[Table of Contents]

Volume: 23S7 - November 1997

CONTROLLING ANTIMICROBIAL RESISTANCE
An Integrated Action Plan for Canadians

Appendix V Consolidation of Recommendations by Issue

National Steering Committee

• To mobilize leadership mechanisms to address antimicrobial resistance.
• To convene a Canadian Coordinating Committee on Antimicrobial Resistance (CCCAR) within 6 months of this conference. This committee with a broad representation of stakeholders will meet twice a year and will take leadership and responsibility for ensuring effective implementation of recommendations by the stakeholder groups.
• To provide CCCAR with a full-time secretariat (financed chair).
• To subject each recommendation of this consensus conference to periodic review and evaluation to examine:
  • The stages of implementation and its effectiveness in mobilizing leadership mechanisms to address anti-microbial resistance issues;
  • Its effectiveness in terms of measurable outcome goal achievements.
• To develop a strategy to ensure that adequate resources are allocated for the implementation of the overall recommendations.
• To explore regional funding mechanisms to ensure availability of needed experts (infection control, infectious diseases, medical microbiologists) now and in the future.

Surveillance and Laboratory Proficiency

• To establish a surveillance system permitting timely acquisition and analysis of local, regional, provincial/territorial and/or national data concerning antimicrobial resistance in human pathogens.  The specific organisms and the methodology should be determined by an expert working group.
• To create an expert working group to establish national laboratory standards for the detection of antimicrobial-resistant bacteria. These standards will include sample collection and transport, the use of appropriate selective media, identification and antimicrobial susceptibility testing techniques, reporting, and molecular biology techniques used for molecular epidemiology. These standards will also include recommendations concerning proficiency testing and training.
• To determine the scope of antimicrobial resistance and antimicrobial usage in long-term care facilities through either a pilot study involving selected long-term care facilities or through a sentinel system of long-term care facilities. This pilot would be used to study the epidemiology of antimicrobial resistance, antimicrobial use and other related issues.
• To establish a national surveillance system to monitor antimicrobial resistance and use in the agri-food and aquaculture sectors. The exact modalities of this system, the target microorganisms, the methods to be used, and the involvement of stakeholders in promoting the judicious use of antimicrobials should be determined by an expert working group.

Antibiotic Usage and Expert Resources Needed Locally

• To identify structures and key human resources at the care-setting and (local) regional levels that are/will be most responsible for coordinating the care of clients/patients/consumers affected by antimicrobial resistant organisms.
• To improve funding and access to expert resources on antibiotic use in all Canadian health care settings. This will be accomplished by the creation of expert panels to promote local antibiotic-use protocols and to provide case consultations as an adjunct to existing provincial/territorial or regional public health networks.
• To establish antibiotic stewardship and antibiotic use teams in all Canadian hospitals by:
  
  a) incorporating them into accreditation standards;
  b) obtaining support from the medical and administrative leadership.
  
  
• To establish antimicrobial usage, monitoring, and intervention programs at the long-term care institutional level.
  
  Short term: monitoring of antimicrobial usage
  Intermediate term: monitoring antimicrobial appropriateness
  Long term: optimizing antimicrobial use
  
  
• To reduce overall antimicrobial usage (prescriptions) by 25% within 3 years by focusing on community-acquired respiratory infection.

Communication Strategies

• To generate, interpret and disseminate information that will support evidence-based approaches to dealing with antimicrobial resistance.
• To communicate information that will improve understanding and actions concerning antimicrobial resistance.
• To make notifiable at the provincial/territorial and national levels certain infections due to antimicrobial-resistant organisms. An expert working group should establish the list of microorganisms and the case definitions for the purpose of surveillance.
• To improve the public's perception about the risk/benefits of microorganisms and the risk/benefits of antimicrobial therapy.
• To improve physicians' perception about the risk/benefits of microorganisms and the risk/benefits of antimicrobial therapy.
• To incorporate consumers (targets) and local issues into the development of communications plans for each recommendation. These plans will include needs assessment and identified barriers. Consumers may help to identify positive factors.
• To develop a communication strategy for each recommendation:
  • Who will organize?
  • Who are the targets?
  • What resources are necessary (existing vs. new)?
  • What communications modality will be used?
  • What are the time lines?
  • How will the effect of the communication strategy be evaluated?
• To use a communications package that will promote behaviour change in usable, practical, attractive, achievable steps. Ongoing evaluation of the communications strategy will permit modification and improvement.
• To prioritize each recommendation based on the underlying evidence and importance to antimicrobial resistance and usage.

Infection Control

• To establish a system within acute care hospitals to identify at admission and throughout hospitalization as needed, patients at high risk of harbouring antibiotic-resistant bacteria. These patients should then be screened for the presence of antibiotic-resistant organisms.
• To ensure adequate resources for infection control programs and personnel exist in all Canadian health care settings (including home care, acute care, long-term care, and childhood and adult day-care programs) and to recognize that these programs should be an integral part of the overall program to limit the transmission of antimicrobial resistance.
• To urgently review (within 1 year) infection control guidelines regarding the resources and personnel required in the changing health care environment.

[Previous] [Table of Contents] [Next]