APEC Policy Forum; Strengthening Surveillance and Laboratory

Capacity to Fight HAI and AMR

Using Healthcare Associated Infection Data for Action

December 15, 2016

Go TANAKA, MD, MPH, PhD Councilor, Coordination Office of Measures on

Emerging Infectious Diseases, Cabinet Secretariat, Government of Japan 1

Tokyo Meeting of Health Ministers on AMR in Asia, April 2016

2

We, the Ministers of Health and representatives from countries in the Asia-Pacific region, namely, Australia, Bangladesh, China, India, Indonesia, Malaysia, Myanmar, Philippines, Republic of Korea, Thailand and Viet Nam, have come together on the occasion,,,

Communiqué Strengthen capacities to conserve effectiveness of antimicrobials as a domestic, regional and global public good through: (1)Implementing domestic antimicrobial stewardship programmes that promote the appropriate and prudent use of antimicrobials in humans and animal health and agriculture;

(2) Using quality information generated from domestic AMR surveillance systems following standardized protocols to guide policies and clinical decision-making in human and veterinary medicine;

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Communiqué (3) Developing laboratory capacity to identify pathogens and their antimicrobial susceptibility in order to guide optimal use of antimicrobials in clinical practice; 4) Developing internationally agreed standards for collection of data and reporting on AMR in human health, animal health, and agriculture, and supporting domestic, regional and global laboratory networks to improve the quality of data gathered through AMR surveillance;

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0 5 10 15 20 25 30 35

JapanNetherlands

EstoniaLatvia

HungaryAustria

SwedenSlovenia

GermanyLithuaniaDenmark

NorwayCzech Republic

BulgariaFinlandPoland

SlovakiaUnited Kingdom

Spain (b)Croatia

Iceland (a)Malta

PortugalIreland

ItalyLuxembourg

Cyprus (a)France

BelgiumRomania (a)

Greece

Tetracyclines (J01A) Beta-lactams,penicillins(J01C) Other betalactam antibacterials (J01D)Sulfonamides and trimethoprim(J01E) Macrolides, Lincosamides and streptogramins(J01F) Quinolones (J01M)Other antibacterials(J01X) Sum(J01B, J01G,andJ01R)*

Antimicrobial drug usage for medical purposes (Comparison with EU countries) 2012

Source： Cited and graphed from ECDC AMR Surveillance report 2012 5

DDD（Defined Daily Dose） Average adult usage of antimicrobial drug/day/1000 persons

15.8

※rheum, acute bronchitis, acute sinusitis, acute pharyngitis (except for those identified as bacterial), and acute pharyngolaryngitis

In outpatient care in Japan

Antimicrobial drugs are administered to 60% of upper respiratory inflammation patients.

– Third generation Cephem: 46％, Macrolide: 27％, Quinolone: 16％

Intern Med 2009;48:1369-1375.

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AMR control Action Plan

Ministerial Conference for internationally threatening infection control; April, 2016 Key Performance Indicator;

Cephem, Macrolide and Quinolone OPD use ~50% decrease

2016-20

Field Goal

１ Public awareness/education Promote knowledge and understanding for drug-resistance and further education and training for specialists.

２ Surveillance/monitoring

Monitor drug-resistance and the usage of antimicrobial agents on a continuing basis to understand adequately prior warning for changes or expansion of drug-resistance.

３ Infection prevention/control Prevent expansion of drug-resistant microorganism by properly executing infection prevention/control.

４ Proper use of antimicrobial agents

Promote proper use of antimicrobial agents in the field of medicine and farming/fishery industries.

５ Research & development/drug development

Promote research on drug-resistance as well as R&D to ensure prevention/diagnosis/treatment measure for drug-resistant microorganism.

