Presenter date
Supporting healthcare professionals in the fight against resistance

• Expand the standardized antimicrobial web based PPS at a global scale to collect consistent, valid and comparable antimicrobial prescribing data.
• Monitor rates of antimicrobial prescribing in hospitalized adults, children and neonates.
• Determine the variation in drug, dose and indications of antimicrobial prescribing across continents.
• Identify targets to improve quality of antimicrobial prescribing.
• Help designing hospital interventions to promote prudent antimicrobial use.
• Assess effectiveness of interventions through repeated PPS.
• Increase public health capacity.
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 What is the quantity and quality of antimicrobial prescribing?
 Geographical distribution and ranges
 Broad versus narrow spectrum antibiotic use
 Adults – children - neonates
 Dose
 ……
 What are determinants of inappropriate antimicrobial prescribing ?
 Patient related : age, diagnosis, indication
 Institutional : hospital type, ward type, national/local policy, existing guidelines, ….
 Geographical factors: region, country, cultural, availability of drugs on market, prescriber related (training), custum, ….
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• Creation of multidisciplinary team
• Allocation of local Global-PPS administrator
• Ethical approval
• Guarantee of data privacy
– Hospital names will never be revealed in any report or publication
– Complete anonymous patient data-entry
• Data are property of the respective hospital
• Publication policy available on request
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• All wards (units/departments) of the hospital will be included “once” during February-April 2015 .
• Data collection is done on a working day and never during a day of the weekend or bank holiday.
• Surgical departments are not to be surveyed on a
Monday (or after a not-working day or bank holiday) to allow retrospective data collection on surgical prophylaxis.
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Adult departments Paediatric departments
AMW (Adult Medical Ward) PMW (Paediatric Medical Ward)
HO-AMW (Haematology-Oncology AMW) HO-PMW (Haematology-Oncology PMW)
T-AMW (Transplant (BMT/solid) AMW) T-PMW (Transplant (BMT/Solid) PMW)
P-AMW (Pneumology AMW)
ASW (Adult Surgical Ward)
AICU ([Adult] Intensive Care Unit)
PSW (Paediatric Surgical Ward)
PICU (Paediatric Intensive Care Unit)
Neonatal departments
NMW (Neonatal Medical Ward)
NICU (Neonatal Intensive Care Unit)
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1.
Data collection on paper forms :
 Department (Ward) form (denominator data)
 Patient form (numerator data)
2.
Web-based data-entry, verification, validation and reporting with the help of the Global-PPS programme.
URL: http://app.globalpps.uantwerpen.be/globalpps_webpps/
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1.
Data collection on paper forms :
 Department (Ward) form (denominator data)
 Patient form (numerator data)
2.
Web-based data-entry, verification, validation and reporting with the help of the Global-PPS programme.
URL: http://app.globalpps.uantwerpen.be/globalpps_webpps/
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Description of ward :
* Total of patients presents on the ward before 8 am and
* Total beds on the ward at 8 am on the day of the survey.
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Patients
Include all in-patients receiving an “active/ongoing” antimicrobial prescription at 8 am on the day of survey
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Definition of an antimicrobial agent – Which one and when to include ?
 Prescribed at 8 am the day of the survey
 Include active and ongoing antimicrobials : include an ongoing antimicrobial prescribed e.g. 3 times/week but not on the day of the survey
Antimicrobials under surveillance
(according to WHO ATC classification)
• Antibacterials for systemic use: J01
• Antimycotics and antifungals for systemic use: J02 and D01BA
• Antibiotics and other drugs used for treatment of tuberculosis: J04A
• Antibiotics used as intestinal anti-infectives: A07AA
• Antiprotozoals used as antibacterial agents, nitroimidazole derivatives: P01AB
• Antivirals used for influenza - Neuraminidase inhibitors: J05AH
• Antimalarials: P01B
• Antimicrobial for topical use are excluded !
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• Day hopsitalizations and amulatory care patients
• Patients admitted on the ward after 8 am on the day of the survey
 Those patients are NOT counted in the numerator neither in the denominator!
