IMPORTANT DEVELOPMENTS for implementation of healthcare-associated infections and AMR prevention and control measures-Republic Bulgaria-2008. Assoc. Prof. R.VatchevaDobrevska,MD,PhD National Reference Centre for Nosocomial Infections, NCIPD, Sofia Ministry of Health, Republic Bulgaria.
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IMPORTANT DEVELOPMENTSfor implementation of healthcare-associated infections and AMR prevention and control measures-Republic Bulgaria-2008
Assoc. Prof. R.VatchevaDobrevska,MD,PhD
National Reference Centre for Nosocomial Infections, NCIPD, Sofia
Ministry of Health, Republic Bulgaria
Republic Bulgariasupports the development of measures aiming to limit the spread of HAI and AMR considers that the objectives will be achieve real results through recovering the necessary aspects of the problem areas of health and offer options within the framework of cooperation between Member States.
First of all it should be noted that one of the most important decisionsof the Bulgarian Ministry of Health, concerning coordination of the HAI control is the creation of National Reference Center for Nosocomial Infections.
The National Reference
a specialized unit at the
National Center of Infectious
and Parasitic Diseases (NCIPD),Director Academician Dr Bogdan Petrunov, DSc
hasbeensetupwiththesupportof BulgarianMinistry of Health, Swiss Confederation’s Government - Swiss Red Cross viaBulgarian-SwissHospital HygieneProgramme and indicated as a competent local authorized structures for HAI.
1. A proposal of “NATIONAL PROGRAMME for
PREVENTION AND CONTROL OF HAI and
RESTRICTION of SPREAD of AMR 2009-2011”
The Programme was presented at the Ministry of health for financial support of the activities
control of HAI and AMR “ and
Commission to the European Parliament and
the Council on Patient safety, including the
prevention and control of HAI” (Brussels,
15.12.2008, COM, 836, final) .
2. In order toharmonize the existing legislation with EU standards and make it relevant to the current level of medical science and good practice the MEDICAL STANDART on HAIwas developed.
3. An EXPERT COUNCIL for infection control to Health Minister has been created – to thehigher decisions making level in the health care system.
and presented to a wide range ofprofessionals:
clinical microbiologists, hospital epidemiologists ,
Regional Inspectorate,infection and infection
control specialists, nurses, and others, within the
range of a Congress of the BulgarianAssociation
of Microbiologists (BAM) in 2008.
The ESCMID President,
Professor Giuseppe Cornaglia
was a special guest, during the
“IPSE Working Party TwoConsensus on EU Hospital Infection Control and Antimicrobial Resistance Standards and Performance Indicators” Prof. Barry Cookson,
Ana Paula Coutinho
6. NATIONAL MEETING on HAI with a FOCUS on MRSA (methicillin-resistantStaphylococcus aureus)was organized by NCIPD-NRC-NI- 19.06.2008 in Sofia.
clinical microbiologists, epidemiologists,
infection andclinicalspecialists, managers
of HCF and others were participated
in the meeting.
6.1. A Survey of HCF for hospital care was conducted by NRC-NI with the support of the Ministry of Health,to assess the approaches andprograms for limiting the spread of MRSA and preventing infections caused by them.
6.2. The processing and analysis of data, imminent conclusions and report presentation has been made.
6.3. A project of Guidelines for control and prevention of MRSA in HCF in the country is coming to be developed by NRC-NI.
6.4. The topics of the Bulgarian and foreign experts’ presentations covered various aspects, including the approaches for patients and staffsafety,corresponding to the World Alliance for Patient Safety established by the WHO in 2004.
6.5.Dr Bart Gordts,Brugge, Belgium-The President of the Belgian national platform for infection control was a special guest speaker during the meeting.
The guest sharedexperience of his country with Dr. T. Tenev, Chief of Medical Officers, MHat the time of round table in the Ministry of health. They also discussed the possibility of future consultations and collaboration in
the process of development of
the Bulgarian system.
7.1. The data from the HAI surveillance for 2007wascollected by NRC-NI, imported and processed by electronic means. Their analysis and report are imminent.
