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GUIDE FONT SIZES GENERAL SLIDE TITLE: 28pt (Optional SLIDE SUB-TITLE: 26pt) 1ST LEVEL BULLET: 22pt SUB-BULLETS: 20pt BODY COPY/TEXT BOX: 18pt PRESENTATION SLIDE TITLE: 28pt PRESENTATION SLIDE SUB-TITLE: 22pt PRESENTATION SLIDE NAME: 18pt PAGE NUMBER, DATE, FOOTER: 8pt ALL FONT TYPEFACE TO BE IN VERDANA

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HCAI – International Experiences 26/09/14

Jon Otter, PhD FRCPath

Scientific Director, Healthcare, Bioquell

Research Fellow, King’s College London

www.micro-blog.info

@jonotter

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MRSA bacteraemia, England 2001-2013

0

500

1.000

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Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1

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1. Mandatory reporting, 2001

2. ‘Gettting ahead of the curve’, 2002

3. ‘Winning ways’, 2003

4. ‘Towards cleaner hospitals’, 2004

5. ‘Cleanyourhands’, 2004

6. Targets introduced, 2004

7. Cleanliness improvement, 2005

8. ‘Going further faster’, 2006

9. Root cause analysis, 2006

10.Revised national guidelines, 2006

11.Deep clean, 2007

12.Screening elective admissions, 2008

13.Universal screening, 2010

1 2 3

4 5 6

7

8 9

10

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13

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CDI cases, 2004-2013 C. difficile infection (CDI), England 2004-2013

1. Mandatory reporting, 2004

2. Targets, 2007

3. Revised guidelines, 2009

1

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maio

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Ecoli MSSA

E. coli and MSSA bacteraemia, England

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MRSA invasive infections, Europe

EARS-Net

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MRSA invasive isolates, UK v Portugal

EARS-Net

0,0%

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1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012

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MDR K. pneumoniae invasive isolates

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3rd gen cepalosporin resistance, E. coli

0,0%

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EARS-Net

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Invasive CRKP isolates (EARS-Net)

2009 2010

2011 2012

2009 2010

2011 2012

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ECDC Point Prevalence Survey, 2013.

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ECDC EARS-Net

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Greece

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m Emergence of CRE in the UK

PHE AMRHAI, 24/01/14 Courtosy of Dr Neil Woodford

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CRE in the UK and US

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Antibiotic consumption

Van Boeckel et al. Lancet Infect Dis 2014;14:742-750

Consumption (standard units) per person, 2010

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Antibiotic consumption

Van Boeckel et al. Lancet Infect Dis 2014;14:742-750

Compound annual growth rate, 2000-2010

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Antibiotic use, Europe

ECDC Point Prevalence Survey, 2013.

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Carbapenem use, Europe

ECDC Point Prevalence Survey, 2013.

Single rooms

ECDC Point Prevalence Survey, 2013.

Infection control nurse staffing

ECDC Point Prevalence Survey, 2013.

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Messerli FH. N Engl J Med 2012;367:1562-1564.

Correlation between national chocolate consumption and rate of Nobel Prize Laureates!

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Meyer et al. Infection 2012 in press.

Correlation between the proportion of S. aureus bloodstream infections due to MRSA and an indicator for fair play from the European Football Championships (red or yellow cards / 100 min)

Key points for discussion

• What explains the UK success in reducing MRSA and CDI, but failure in reducing MSSA and E. coli?

• What is the relative importance of national strategy vs. local practices?

• How to we address the challenges posed by resistant Gram-negatives?

• How do we explain the differences in epidemiology of key HCAI pathogens between Portugal and the UK?