Consultation on a draft Global action plan to address ... · APOLLO SPECIALITY HOSPITAL 320 ANNA...

Consultation on a draft Global action plan to address antimicrobial resistance

The questionnaire is divided into four sections. The questions are broadly framed and intended to

give you the opportunity to enter into some depth and explain your organization's viewpoint. While

only questions marked with * are mandatory, we would appreciate answers to as many as possible.

Where a choice of answer needs to be selected please highlight your answer.

Before answering the questions, please refer to our list of supporting documents.

http://www.who.int/drugresistance/amr-consultation/en/index.html

About you

1. Name of individual respondent*

(deleted)

2. Email address* (preference for official email addresses)

(deleted)

3. Are you authorised to represent your organization or interest group?* YES

4. Organization Name*

“Chennai declaration” initiative

5. Address of the organization*

APOLLO SPECIALITY HOSPITAL

320 ANNA SALAI, CHENNAI, INDIA 600035

6. Organization website (if available)

www.chennaideclaration.org

7. Country*

India

8. Type of Organization*

• Government department, ministry or agency

http://www.who.int/drugresistance/amr-consultation/en/index.html

http://www.chennaideclaration.org/

• Development or aid agency, foundation, trust or other funding authority

• International developmental organization

• Academic institution

• Civil society

• Private sector

• Other non-governmental organization (NGO)

• Other (please specify)

Position statement by representatives of various Medical societies in India

9. Main sector of interest

• Human health

• Animal health

• Finance/economics

• Agriculture or food

• Environment

• Communication, education and community

• Other (please specify)

10. Would you like to be added to our mailing list to receive updates on the development of the

global action plan?* YES

General questions

1. From the perspective of your organization, what are the most important areas of concern in

AMR?

Chennai declaration document is prepared by representatives of medical societies in India and

various other stakeholders. This is an Indian initiative, primarily aimed at tackling antibiotic

resistance in India and other developing countries.

Important areas of our concern are

1.No functioning antibiotic policies in most South Asian countries including India.

2. Very high antimicrobial resistance in South Asian countries

3. Unregulated OTC sale of antibiotics

4. Sanitation issues in the community

5.Antibiotic use in veterinary practice not regulated.

6. Inadequate awareness on resistance issues among health care professionals and general public

7.Inadequate infection control standards in Indian and other south Asian hospitals.

8.Inadequate training on infection control and antibiotic stewardship in the medical curriculum of

India and other South Asian countries.

2. Is your organization currently involved in work related to AMR? YES

If Yes, How?

Chennai declaration is the first ever joint recommendation by medical societies and other stakeholders in India, to tackle antibiotic resistance issue. Chennai declaration provided a practical and implementable solution to tackle antimicrobial resistance challenge; suitable to the background scenario of heterogeneity of health-care system in the country. Declaration recommendations are already studied in detail by Indian Ministry of Health. We are in constant touch with Ministry of Health officials on a daily basis. Ministry of Health has held multiple meetings to discuss Chennai declaration recommendations. Declaration recommendations have undoubtedly helped in speeding up the tackling resistance efforts by Indian Health ministry. Chennai declaration recommendations are discussed on a regular basis in meetings and conferences

of most medical societies in India. The document and the initiative created a serious attitude change

among Indian medical community. Medical societies became more open about the resistance issue.

Chennai declaration document has helped to create awareness among Indian public, as the details

and the progress of the recommendations are widely reported in Indian media.

Chennai Declaration recommendations are discussed in almost a dozen international medical

journals. Many reputed international medical conferences and policy meetings have discussed the

recommendations. This has helped in generating international opinion on the importance of tackling

resistance activities in developing countries.

Questions about the draft global action plan outline document

Before the WHA resolution was adopted, two WHO AMR Strategic Technical Advisory Group (STAG)

meetings were held in anticipation, which included members plus a large number of representatives

from other organizations. These meetings identified key issues, concerns and led to the

development of a draft outline.

As this consultation progresses and stakeholder meetings are held, the secretariat will harvest and

incorporate the input into the draft global action plan.

1. How would you rate your understanding of WHO’s intention in the development of a global

action plan to address AMR?

