National Mandate
To decrease antibiotic prescriptions in
respiratory tract infections by 25%
1997- Canadian Committee Antibiotic Resistance (CCAR)
3 Key Messages
Handwashing
- most important way to prevent infection
Not all bugs are created equal
- bacteria and viruses are different
Antibiotic resistance is a problem
- use antibiotics wisely
Pilot Project
Grande
Prairie
value of educating
pharmacists
12%
↓ antibiotic prescriptions
value of educating
children
↓ antibiotics / capita
↑use of first line antibiotics
A Community Project for Wise Use of Antibiotics
Capital Health
Population 1,000,000
Alberta
Medical
Association
University
of
Alberta
Partners
Capital
Health
Alberta
Lung
Association
Physicians
Public
Health
Health Care
Professionals
Pharmacists
Dentists
Nursing
Infection Control
Media
Campaign
Website
Grade 2 Student
Program
Public Education
Strategies
Print
Materials
Daycare Centre
Program
9 PRINT RESOURCES
Parent
Guide
Pamphlet
Handwashing signs
Stickers
Activity placemat
Project poster
Punjabi
French
Spanish
Persian
Translations
Chinese
simplified
Vietnamese
Arabic
Chinese
traditional
Distribution of Print Materials – Healthcare Professionals
Dentists
Physicians
Infection
Control
Pharmacists
Healthcare
Professionals
Occupational
Health
Public Health
Continuing
Care
Distribution of Print Materials - Public
Churches
Public Transport
Restaurants
Daycare Centres
University of Alberta
Public
Senior Centres
Businesses
Recreation
Centres
Schools
Library
Website
www.dobugsneeddrugs.org
 All programs on-line
 Translations
 Kid’s section with games
 Tips of the week
 Links
 Over 2,000,000 hits per year
Website file use
Public
3.5%
Parents
5.1%
Daycare *
3.0%
Occupational
health
0.3%
Teachers
8.5%
Multilingual
10.5%
Healthcare
professionals
54.5%
Kids
14.5%
* Introduced March 2003
Children Programs
– Daycare Program
– Assisted Living Program
– Grade Two Program
Daycare Program
Target:
Daycare children
Staff
Parents
Disseminated by:
Pharmacists and public health nurses
Nursing students
Train the trainer program
→ Instruction for early childhood education students
DAYCARES
Pick - a bug
Bugaloo glove
puppet
“Prop Box”
Bug Toss
Game
Wash the bugs away
Invisible Germs
Assisted Living Program
Target:
Adults in assisted living
Staff
Relatives
Taught by:
Post secondary students
High school students
Note: New program for 2006
Assisted Living Program
Dark light, gel and powder
Large print
Crossword Puzzle
Word Search
Bug Bingo
Grade Two Program
Target:
Grade two children
Parents
Teachers
Taught by:
Post secondary students in healthcare fields
Public health nurses, pharmacists, physicians
Older children in the same school
Development of Grade 2 program
Grande Prairie 1998-1999
Pilot project
• Handwashing presentation to Grade 2 students
– No formal presentation of other key messages
– Presented by community and hospital pharmacists,
public health nurses
• Survey sent home for parents
– Prize for classroom returning the most surveys
• Print materials
– Project poster, stickers “Bugsy Says Wash Your Hands”
sign, tattoos
Awareness of Handwashing as a Preventative Measure
Comparison of General Public, Grade 2 Parents, and Age-Matched Cohort
(P<0.001)
100%
21.8
80%
60
60.5
60%
78.2
40%
20%
40
39.5
0%
Pre-Project Public Mid-Project
(n =979)
Grade
2 Parents
(n = 408)
Pre-Project Public < 45 yr
(n=618)
Yes
No
Development of Grade 2 Program
Capital Health
Print materials
–
–
–
–
–
–
Parent guide
Project poster
Program pamphlet
Activity Placemat
“Bugsy Says Wash Your Hands” sign
Stickers
• “Tell Germs to Bug Off ”
• Bugsy
Development of Grade 2 program
Capital Health
Grade 2 program
– Development of formal presentation for Grade 2
students – 1 hour
– Program packaged into easily transported kit
Grade 2 presentation
Activity 1 (20 minutes)
• Do Bugs Need Drugs? Interactive dialogue with
Bugsy hand puppet – (15 min)
• Resource book – 5 minutes
– “Germs Make Me Sick”
Berger,Melvin and Marilyn Hafner: Harper
Collins New York 1995
Grade 2 presentation
Activities 2/3 (20-25 minutes)
• “Bacteria and Viruses are Different”
– Four coloured overheads
• Handwashing demonstration
– fluorescent lotion and black light
» Glogerm Company http://www.glogerm.com
– “Twinkle Twinkle Little Star”
Grade 2 presentation
Activity 4 ( 3 minutes )
• Game with colouring sheets
Activity 5 (5 minutes)
• Skit
– Bugsy in doctor’s office
videotape available
Grade 2 presentation
Optional Activities (2 minutes)
• Poems / Songs
– Those Bugs Don’t Need Drugs
– Do Bugs Need Drugs?