7.2. The data from the National prevalent survey of HAI is being analysed and their publication is coming.
7.3. A Prevalence survey of HAI in regional hospitals in Sofiaregionwas conducted in 2008 by staff of the NRC-NI-and Regional Inspectorate- Sofia.
7.4. A study of some hospital outbreaks was completed. Molecular-typing of isolates caused infections was conducted, too. The report was presented in May 2008during the National meeting of Ministry of Health with participation of epidemiologists and Regional inspectorates Chiefs. Representatives from the ECDC, Stockholm and WHO took part in the Meeting.
8.3. It was finished an examination ofState graduation of50 nurses as “Infection Control Nurse” (ICN).
8.4. The training of the clinical staff responsible for HAI of medical and nurses level (link staff) is institutionalized and introduced on the system of CME;
8.5. Two training courses ”Contemporary aspects of the control and prevention of HAI” were been provided in NRC-NI :one for doctors, one for nurses from different HCF of the country.
8.6. A training courseabout diagnostic methods, risks and staff and patients safety in the field of organ transplantation has been provided in the “National Agency of transplantation”
9.1. In the NRC-NI standard protocols for epidemiological typing of certain indicator bacterial species with increasing epidemic meaning, by methods of molecular biology are developed. Protocols for typing of Pseudomonas aeruginosa, Serratia marcescens, Enterobacter spp., ESBL-Enterobacteriaceae, Acinetobacter baumaniietc. have been developed.
9.2.The following methods have been implemented for typing and detection of resistance genes in nosocomial pathogens: PFGE, MLVA, ERIC, REP-PCR.
9.3. Typing of isolates , causing different outbreaks has been made.
9.4. Author’s team from the NRC-NI has participated in the scientific events:The Bulgarian Association of Microbiologists Congress/Plovdiv,2008, The European Congress ECCMID / Barcelona, 2008,The European Congress of Micobacteriology/Report for ensures safety of patients and staff at health-care facility on TB/
9.5. NCIPD, in particulary and NRC-NI, was a host of the exclusive European Forum: TAIEX event: INT MARKT 30085:
Seminar on communicable diseases prevention
and control: 29/09/2008 - 02/10/2008,
organized by Directorate-
The colleagues from the NRC-NI actively participated in the workshop organisation, withpresentations also . NRC-NI was a host for the laboratory work of 25 foreign participants: lectures and practical work of workshops on 2 methods for molecular typing.
The key issues over next years are the practical implementation of Medical HAI Standard and Programme for HAI Prevention and Control and restriction of spread of AMR 2009-2011.
The General Objective is to harmonise the practical standards for infection prevention and control in Bulgaria with European standards.
The long term effect of National HAI Programme will comprise decreased rates of hospital acquired infections, restriction of spread of AMR , and an overall quality improvement of the services provided in the health care establishments in Bulgaria.
The priorities will be as follows:
A. Practical implementation in the health-care establishments measure for improving patient, personnel and visitors safety by means of high quality health care, including containment of HAI and AMR
B. Development of the Bulgarian Post-Graduate Education of training/retraining courses in the field of infections prevention and control. These training programmes shall target all infection control practitioners (ICP), such as epidemiologists, clinical microbiologists, nurses, and clinicians concerned as well as the specialists in the field of central sterilisation/Central Sterile Supply Department.
C. An increased effectiveness of the Bulgarian system for prevention and control of nosocomial infections. This should be based on improved capacity, broader competences, and clear division of roles and responsibilities within the system (e.g. the parties who plan, implement and account for the annual infection control plan in the hospital).
D.To create awareness of the real scale of the problem with HAI throughout the medical community. Improved recognition rates for HAI via establishing and strengthening active surveillance system and extent application of molecular biology methods
E. An enhanced surveillance and control of the spread of antimicrobial resistance.
This should support the formulation of an adequate national antibiotic strategy, respectively of cost-effective local antibiotic policies.
F. Enhance of awareness of institutions and society for the burden and consequences of HAI through appropriate informational campaigns.