Very good__ Good__ Fair__ Poor__

Additional comments

WHO must take active interest in tackling antibiotics resistance activities by moving beyond an

advisory role , to the role of a real leader.

2. From the perspective of your organization, are the major issues relating to AMR outlined in

the draft global action plan? __ Y __

If No, what additional issues need to be addressed?

Most of the issue are mentioned. We must add the point that developed countries must help

developing world in stepping up infection control and laboratory facilities in developing countries.

Questions on the ‘Building blocks’ described in the draft outline.

You will notice, the global action plan has been constructed around “building blocks” in recognition

that different countries will have different starting points. In this situation, countries can choose

building blocks to concentrate upon. Each building block specified has been identified as a key area

where specific attention, planning and work are needed to achieve progress in addressing AMR.

Through questions in this section, we would like to hear your opinions on these building blocks in

more detail.

I. Building block-1: Increasing awareness and understanding about AMR and of the actions and

changes needed

a) What do you consider to be the main issues under this priority?

In developing world:

Health care professionals still lack understanding on the extent and the significance of antimicrobial

resistance problem.

Authorities in most developing countries not yet motivated to take initiatives to control resistance

menace.

Public not yet aware of the significance of the issue.

Media participation inadequate in most part of the developing world

b) What are the main actions that needs to be done -- and who are the main

actors/stakeholders who need to take action -- to go beyond the status quo?

WHO to take initiative to coordinate actions to convince authorities in developing countries

Chennai Declaration document and initiative in India made excellent progress in convincing medical

societies and authorities on the importance of the resistance issue. Indian Ministry of Health studied

the document in detail and the initiative played significant role in fast tracking the recent tackling

resistance initiatives by Ministry of Health and medical societies. All countries in developing world

should have similar initiatives. Chennai Declaration five- year plan is an ideal backbone for

implementation and formulation of strategies.

Authorities, medical societies, public, media and the health care industry are the main stakeholders.

c) What steps have already been taken to address this priority? (Please provide references

where possible)

1. In India representatives of medical societies, Health Ministry and other stakeholders organised a

meeting “A Road map to tackle the challenge of antimicrobial resistance”, the first ever meeting of

medical societies in India to discuss the resistance issue (August 2012)

The Chennai declaration document and initiative is as a result of this meeting.

Constant communication by Chennai declaration team with ministry of Health accelerated

publication of the modified OTC rule, initiation of preparation of the National antibiotics guideline

etc..

Chennai Declaration created a serious attitude change among Indian authorities, medical community

to a significant extent.

References

Ghafur A, Mathai D, Muruganathan A, et al. The Chennai declaration: a roadmap to tackle the

challenge of antimicrobial resistance. Indian J Cancer 2013; 50: 71–73.

http://www.indianjcancer.com/preprintarticle.asp?id=104065

Team C. "Chennai Declaration": 5-year plan to tackle the challenge of anti-microbial resistance.

Indian J Med Microbiol 2014;32:221-8.

http://www.ijmm.org/temp/IndianJMedMicrobiol323221-4847733_132757.pdf

Kanungo R. Endorsing Chennai declaration and implementing the strategy. Indian J Med Microbiol

2014;32:109


Goossens H. The Chennai declaration on antimicrobial resistance in India.Lancet Infect Dis 2013; 13:

105–06.

http://www.indianjcancer.com/preprintarticle.asp?id=104065



d) What are concrete and measurable indicators of progress for this priority? (Including, for

example, global and national goals to be achieved within 2, 5 and 10 years)

Chennai Declaration five year plan has explained these goals in detail. I have attached the document.




II. Building block-2: Identifying the most important approaches for preventing development of

infections and the steps needed to move beyond guidance to more effective implementation of such

approaches


In developing countries lack of infrastructure to follow infection control precautions and guidelines is

the main impediment. Lack of awareness on the importance of the issue is also a major factor.

Sanitation issues in the community setting is an important risk



Basic facilities in hospitals in developing countries should be improved.

