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