Press Release

Department of Health allocates €7 million for antimicrobial resistance and infection prevention & control

Minister for Health Simon Harris TD has today welcomed an allocation of €7 million for antimicrobial resistance (AMR) measures in the health service.

Minister Harris said the funding will be used for infection prevention and control teams in both acute hospitals and community care settings in 2019. This includes €2 million allocated in 2018 and a further €5 million for 2019.

Minister Harris said “I am delighted to announce this significant targeted investment to increase our public health system’s capacity to tackle AMR and healthcare associated infections, including the superbug CPE.

“This represents a significant step forward in funding our infection control teams in hospitals and community care settings.”

He continued “Ireland is standing up and playing its part in tackling the global threat of AMR in our health services and in health services around the world. As the World Health Organisation has emphasised, managing the AMR crisis is of the utmost urgency and the Government is doing exactly that. We are building infection prevention and control teams both in hospitals and in the community to reduce the spread of infection and disease, enhance surveillance and optimise the use of antimicrobials such as antibiotics.”

The National Public Health Emergency Team (NPHET) was convened as a result of the activation of the Public Health Emergency Plan, on 25 October 2017, by the Minister Harris as a public health response to CPE in Ireland.

The purpose of the NPHET has been to provide advice, guidance, support and direction on the surveillance and management of CPE at national level.

Over the last eighteen months, a number of measures have been put in place and the Department of Health and the HSE will continue to work closely together on this.

The Chief Medical Officer, Dr Tony Holohan, who chaired the NPHET, added that “The NPHET sought to develop and implement a strategy to contain CPE. I am pleased to say that we have come a long way in overseeing the health system’s response to CPE.

“This funding is key to ensuring a sustainable response in Ireland to healthcare associated infections and antibiotic resistant organisms, including CPE.”

Throughout its work on this issue, the NPHET has implemented strong governance arrangements for healthcare associated infections (HCAIs) and AMR within the HSE. The NPHET has also driven enhanced surveillance of HCAIs and built capacity within the system for the challenges associated with these threats.

Many guidance documents have been developed by the Expert Group convened by the NPHET which provide expert advice to hospitals and the community health care services regarding actions that should be taken regarding CPE screening and control of spread of CPE.

The next phase of work focuses on the HSE implementation and operationalising of measures to address CPE and other HCAIs.

While the number newly diagnosed CPE patients has slightly increased, this is in the context of substantially increased screening activity over the past year. By screening and diagnosing more patients, we can ensure that CPE patients are managed more effectively in our hospitals, limiting its impact on fellow patients.

Through the work of the NPHET, hospitals have significantly enhanced their screening activities and this additional screening information has proven vital in allowing the NPHET to make informed decisions regarding CPE management.

Newly appointed Director of the National Patient Safety Office, Marita Kinsella, said “AMR is a significant challenge to medicine and society as a whole. Prevention of infection and appropriate management when it does occur is a cornerstone of patient safety.”
This investment will work towards advancing the strategic actions outlined in iNAP, Ireland’s National Action Plan on Antimicrobial Resistance 2017 – 2020.

ENDS

Notes to the Editor

What is AMR?
AMR stands for Antimicrobial Resistance. Antimicrobials such as antibiotics are medicines used to prevent and treat infections, and are essential in both human and animal health. Antimicrobial resistance occurs when an antimicrobial that was previously effective, is no longer effective in treating an infection caused by microorganism or bacteria, fungi or viruses (bugs).

The development of resistance is a natural phenomenon that occurs when antimicrobials are used to treat disease. The problem at the moment is that the sheer volume of antimicrobials being used globally in humans and animals. This is leading to significant increases in the rate of development of resistance. This results in common infections becoming more difficult to treat and the emergence of so called ‘superbugs’, or resistant bugs.

What is the global impact of AMR?
AMR has been described by the World Health Organisation as “a crisis that must be managed with the utmost urgency”. It is estimated, that by 2050, if the world does not address this risk, AMR will be responsible for 10 million deaths annually (more than are currently lost to cancer) and will have cost USD$100 trillion in lost global production. For these reasons, AMR is now receiving worldwide attention at the highest levels (United Nations, World Health Organisation, World Organisation for Animal Health, European Commission).

What is the National Action Plan on AMR (iNAP)?
Ireland’s National Action Plan on Antimicrobial Resistance 2017-2020 aims to implement policies and actions to prevent, monitor and combat AMR across the health, agricultural and environmental sectors. Reducing the inappropriate use of antimicrobial medicines, as well as preventing infections, is vital to stop the development and spread of resistant microorganisms.

This Ireland’s National Action Plan on Antimicrobial Resistance 2017-2020 provides an overview for the health, agricultural and environmental sectors. It presents key strategic interventions for tackling antimicrobial resistance in line with World Health Organisation (WHO) requirements across the three sectors. These interventions represent Ireland’s commitment to the development and implementation of a holistic, cross-sectoral ‘One Health’ approach to the problem of antimicrobial resistance.

What does the National Action Plan on AMR aim to do?
The overall goal of Ireland’s National Action Plan on Antimicrobial Resistance 2017-2020 (iNAP) is to ensure, for as long as possible, the availability of effective antibiotic treatment options for both the human and animal population, with safe medicines that are quality-assured, used in a responsible way, and accessible to all who need them.