Governments in developing countries to devote more funds for this purpose

Developed world to help developing countries financially and technically to improve infection

control standards.

c) What significant work has already been done to address this? (Please provide references

where possible)

An attitude change (to acceptance of the problem) is the most important first step in tackling any

issue. In India Chennai Declaration initiative created this attitude change among Indian medical

societies and the authorities. This attitude change has resulted in multiple meetings at highest levels

in Indian Government to tackle the resistance issue. The results are already evident in the way Indian

authorities acknowledge the resistance issue and participate and collaborate in the tackling

resistance and infection control initiatives at national and international level.



Chennai Declaration five year plan has explained these goals in detail. I have attached the document.


Reference also provided.

III. Building block-3: Optimizing the use of existing antimicrobials for human and animal health

and in agriculture


Lack of functioning antibiotics policies in most developing countries, to rationalise human and

veterinary antibiotic use.

Inadequate awareness on the importance of rational antibiotic use and resistance issue, in most

developing countries.



All developing countries must formulate an antibiotic policy and whole-heartedly take efforts to

implement it to the best of their ability.

A step –by- step strategy will be ideal for developing countries, starting with a liberal policy and then

made stricter once success of early stage is ensured. The new over the counter sale rule in India is

based on this strategy. Chennai declaration document has explained the strategy in detail.


where possible)

India has already published a modified rule (H1 rule) to rationalise the OTC antibiotics sale. The

implementation is in early stage. Once succeeded, will provide the best strategic example to be

followed by all developing countries.



Chennai Declaration five year plan has explained this in detail. Document and reference attached.

IV. Building block-4: Identifying and closing critical gaps in knowledge needed to address AMR


Most developing countries do not have nationwide surveillance system and hence do not know the

real extent of the problem.



1. Health ministries of all developing countries must take initiatives to establish a national

surveillance system

2. WHO should be the agency the coordinating various national networks, developing a global

network.


where possible)

Some developing countries have networks but mostly inadequate.



Chennai declaration five year plan attached.

V. Building block-5: Developing an innovative and sustainable approach to develop and

distribute critical products and technologies needed to address AMR


Lack of enough research to develop new antibiotics, especially ones against Gram negatives.

The only immediate solution to the resistance problem is development of new antibiotics.



Enhancing research to develop new antibiotics. Pharmaceutical industry and Governments

c) What steps have already been taken to address this priority? (please provide references

where possible)

There have been efforts to address the issue, but needs more momentum at international and

regional level



Strategy for developing countries explained in Chennai declaration five year plan

VI. Building block-6: Assessing the long term economic, developmental and social costs and

implications of AMR as a basis for sustainable investment and action


Inadequate investment by Governments on tackling resistance issue



1. Investment to improve sanitation issues in developing countries.

2.Investment in improving infection control standards in hospitals

3. Investment to improve laboratory network in developing countries.

c) What steps have already been taken to address this priority? (please provide references

where possible)

Indian Govt. has announced a master plan to improve sanitation in Indian cities.

Indian health ministry has decided to expand vaccination coverage

Indian Health Ministry has allotted funds to tackle antibiotics resistance.



Explained in Chennai declaration five year plan-attached.

Concluding questions

3. What contribution would your organization be able to make in implementing the global

action plan?

1. Will communicate and motivate Indian Health Ministry to implement the recommendations

2. Will motivate all stakeholders to cooperate in implementing the recommendations.

4. Additional input that you feel would be facilitate development of the GAP.

We already have plenty of well-intentioned documents to tackle the resistance, prepared by various

organisations.

What the world needs is real action.

Reproduced with kind permission of “Chennai Declaration five year plan team” and Indian

Journal of Medical Microbiology(IJMM)




Chennai Declaration Implementation-Five Year Plan

The “Chennai declaration-five year plan” is designed as a companion document to the original

“Chennai declaration”.1Details on various components of the five-year plan are already

elucidated in the declaration document. The proposal provides a time bound action plan to

various recommendations of the declaration. Readers are encouraged to refer to “The Chennai

declaration” document for details.


http://www.indianjcancer.com/preprintarticle.asp?ID=104065

STRATEGY ONE YEAR TWO YEAR FIVE YEAR

OVER THE COUNTER SALE OF

ANTIBIOTICS (SCHEDULEH1 )13

Coordinator: DCGI/State Drug

Controller

24 antibiotics

included in the

Restricted list (as

per the modified

H1 list published by

MOH)

60% of all antibiotics

to be included in the

restricted list

90% of all to be

included antibiotics

in the restricted list

IN-HOSPITAL ANTIBIOTIC

MONITORING (STRATEGY AS PER

THE CHENNAI DECLARATION

RECOMMENDATION1)

Coordinator: Hospital infection

control committee

Collaborator: State ICC, National

Task Force, Hospital

accreditation agencies

ANTIBIOTIC POLICY

All tertiary

care***hospitals to

have an antibiotic

policy.