– Wash, Wash, Wash Your Hands
GRADE TWO KIT
Book
Overheads
Bugsy puppet
Dark light and gel
When to Wash Hands
How to Wash Hands
Student Education Program
Students
•
Children enrolled in Grade 2
Teachers
•
Students in healthcare faculties
– Interdisciplinary Course – University of Alberta
– Grant MacEwan College Nursing Program
Student teaching
Inter D 410 course
• University students enrolled in health related fields
– enrollment 700-900/year
Training (3 hours)
• Classroom orientation by infectious diseases physician
• Small group orientation to Grade 2 teaching kits
Teaching
• Inter D staff schedules Grade 2 classes for teaching
– Teach Grade 2 classes as interdisciplinary team (3 hours)
• Program now running for 6 years
– 60 Grade 2 classes / year
Student teaching
Grant MacEwan College
• Partnership with nursing program
– enrollment 300 students
Training (2-3 hours)
• Classroom orientation by pharmacy expert
Faculty of Pharmacy –University of Alberta
• Small group orientation to Grade 2 teaching kits
Teaching
• teach grade two students as part of community placement in
public health clinics
– Scheduling in conjunction with Capital Health Public
Health Clinics
• Teach in groups of 3-4
– Teach 200 classrooms / year
Student Education Program
Endpoints:
1) Target parents through educational sessions for their
children at school
2) Innovative partnership with post secondary institutions to
train future healthcare professionals
Teachers
Evaluation of Program
7 question survey post program
– 119 teacher responses
• 50% responses:
5/5 for all questions
Overwhelmingly positive responses/comments
Post secondary students
(P <0.01)
100
90
80
70
60
50
40
30
20
10
0
expect
antibiotics for
cold/flu
colds due to
viruses
antibiotics not
helpful in flu
pre
survey
post
survey
use of
antibacterial
soap
The Effect of Hand Hygiene on Illness Rate
Among Students in University Residence Halls
AJIC 2003;31:364-70
College dorms randomized :
Alcohol hand rubs in various locations vs. no alcohol hand rub
Alcohol hand rub groups:
 14.8% -39.9% reduction in respiratory illness symptoms
 43% fewer sick days
Daycare Centre Program
Funded by grant from Health Innovation Fund –
Alberta Health ($220,000)
2001- 2003
– 101 daycares in Edmonton – 40.1%
– 65 daycares in Calgary (control) – 41.9%
Daycares
Handwashing as a way to prevent the spread of
infection.
% List Handwashing
95.0
*
*
90.0
85.0
Pre intervention
Post intervention
80.0
75.0
70.0
A
* p=<0.05
B
C
Study Group
CONTROL
Daycares
Are colds caused by bacteria or
viruses?
85.0
*
% Answer Viruses
80.0
*
75.0
Pre intervention
Post intervention
70.0
65.0
60.0
A
* p=<0.05
B
C
Study Groups
CONTROL
Daycares
If you had a cold, would an antibiotic
help you get better?
16.0
14.0
*
12.0
% Yes
10.0
*
8.0
Pre intervention
Post intervention
6.0
4.0
2.0
0.0
A
* p=<0.05
B
C
Study Group
CONTROL
Daycares
Use an antibacterial soap at home?
45.0
40.0
*
35.0
% Yes
30.0
*
25.0
Pre intervention
Post intervention
20.0
15.0
10.0
5.0
0.0
A
* p=<0.05
B
C
Study Groups
CONTROL
Parents
p < 0.01
– less likely to expect antibiotics for cold/flu
– reduced use of antimicrobial soap
Program expansion
2005 - British Columbia
Pharmacare division of government
– Grant $1,300,000 for 3 years
– Dissemination of Program
• Media campaign
• Physician / pharmacist education
– Distribution of Bugs and Drugs book
• Grade 2 program
– Coordinated by Public Health
• Daycare program
– Fall 2006
Program expansion
British Columbia
Grade 2 program
– 150 nursing students
– Vancouver Coastal
» other regions coming on board
– 118 schools
» 209 Grade 2 classes
» 4218 children
Program expansion
British Columbia
2006 - Michael Smith Foundation
$98,000 grant for evaluation of program
2007 – start of physician/pharmacist
education programs
??funding
Program expansion
2006 - Alberta
Alberta Health division of government
– Grant $1,000,000 for 2 years
– Further dissemination of program
• Train the trainer program – pharmacists
• Target of 50 pharmacist trainers by end of
2007
Program expansion
2006 - Alberta
• Canadian Council Continuing Education in
Pharmacy (CCCEP)
– 4 continuing education credits
• 176 pharmacists attended course
50 trainers
– achieved target in 4 months!
– commit to 9 hours of teaching in their
communities
compensated for their time
Program expansion
2006/2007 - Alberta pharmacists
• Teach to nursing students
→ Grade 2 program
• Early childhood education students
→ Daycare program
• Nurses in long term care
→ Assisted Living program
Effect of Handwashing on Child Health:
A Randomised Controlled Trial
Lancet 2005;366:225-233
Squatter settlements in Karachi, Pakistan
• 50% reduction in pneumonia
• 53% reduction in diarrhea
• 34% reduction in impetigo
No difference between plain soap and antibacterial soap
Deb
Wilson
Mary
Carson
Edith
Blondel-Hill
PARTNERS IN DEVELOPMENT
Marilyn
Tomney
Sharon
Mitchell
Susan
Fryters