６ International cooperation Work in cooperation on a multidisciplinary level from international perspectives to promote drug-resistance control. 8

Japan Nosocomial Infections Surveillance National Institute of Infectious Diseases

Government led nationwide surveillance

Surveillance of AMR and HAI since 2000

Participation on voluntary basis; Independent from the mandatory surveillance conducted by infection control law Feedback to member hospitals and also to the public

Future Perspective

Inclusion of hospitals with < 200beds

Data stratification

Trends for introduction of genomic method

Division Measurement

Clinical Laboratory (CL)

Prevalence of major antimicrobial-resistant bacterial

(isolates base)

AMR Bacterial Infections (ARBI)

Incidence of antimicrobial-resistant bacterial infections

(patients base)

Surgical Site Infections (SSI)

Incidence of surgical site infections

(patients base)

Intensive Care Unit (ICU)

Incidence of device-associated infections (CRBI, VAP, UTI) in ICU

(patients base)

Neonatal Intensive Care Unit (NICU)

Incidence of all infections in NICU (patients base)

The Five Divisions of JANIS

Participating hospitals Approximately 1,300 hospitals with >200 beds are participating

Total

AMR Bacterial Infection

SSI ICU

NICU

Clinical Laboratory

New participants are recruited every year.

Reimbursement of infection control fee

JANIS format data

Convert all electrical data to JANIS format

National Institute of Infectious Diseases

Compile data from all hospitals Analyze and publish information periodically

Clinical laboratory in participating hospitals

Data collection

Numbers of isolates cultured at participating hospitals

Samples No of samples No of culture-positive samples

No of cultured isolates

Respiratory tract 1,293,727 841,064 1,784,976

Urine 504,552 265,950 409,324

Stool 357,340 185,070 372,037

Blood 1,166,599 153,348 173,355

Spinal fluid 54,308 3,155 3,638

Others 854,260 404,288 709,226

Total 4,230,786 1,852,875 3,452,556

Open report 2012, JANIS

MRSA isolation Rate; 51% of all

S. aureus detected (118,539 / 231,909)

Open Report 2013, Clinical laboratory, JANIS

Handling during an outbreak (Assuming multi-drug resistant microbe)

Infection Control Committee

Infection Control Team

Support Consultation with local specialists

Inter-institutional network

If an outbreak of nosocomial infection is suspected (If there are 3 or more total cases within 4 weeks of the initial case of multi-drug resistant microbe)

Report Instruction/advice

Public Health Center

New cases of infection are found

Request support from specialists in medical institutions participating in the local network to prevent the spread of infection

If many cases of infection due to a single causative microbe in the same medical institution occur (approximately 10 patients or more)

Division Clinical Laboratory

Antimicrobial- Resistant

Bacterial Infections

Surgical Site

Infections

Intensive Care Unit

Neonatal Intensive Care Unit

Frequency of reporting monthly monthly half year half year annually

JANIS Open Report

(for public)

Monthly ＿ ＿ ＿ ＿ ＿

Quarterly/ Half year

○ （ Quarterly）

○ （ Quarterly）

○ （ Half year）

○ （ Half year）

＿

Annual ○ ○ ○ ○ ○

JANIS Feedback

Report (for

member hospitals)

Monthly ○ ○ ＿ ＿ ＿

Quarterly/ Half year

○ （ Quarterly） ＿

○ （ Half year）

○ （ Half year）

＿

Annual ○ ○ ○ ○ ○

Data submission and feedback

Merit for each participating hospital Confidential feedback report Provision of summary of each hospital data Provision of benchmark data by comparison with other hospitals. Help map out strategies for infection control

Feedback information for JANIS member hospitals

Inter-hospital comparison

From when?

In which ward?

Available within 48 hr after data submission

Domestic data Hospital K

An example of an antibiogram of a hospital where an A. baumannii outbreak was reported

JANIS Server (For Japanese hospitals)

JANIS Server (For foreign countries)

Convert data to JANIS format

Automated Analyzer

Hospitals (Japan)

Overseas hospitals

Disk diffusion

WHONET

Data submission

Automated Analyzer

JANIS: Development of global database for antimicrobial resistance

Data submission

Call for participating hospitals from APEC economies

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Viet Nam Indonesia Cambodia

,,,,, Contact;

go.tanaka@cas.go.jp

Indian Embassy at Tokyo（April, 2016） MoU btw NIID and Indian Council of Medical Research

Way forward of JANIS