All secondary care**

and primary care*

facilities to have an

antibiotic policy.

HIGH END ANTIBIOTIC MONITORING

Initiatives to

implement the

strategy1 in all

tertiary

carehospitals.(App

endix 1&2)

All tertiary care

hospitals following the

strategy.

Initiatives to

implement the

strategy in all

secondary care

hospitals.

All hospitals

following the

strategy.

ANTIBIOTIC STEWARD1

Second opinion on

high end antibiotic

usage by an antibiotic

steward available in all

tertiary care hospitals.

Second opinion by

an antibiotic steward

available in

secondary care

hospitals.

SURGICAL ANTIBIOTIC PROPHYLAXIS MONITORING

SHEET(APPENDIX 3)

Surgical antibiotic

prophylaxis

monitoring sheet

to be used in all

tertiary care

hospitals

Surgical antibiotic

prophylaxis

monitoring sheet to be

used in all secondary

care* hospitals

Surgical antibiotic

prophylaxis

monitoring sheet to

be used in all

primary* hospitals

AN AUTONOMOUS ANTIBIOTIC

POLICY ACCREDITATION AGENCY

(APAA)

(May be within NABH or as an

independent body) should be

constituted by State/Centre and

all hospitals mandated to apply

for accreditation it at a nominal

fees.

Insurance/Corporate and third

party payers encouraged to send

their clients only to hospitals

accredited with such a policy.

Initiatives to set up

APPA

All major tertiary care

hospitals APAA

accredited.

Initiatives to get

secondary care

hospitals APPA

accredited.

All primary and

secondary care

hospitals APAA

accredited.

STEPPING UP INFECTION

CONTROL FACILITIES IN

HOSPITALS

Coordinator: Hospital Infection

control committee

Collaborator: State ICC, Central

task force, Hospital accreditation

National task force

formed.

State infection control

committees and

District task forcesset

up

All tertiary and

secondary care

hospitals to have

infection control

Primary care hospitals

to have infection

control teams.

agencies.

teams.

Use of alcohol

hand rub in all

tertiary care

facilities

Alcohol hand rubs to

be used in all

secondary and

primary care facilities.

Measures to

increase compliance

to hand hygiene

techniques in all

health care facilities

Isolation precautions

strictly followed, in

practice, in all tertiary

care facilities, to the

best of their ability.

Isolation precautions

to be followed in

practice, based on

the available

infrastructure, to the

best of their ability,

in all health care

facilities.

NATIONAL ADVISORY BOARD

(DOH/NCDC) TO PREPARE

GUIDELINES FOR INFECTION

PREVENTIONAND

ANTIMICROBIAL STEWARDSHIP

IN INDIA

Coordinator: Directorate General

of Health Services/National

Centre for Disease Control

(DGHS/NCDC)

Collaborator: Medical Societies

Guideline

committee to

initiate formulation

of national

guidelines.

Guideline committee

to publish national

guidelines.

Guideline committee

to modify

recommendations

basedon prevailing

resistance scenario

and the success of

various tackling

resistance efforts.

RATIONALISING ANTIBIOTIC

USAGE IN VETERINARY PRACTICE

Coordinator: State Animal

Husbandry Department and State

Drug Controller

REGULATION OF ANTIBIOTIC USAGE IN VETERINARY PRACTICES

Antibiotics used in

human treatment

to be banned as

growth promoters

in food animals

To regulate

prophylactic and

metaphylactic usage

of antibiotics in

veterinary practice.

All veterinary

antibiotics should

need prescription.