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At the level of the patient : age, gender and weight
At the level of the antimicrobial prescription:
 Antimicrobial agent/s (substance level - generic name)
 Dose per administration - N doses/day - route of administration
 Reasons for treatment (anatomical site of infection): what the clinician tends to treat
 Indication for therapy (Community Acquired or Health care
Associated Infection; Medical or Surgical Prophylaxis)
 Reason of therapeutic or prophylactic prescription written in notes?
 Stop of review date prescription written in notes?
 Prescription compliant with local guidelines?
 “Empiric” versus “Targeted” treatment
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At the level of the antimicrobial prescription, next:
 Treatment based on biomarker; and which one (CRP, PCT or other lab-based biomarker)
 Microbiology data (if targeted treatment and one of the following):
 MRSA
 Methicillin-resistant coagulase-negative staphylococci
 VRE
 ESBL-producing Enterobacteriaceae
 3 rd generation cephalosporin resistant Enterobacteriaceae non-
ESBL producing or ESBL status unknown
 Carbapenem-resistant Enterobacteriaceae
 ESBL-producing nonfermenter Gram-negative bacilli
 Carbapenem-resistant non fermenter Gram-negative bacilli
 MDR organisms
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GLOBAL-PPS PATIENT Form (Please fill in one form per patient on antimicrobial treatment/prophylaxis)
Ward Name/code
Hemato-D4
Activity
(M, S,
IC)
M
Patient Identifier
456def
Survey Number
Years
(if ≥ 2 years)
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Patient Age v
Months
(1-23 month)
Days
(if <1 month)
Weight
In kg,
2 decimals
51,50
Gender
M or F
M
1. Meropenem 2.Co-trimoxazole 3. Teicoplanin 4. Amikacin 5.
Antimicrobial Name V
Single Unit Dose vi Unit (g, mg, or IU) vi
770 mg 480 mg 400 mg 500 mg
Doses/ day vii Route (P, O, R, I) ix
Diagnosis x (see appendix II)
Type of indication xi (see appendix III)
Reason in Notes (Yes or No) xii
Guideline Compliance (Y, N, NA, NI) xiii
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SEPSIS
HAI2
NO
N
P 1
MP
MP
NO
Y
O 1
SEPSIS
HAI2
NO
N
P 1
SEPSIS
HAI2
NO
Y
P
Is a stop/review date documented?
(Yes/No)
NO NO NO YES
Treatment ( E: Empirical; T: Targeted)
T E T T
Treatment based on biomarker data
(Yes or No) xiv
If yes, on which biomarker xv
(fill in: CRP, PCT or other)
/
NO
/
NO
/
NO
/
NO
The next section is to be filled in only if the treatment choice is based on microbiology data (targeted treatment) AND the organism is one of the following:
YES MRSA (Yes or No) xvi
MRCoNS (Yes or No) xvii
VRE (Yes or No) xviii
ESBL-producing Enterobacteriaceae
(Yes or No) xix
3rd generation cephalosporin resistant
Enterobacteriaceae non-ESBL producing or ESBL status unknown (Yes or No)
Carbapenem-resistant Enterobacteriaceae (Yes or
No) xx
ESBL-producing non fermenter Gram-negative bacilli (Yes or No) xxi
Carbapenem-resistant non fermenter Gramnegative bacilli (Yes or No) xxii
Targeted treatment against other MDR organisms
(Yes or No) xxiii
YES YES
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Following anatomical site of infection
 Therapeutic
 Prophylactic
• Surgical
• Medical
 Neonates
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APPENDIX III - Type of Indication
CAI Community acquired infection
Symptoms started <48 hours from admission to hospital (or present on admission).
HAI Healthcare-
Associated Infection
HAI1 Post-operative surgical site infection (within: 30 days of surgery OR; 1 year after implant surgery)
 Symptoms start
48 hours after admission to hospital
HAI2 Intervention related infections including CR-BSI, VAP and C-UTI
HAI3 C. difficile associated diarrhoea (CDAD) (>48 h postadmission or <30 days after discharge from previous admission episode.
HAI4 Other hospital acquired (includes HAP, etc)
HAI5 Infection present on admission from another hospital
HAI6 Infection present on admission from long-term care facility (LTCF) or Nursing Home*.
