Relevance of AMR in national agendas in some Nordic Countries Presentation from Finland

1. ANTIMICROBIAL RESISTANCE
AND
HEALTHCARE-ASSOCIATED
INFECTIONS IN FINLAND
Jari Jalava
Outi Lyytikäinen
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2. Antimicrobial resistance in Finland
 Antimicrobial resistance (AMR) situtation in Finland still rather
good.
– Certain multi-drug resistant (MDR) microbes are an increasing
threat such as MRSA, VRE, ESBL and CPE
 Continiously clusters and outbreaks in healthcare facilities
 Worsening of the resistance situation
 Total consumption of antimicrobials has constantly
decreased.
– Wide-spectrum antimicrobials are used more compared to other
Nordic countries and the Netherlands
– Regional differences in consumption
– Gaps and problems in usage of surveillance data in action
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3. Controlling AMR
 National action plan on AMR
– Ministry of Social Affairs and Health, 2017
– Tasks for National Institute for Health and
Welfare (THL)
 Developing surveillance and surveillance
indicators
– Antimicrobial resistance
– Antimicrobial consumption
– Healthcare-associated infections (HAI)
 Controlling spread and prevention of
infections
– Outbreak investigations
– Guidelines
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4. National expert group for AMR control
 Set up by THL (2018–2020)
 Tasks are to plan and follow up the implementation of the national plan as
well as to discuss current topics related to AMR which come up nationally
or internationnally.
 Members (One health -approach):
– Ministries: Social Affairs and Health (STM), Agriculture and Forestry
(MMM) and Environment (YM)
– THL, Finnish Medicines Agency, Agency of Reimbursement for Medicine
expences, Finnish Food Authority, Zoonotic Center
– Experts: clinical microbiology laboratories, universities, infectious disease
physicians, infection control nurses
– Representatives: healthcare centers (general practitioners), specialty
care, long-term care, university and central hospitals
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https://thl.fi/fi/web/infektiotaudit/yhteystiedot/asiantuntijatyoryhmat/mikrobilaa
ke-resistenssin-torjunnan-kansallinen-asiantuntijaryhma
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5. Surveillance of AMR
 Communicable Diseases Act
(1227/2016) requires
comprehensive surveillance of
AMR.
 Surveillance and developing
indicators are mainly THL’s
responsibility, mostly functioning.
 All clinical microbiology
laboratories including private
laboratories are participating in
surveillance
 Participation in EARS-net
conducted by ECDC
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6. Surveillance of antimicrobial consumption
 Surveillance has been conducted
in Finland since 1997 in
collaboration with Finnish
Medicines Agency (Fimea)
 So far based on sales data
 Problems in surveillance and
usage of surveillance data
 Separating consumption in
community vs. hospitals
 Age and gender (prescription
data)
 Indications (outpatient visits,
eletronic prescriptions)
 Participation in ESAC-net
conducted by ECDC
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7. Surveillance of healthcare-associated infections
 Finnish Hospital Infection Program (SIRO) collaborates with regional
authorities and experts and acute care hospitals and long-term care
facilities to increase awareness in HAIs and HAI prevention
– THL provides surveillance methods to identify HAI problems
– THL evaluates infection prevention and control activities in acute care
hospitals
– THL drews up guidelines to prevent most common HAIs
– THL support communication between different actors in outbreaks in order
to implement control measures timely
 Specialty care/acute care hospitals (Communicable Disease Act 13§)
– National surveillance of certain HAIs
– Annual surveys in infection prevention and control activities
 Specialty care/acute care hospitals and long-term care faciliteis
(Communicable Disease Act 13§)
– Prevalence surveys every 5 year in collaboration with ECDC/EU member
states
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8. Outbreak investigations
 THL supports outbreak investigations
– Provides typing data for bacteria in order to detect outbreaks and trace
back transmission routes
– Typing done only by THL, no competence or interest elsewhere
– Consultation in control measures
 News communication channel (HARVI): Aim is to support information
flow between different actors in order to implement appropriate control
measures timely and detect common threats.
 Severe case and susptected outbreak caused by extremely drug-
resistant microbes when consultation is needed (Communicable
Disease Act 36§).
 Notifyers: local or regional authority or expert (infectious disease
physician or infection control/public health nurse) or head of a long-
term care facility
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9. 7/2/2019 AMR and HAI, Finland 9

10. 7/2/2019
2 clusters 2013-2018: 20 cases, 16 found in
clinical specimens and four in screening
Cluster 1: 18 cases 5 HCFs, index case unknown
link abroad, 6/18 the same room different time ,
environmental specimens negative
HCF A: 3 cases 2013, 2016, 2017
HCF B: 1 case 2014
HCF C: 8 cases 2015-2017
HCF D: 4 cases 2016-2018
HCF E: 2 cases 2017, 2018
Cluster 2: 2 cases, index case transferred from
Italy, the same room different time (8 months),
contaminated toilet
HCF F: 2 cases 2015 and 2016
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11. Infection prevention guidelines
 Control of healthcare-
associated infections -text
book (publisher THL, 2018)
 National guidelines
– Control of multi-drug
resistant microbes
 Webinars
– Preventing and controlling
infections in long-term care
 Infection prevention
guidelines to hospitals
– Peripheral venous catheters
– Surgical site infections
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12. Communication
 Improve public awareness and knowledge in antibiotics and
antimicrobial resistance
 Support infection control activities conducted by local and
regional authorities and experts
 Annual meetings, webinars and awareness days
– WHO: Hand Hygiene Day in May
– Annually 2-day meeting with regional authorities and experts in
September: discussion on actual topics/problems
– ECDC: Euroepan Antibiotic Awareness Day in November
– Training related to surveillance such as European prevalence
surveys (ECDC-PPS and HALT)
– Training related to guidelines
– Infectious disease news
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