Coordinator: State Animal OVER THE COUNTER SALE OF ANTIBIOTICS FOR ANIMAL USE

Husbandry Department and State

Drug Controller

Efforts to formulate regulations to rationalize OTC sale of antibiotics for animal use

Initiation of implementation of the rule.Sale of antibiotics only on the prescription slips of the veterinarians under their registered license number. Restriction on sale of antibiotics to dairy farmers and unauthorized veterinary workers

Efforts to increase

compliance to the

policy

Coordinator: State Animal Husbandry Department Collaborator: State

Agricultural/Veterinary

Universities and ICAR(Indian

Council of Agricultural Research)

and ICMR(Indian Council of

Medical research)

NATIONAL ANTIBIOTIC RESISTANCE MONITORING NETWORK.

At district level

Veterinary

Hospitals to

participate in the

network, prepare

data base of

antibiotic

resistance

About 5 Veterinary

Hospitals in each

district participating in

the network

About 10-15

Veterinary Hospitals

in each district

participating in the

network

SETTING UP OF FACILITIES FOR ANTIBIOTIC SENSITIVITY TESTING

OF MASTITIS AND CLINICAL SAMPLES FROM ANIMALS

District level Tehsil level Block level

MONITORING OF ANTIBIOTIC RESIDUES IN FOOD OF ANIMAL ORIGIN.

National task force

formed

State level task force

formed

District level task

force

Coordinator: State animal Husbandry Department Collaborator: ICAR and State Agricultural/veterinary Universities

STRICT COMPLIANCE FOR OBSERVANCE OF THE ANTIBIOTIC WITHDRAWAL PERIOD FOR FOOD ANIMALS.

State level

monitoring system

Divisional level

monitoring system

District level

monitoring system

CLINICAL RESEARCH TO EXPLORE

EXISTING OPTIONS TO TREAT

INFECTIONS DUE TO MDR GRAM

NEGATIVE BACTERIA

Coordinator: ICMR

Multicentre clinical

studies on

combination

therapy against

MDR Gram

negative infections

initiated.

Preventive strategies, including decolonization trials

Results of the large

multicenter trials

published. Clinicians

able to choose the

best combination

against these bacteria

Need community based studies on the prevalence of MDR bacteria

India to be making a

significant

contribution to

academic world

knowledge on

treatment of MDR

bacterial infections.

Implementation of

protocol studies

MEDICAL COUNCIL OF INDIA AND

CURRICULUM CHANGES

Coordinator:MCI(Medical council

of India)

Collaborator:DME(Directorate of

Medical Education)

Initiating

discussions on

necessary

curriculum changes

to encourage

rational antibiotic

usage and infection

control (for

doctors, nurses and

pharmacists)

MCI/National

Board to take

initiative towards

DM/DNB training in

ID

New modules

introduced into all

medical schools.

Discussions on

extensive curriculum

changes initiated.

Post-doctoral training

in Infectious diseases

(DM/DNB) started in

at least 10 medical

schools

Modified curriculum

introduced into all

medical schools.

At least 50 medical

schools starting

infectious disease

training

NATIONAL ANTIBIOTIC

RESISTANCE MONITORING

NETWORK

Coordinator: NCDC/ICMR

Collaborator: NCDC/ICMR, state

DOH

10-25 hospitals

from each state

participating in the

network

50 hospitals from each

state in the network

100 hospitals from

each state in the

network

NCDC /ICMR

functioning as the

national reference

laboratory for

antibiotic

resistance studies

Data available on

molecular

epidemiology of MDR

bacteria especially

Gram-negatives.

Extensive nationwide

data available on

molecular

epidemiology of

MDR Gram-positive

and -negative

bacteria.

ENCOURAGE RESEARCH TO

DEVELOP NEW MOLECULES

Coordinator: Council of Scientific

and Industrial Research(CSIR)

Collaborator:ICMR,Pharmaceutic

al industry

ANTIBIOTICS

Discussion with

pharma industry to

identify molecules

already in

development and

encourage the

progression of

promising leads

Public private

partnership to develop

new molecules

explored

Fast tracking of

promising antibiotics

especially those active

against MDR Gram-

negative bacteria

VACCINES

Encourage research to

develop new vaccines

Promising vaccines

identified and

options to enhance

further research

explored

ACTIVE CONTRIBUTION OF

MEDICAL SOCIETIES

POSITION STATEMENT FROM ALL

MAJOR SOCIETIES TOWARDS

INFECTION CONTROL AND

ANTIBIOTIC STEWARDSHIP

CONTINUING MEDICAL EDUCATION(CME)