SP Surgical prophylaxis
SP1 Single dose SP2 one day SP3 >1 day
For surgical patients , administration of prophylactic antimicrobials should be checked in the previous 24 hours in order to encode the duration of prophylaxis as either one dose, one day (= multiple doses given within 24 hours) or >1 day.
MP Medical prophylaxis
For example long term use to prevent UTI’s or use of antifungals in patients undergoing chemotherapy or penicillin in asplenic patients etc .
OTH Other For example erythromycin as a motility agent (motilin agonist).
UNK Completely unknown indication
Select 1 possibility for each reported antimicrobial
 Community acquired
 Nosocomial
 Prophylaxis
• Surgical
• Medical
 Other
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1.
Data collection on paper forms :
 Department (Ward) form (denominator data)
 Patient form (numerator data)
2.
Web-based data-entry, verification, validation and reporting with the help of the Global-PPS programme.
URL: http://app.globalpps.uantwerpen.be/globalpps_webpps/
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Register each institution
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Each department need to have a unique name !
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1.
Extraction of own data containing raw data allowing verification and analysis of own hospital results (excel).
2.
Generation of simple, easy to use feedback on own hospital data ready to use for local presentations.
 Descriptive statistics comparing your hospital with average national (if N≥3 institutions) and continental results.
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Ward type
All wards AMW HO-AMW T-AMW P-AMW ASW AICU
N patients
N treated patients
% treated patients
N patients
% treated patients
N patients
% treated patients
N patients
% treated patients
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Antimicrobial prevalence rates by activity
Centre Country Europe EU – type of centre
Adults (>=18 year)
Medical
Surgical
AICU
Children (=<17 year)
Medical
Surgical
AICU
Neonates
GNMW
NICU
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Hospital
Country level
Same graph for all hospitals together at country level
Continental level
Same graph for all participating hospitals at continental level
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 Uniformity of data collection - Use of similar study designs, standardized protocol and data collection templates
 Implementation of common methodology to collect valid and comparable antimicrobial consumption data
 SIMPLE protocol and web-based tool for data entry and validation = feasible & achievable surveillance
 Quality assurance approach – implementation of data validation process
 Central support towards data collection or other
(helpdesk, FAQ, IT-manual)
 Continuous work on data accuracy
 Opportunity to stimulate local networking
 Mutual cooperation/feedback is highly motivating
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• Instant web-report per hospital with quantifiable outcome measures and targets for quality improvement of antibiotic treatment and prophylaxis
• Enables in-depth interpretation of antimicrobial consumption data at different levels (geographical, institutional and patient characteristics)
• Creation of reference database for scientific research and hypothesis formulation at national and international level (data are safeguarded at the University of Antwerp,
Belgium, Europe).
• Data-sharing upon agreement with all partners
 publication policy is available at global-PPS@uantwerpen.be
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• Tool for assessing interventions to improve antibiotic prescribing in hospitals when PPS repeated
• Consistency and reproducibility
• Continually improve healthcare quality
• Combat antibiotic resistance
• Improve antibiotic use for better patient health
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• 1-day PPS = cross-sectional snapshot of prescribing practice
 Seasonal variation
• No risk factors in denominator data except for institutional factors (hospital and ward type, geographical localization)
• Lack of standardized clinical information
 diagnosis refers to what the clinician tends to treat (for example pneumonia)
• Self-training on protocol and web-based data entry, however helpdesk !
• No information on therapeutic antimicrobial course duration

• Pilot-PPS: October 2014
• Global-PPS: February-September 2015
Discussion of first results and future plans at the
5th HAI Forum: June 2015
- Global dissemination at the (European) Antibiotic
Awareness Day/Week: 18 November 2015
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Sponsor
bioMérieux is the sole sponsor of the GLOBAL Point Prevalence Survey.
The funder has no role in study design, data collection, data analysis, data interpretation, or writing the report. Data are strictly confidential and stored anonymous at the coordinating centre of the University of Antwerp.”
Lead Investigators
Herman Goossens (University Hospital of Antwerp, Belgium)
Dilip Nathwani (Ninewells Hospital and Medical School, Dundee,
Scotland)
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Contact
Ann Versporten at global-PPS@uantwerpen.be
URL http://app.globalpps.uantwerpen.be/globalpps_webpps/
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