Die Situation in den NiederlandenDie Situation in den Niederlanden(The Dutch Approach)(The Dutch Approach)

Hajo GrundmannHajo Grundmann

University Medical Centre Groningen, University Medical Centre Groningen, Rijksuniversiteit Groningen, National Institute Rijksuniversiteit Groningen, National Institute

for Public Health and the Environment, for Public Health and the Environment, Bilthoven, NLBilthoven, NL

The Dutch approachThe Dutch approach

robustrobust

targetedtargeted

effectiveeffective

The Dutch approachThe Dutch approach

robustrobust

targetedtargeted

effectiveeffective

The Dutch approachThe Dutch approach

Following an outbreak of Oxa-48 +ve Following an outbreak of Oxa-48 +ve Klebsiella pneumoniae Klebsiella pneumoniae that infected 58 that infected 58 patients in an acute care hospital in patients in an acute care hospital in Rotterdam between Sept. 2010 and June Rotterdam between Sept. 2010 and June 2011 (attributable mortality 5-22%), 4.000 2011 (attributable mortality 5-22%), 4.000 patients were called back for screening patients were called back for screening (approx. 2.000 have been screened so far (approx. 2.000 have been screened so far and 20 carriers have been identified)…. and 20 carriers have been identified)….

The Dutch approachThe Dutch approach

…….the hospital laboratory (microbiology) .the hospital laboratory (microbiology) and infection control department were put and infection control department were put under external supervision, and the under external supervision, and the hospital director was fired (August 16). hospital director was fired (August 16).

Antibiotic policy Antibiotic policy (Nat. Health Council 2001)(Nat. Health Council 2001)

Working Group on Antibiotic Policy, SWAB (Stichting Working Group on Antibiotic Policy, SWAB (Stichting Werkgroep Antibiotica Beleid). Werkgroep Antibiotica Beleid).

training programmes for the rational prescription of training programmes for the rational prescription of antimicrobial drugs, antimicrobial drugs,

development of evidence-based prescription guidelines, development of evidence-based prescription guidelines,

the implementation of tailor-made hospital guidelines the implementation of tailor-made hospital guidelines for antibiotic prophylaxis and therapy, for antibiotic prophylaxis and therapy,

integrated nationwide surveillance system for antibiotic integrated nationwide surveillance system for antibiotic use and antimicrobial resistance. use and antimicrobial resistance.

Antimicrobials for systemic use (J01)Antimicrobials for systemic use (J01)

Antimicrobials for systemic use (J01)Antimicrobials for systemic use (J01)

Germany

Netherlands

1)1) The Dutch “Search and Destroy” policy works rather well The Dutch “Search and Destroy” policy works rather well

because the national health care network is more resilient to because the national health care network is more resilient to

epidemic spread than that of other countries.epidemic spread than that of other countries.

2)2) Antibiotic policies engender guidelines, not rules.Antibiotic policies engender guidelines, not rules.

3) In clinical practice antibiotics are used according to 3) In clinical practice antibiotics are used according to

judgement and experience and more often than not judgement and experience and more often than not

according to custom.according to custom.

The Dutch approach: a sceptical viewThe Dutch approach: a sceptical view

However:However:

There is a custom of antibiotic restraint in the Netherlands.There is a custom of antibiotic restraint in the Netherlands.

This applies to clinicians, (no AB for sinusitis and middle-ear This applies to clinicians, (no AB for sinusitis and middle-ear infections)infections)

as well as to patients, (“Niet klagen, Maar dragen”).as well as to patients, (“Niet klagen, Maar dragen”).

The Dutch approach: a sceptical view 2The Dutch approach: a sceptical view 2

Thank you !Thank you !

Structural DifferencesStructural DifferencesIndikatorIndikator NLNL DEDE

EinwohnerEinwohner 1,709.7941,709.794 1,340.8771,340.877

KH total (Betten)KH total (Betten) 15 (5813)15 (5813) 29 (6839)29 (6839)

KH-Betten/ 1000 EinwohnerKH-Betten/ 1000 Einwohner 3,43,4 5,15,1

Rettungsdienste/ 1000 Ew.Rettungsdienste/ 1000 Ew. 0,0230,023 0,0250,025

Alten- und Pflegeheime/ 1000 Alten- und Pflegeheime/ 1000 Ew.Ew.

0,10,1 0,20,2

GesundheitsGesundheitsäämter totalmter total 33 1010

Arztpraxen/ 1000 Ew.Arztpraxen/ 1000 Ew. 0,440,44 1,51,5

Ärzte Ärzte Mikrobiologen/KHHygieniker Mikrobiologen/KHHygieniker pro 1000 Bettenpro 1000 Betten

33 0,30,3