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IMPORTANT DEVELOPMENTS for implementation of healthcare-associated infections and AMR prevention and control measures-Republic Bulgaria-2008 PowerPoint PPT Presentation


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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 DEVELOPMENTS for implementation of healthcare-associated infections and AMR prevention and control measures-Republic Bulgaria-2008

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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


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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.


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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.


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The National Reference

Centerfor Nosocomial

Infections(NRCNI) ,

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.


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The main activities of NRCNI were in different fields as follow:

  • Implementation of adequate institutional and regulatory basis at all levels

    1. A proposal of “NATIONAL PROGRAMME for

    PREVENTION AND CONTROL OF HAI and

    RESTRICTION of SPREAD of AMR 2009-2011”

    was developed

    The Programme was presented at the Ministry of health for financial support of the activities


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The National HAI PROGRAMME is based on:

  • IPSE international documents“Recommendations for practical, standards and indicators for monitoring and

    control of HAI and AMR “ and

  • “Communication from the

    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) .


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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.


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Prevention and control policy

  • 4.The final IPSE document “Recommendations for practical, standards and indicators for monitoring and control of HAI and AMR “ was translated into Bulgarian language


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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

BAM congress.


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  • 5. An inquiry investigation was provided in Health-care Facilities (HCF)for hospital care in the country, by Survey Check ListWP2 of IPSE for assessment of the prevention and controlof HAI system. We have got data analysis and written report with feedback with HCF.

“IPSE Working Party TwoConsensus on EU Hospital Infection Control and Antimicrobial Resistance Standards and Performance Indicators” Prof. Barry Cookson,

Ana Paula Coutinho


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6. NATIONAL MEETING on HAI with a FOCUS on MRSA (methicillin-resistantStaphylococcus aureus)was organized by NCIPD-NRC-NI- 19.06.2008 in Sofia.

  • It wassupported by the Ministry of Health and it was under the patronage of Minister of Health Dr Eugeniy Gelev.

  • A wide range of specialists from the country-

    clinical microbiologists, epidemiologists,

    infection andclinicalspecialists, managers

    of HCF and others were participated

    in the meeting.


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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.


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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.


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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.


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Surveillance policy

  • 7. The surveillance activities of HAI аt local and national level aims to achieve knowledge of the real range of the problem with the HAI in the public healthcareby organizing specific measures for change.

  • According with the recommended practices in the final document of IPSE: a set of definitions approved by the EU are included in Medical standard of HAI. The rules for reportingwere coordinated.


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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.


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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.


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Education and Training

  • 8.1. A Nationaltraining program for infectioncontrol doctorshas been developed. Working group for discussions concerning the programme has been formed.

  • 8.2. Measures for institutionalization of the training of infection control doctors (ICD) in the system of CME for acquisition of highly specialized activities have been taken at the level of Ministry of Health.


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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;


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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”


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Scientific-applied and objective investigations

  • 9. In the IPSE document “Recommendations for practical, standards and indicators for monitoring and control of HAI and AMR inthe chapter “Resources”, a special place is devoted to the development of the research investigations in this area.

  • In the Laboratory of Molecular typing of NRC-NIfollowing activities have been developed:


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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.


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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/


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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-

GeneralEnlargement

European Commission.


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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.


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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.


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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:


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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


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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.


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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).


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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


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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.


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F. Enhance of awareness of institutions and society for the burden and consequences of HAI through appropriate informational campaigns.


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