All medical

societies

conducting CMEs

on antibiotic

stewardship and

infection control

(supervised by a

neutral scientific

committee)

through their local

branches-(25% of

local branches

coverage

CME-50% coverage

CME-100% coverage

ACTIVE PARTICIPATION IN ANTIBIOTIC AWARENESS WEEK

ACTIVITIES

Active participation

of half of all major

societies

Active participation of

2/3rdof all major

societies

All major societies

active and regular

participation

INTRODUCTION OF ONLINE

MODULES ON ANTIBIOTIC

USAGE.

(Developed by National

Antibiotic Guideline committee)

5000 doctors

completing the

module

50000 doctors

completing the

module.

All registered

medical practitioners

completing the

module.

MEDICAL JOURNALS To publish

editorials on

tackling resistance-

in all major journals

At least one article on

the subject in every

issue of the journal

Indian journals to

have a leading role in

publishing papers on

antibiotic resistance

ROLE OF MEDIA MOH to issue

advertisements in

visual and print

media on rational

antibiotic usage,

directed at

practitioners and

public.

Active media

participation in

Antibiotic

Awareness Week.

Frequent articles and

programmes on the

subject in the media

NGO (NON -GOVERNMENTAL

ORGANISATIONS)

MOH and medical

societies initiating

discussion with

NGOs seeking

participation in

tackling antibiotics

resistance

activities.

Nationwide

activities. Message

reaching Indian

villages

Awareness

activities in schools

and colleges, clubs

etc...in metros.

Awareness activities in

schools and colleges,

clubs etc. in cities

MEASURES TO IMPROVE Seek advice from

experts in relevant

Pilot schemes in Nationwide

implementation of

SANITATION

Coordinator: Ministry of Drinking

Water and Sanitation(Ministry of

Rural Development)/Ministry of

Urban Development

Collaborator: State Water

Boards

areas of public

health, and various

branches of

science.

Practical and

implementable

strategies

identified.

selected locations successful strategies.

HOSPITAL ACCREDITATION

AGENCIES (NABH, ISO ETC.) ROLE

Strict monitoring

on compliance to

the infection

control and

antibiotic policy,

during

accreditation and

reaccreditation

process.

NABH sending

good practices

advisory to all

hospitals on

antibiotic

stewardship and

infection control

Conducting national

antibiotic stewardship

programmes for all

doctors (nationwide)

Capacity building for

infection control

nursing staff (nation

wide)

Sustaining

standardized

surveillance methods

Establishing

National, State Data

collection and

management and

designing policies

accordingly

*Primary care centers: Hospitals with fewer than 100 beds and no NABL-accredited

microbiology laboratory.

** Secondary care centers: Hospitals with fewer than 500 beds, not having an NABL-

accredited laboratory

***Tertiary care centers: Hospitals with more than 500 beds or hospital of any bed strength

with an NABL-accredited laboratory

STEPPING UP MICROBIOLOGY

LAB FACILITIES ACROSS THE

COUNTRY

Tertiary care

hospital labs

should be able to

perform culture

from all kinds of

samples.

Secondary care

hospitals should be

able to perform

culture of all kinds

of samples. If

unable to process,

outsourcing of

samples is an

option

All secondary care

hospital labs able to

perform culture and

susceptibility testing

of all samples using

standardized

methodology(as per

ICMR surveillance

network

recommendation)

Primary care facilities

able to perform Gram

stain and AFB stains.

All tertiary acre and

secondary care

hospitals in the

country following

standardized

methodology to

perform cultures and

susceptibility testing

of all samples.

COMPUTERISATION.

SOFTWARE BASED PROGRAMME:

Eg: WHONET

All tertiary care

hospitals using

WHONET software

All secondary care

hospitals using the

software

Nationwide data

available via online

data entry in a

designated website

Consultation on a draft Global action plan to address ... · APOLLO SPECIALITY HOSPITAL 320 ANNA...

Documents

Transcript of Consultation on a draft Global action plan to address ... · APOLLO SPECIALITY HOSPITAL 320 ANNA...