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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,,,

  • Communiqu 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;

    3

  • Communiqu (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;

    4

  • 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

    DDDDefined 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.

  • 7

    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

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

    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.

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

    Proper use of antimicrobial agents

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

    Research & development/drug development

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

    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

    http://www.google.co.jp/url?sa=i&rct=j&q=&esrc=s&frm=1&source=images&cd=&cad=rja&uact=8&docid=LzHB7RqX_CIJaM&tbnid=7W1mT8WQUYUeNM:&ved=0CAUQjRw&url=http://www.hitachi.co.jp/products/infrastructure/product_site/urban/bivale/service/energy_saving/package/function.html&ei=geGfU6mRFoS2kgXN14HoDA&psig=AFQjCNGBBj1U0jwJj9hwrm9nx42qmPbLWw&ust=1403073263203338

  • 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

    Cal

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