More specifically, Ireland’s National Action Plan on Antimicrobial Resistance 2017-2020 aims to:
• Improve awareness and knowledge of AMR through information campaigns, education, intelligence and data
• Enhance surveillance of antibiotic resistance and antibiotic use through surveillance systems that facilitate greater standardisation of data collection, data linkage and sharing of real time information
• Reduce spread of infection through infection and disease prevention and control measures, including national guidelines and standards in relation to hygiene and biosecurity practices
• Optimise the use of antibiotics in human and animal health through development and implementation of antimicrobial stewardship programmes, promotion of prudent prescribing practices and access to rapid diagnostics
• Promote research and sustainable investment in new medicines, diagnostic tools, vaccines and other interventions through measuring evaluable costs of HCAI/AMR, identifying research opportunities and working with key stakeholders to develop alternative disease treatment tools.

Where can I access the National Action Plan on AMR?
The National Action Plan on AMR is available online on the Department of Health and Department of Agriculture, Food and the Marine’s websites.

What are antimicrobials? What antibiotics are affected by AMR?
An antimicrobial is a medicine that kills or stops the growth of microorganisms (bugs). These can be bacteria, viruses or fungi. In particular, antibiotics are used to treat infections caused by bacteria. Antimicrobials are used to treat infections in both humans and animals. With increased use, the bugs causing the infection can adapt and change in a way that makes them resistant so that the antimicrobial can no longer attack them. This is known as antimicrobial or antibiotic resistance. When the antimicrobial or antibiotic is used again on the resistant bug, it will no longer work. All antibiotics/antimicrobials are potentially affected.

What can I do, as a member of the public, to help limit AMR?
One of the key ways to prevent AMR is to avoid the need for antibiotics in the first place. This can be done by things like taking care of your general health with respect to diet and exercise, and having good hand hygiene and getting the appropriate vaccinations. Check out www.hse.ie/handhygiene and www.immunisation.ie for further information

Antibiotics are only effective for bacterial infections. If you do need to take antibiotics, make sure you that you follow the advice from your doctor or pharmacist in terms of how much and for how long you should take the antibiotic. Read the label and any leaflet provided with the antibiotic.

What are healthcare-associated infections (HCAI)?
A healthcare-associated infection is an infection that is acquired after using a healthcare service and that is related to the healthcare service. This is most frequently after treatment in a hospital, but can also happen after treatment in outpatient clinics, nursing homes and other healthcare settings. Healthcare-associated infections that are picked up in hospital are also known as “hospital-acquired infections”

What could happen if AMR is allowed to continue to grow?
If AMR is allowed to continue without intervention, then our antimicrobials will become increasingly ineffective over time. This means that infections will become more difficult, time-consuming and expensive to treat. Since the 1940s, antimicrobial medicines have substantially reduced death rates from infectious diseases. They have provided protection against infectious complications for many modern medical practices including surgery, neonatal care and cancer treatment. Surgery, organ transplantation and many advances in modern medicine could not be safely carried out without effective antimicrobial cover.

What is CPE?
Carbapenemase Producing Enterobacterales CPE is a superbug resistant to many antibiotics. It is carried in the bowel and can cause blood stream infection in people who are vulnerable, such as the elderly and those with low immunity.

CPE is a superbug resistant to most commonly used antibiotics. It is carried in the bowel and can cause blood stream infection in people who are vulnerable, such as the elderly and those with low immunity

CPE are an established threat to human health, particularly in hospital settings. They are shed in the faeces and transmitted by direct and indirect contact. A period of 4 weeks or more may elapse between that contact that results in acquisition of the organism and the time at which CPE becomes detectable in the faeces of the contact. More than half of all patients who develop blood stream infections with CPE may die as a result of their infection though prompt diagnosis and targeted treatment improves the chances of recovery.
CPE has been identified throughout the world in recent years. Ireland has seen an increase in the number of cases year on year for the past several years. The spread of this superbug in hospitals can harm patients and lead to the closure of beds, wards and units removing thereby, essential capacity to provide services, to admit patients from Emergency Departments and to address waiting lists effectively.

Public Health and microbiological advice indicate that the opportunity remains for effective interventions to be taken which can protect our patients, protect our hospital capacity from unplanned closures and ultimately lead to a halting or reduction in the spread of this superbug.

What is a public health emergency?
A public health emergency is described as any serious or unexpected event, due to an infectious disease, which causes, or threatens to cause, death or serious illness to large sections of the population, an individual region or a specific cohort of individuals and which will have a major impact on the normal functioning of the health system and on society in general.

What is the Public Health Emergency Plan?
The Department of Health’s National Health Emergency Plan is a plan for activation in the event of a national/large-scale public health emergency in the event of an infectious disease outbreak or similar health issue. The purpose of the plan is to assist all health agencies in the State to respond to a public health emergency in an integrated and co-ordinated manner.

The National Public Health Emergency Team was convened as a result of the activation of the Public Health Emergency Plan, on 25 October 2017, by the Minister for Health (Mr Simon Harris, T.D.) as a public health response to CPE in Ireland.

Further information

Department of Health – http://health.gov.ie/national-patient-safety-office/patient-safety-surveillance/antimicrobial-resistance-amr-2/public-health-emergency-plan-to-tackle-cpe

Department of Agriculture, Food and the Marine – www.agriculture.gov.ie

National Interdepartmental AMR Consultative Committee – www.health.gov.ie/national-patient-safety-office/patient-safety-surveillance/national-interdepartmental-amr-consultative-committee-meetings 

HSE – www.hse.ie/infectioncontrol