UAE Higher Committee on AMR UAE National Action Plan for AMR

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1 UAE Higher Committee on AMR UAE National Action Plan for AMR Najiba M Abdulrazzaq Internist, Al Baraha Hospital Head of infection prevention and control, MOHAP Co-Chair of National AMR committee

2 No conflict of interest

3 Antimicrobial resistance (AMR) threatens the effective prevention and treatment of an ever-increasing range of infections serious threat to global public health very costly to patients and facilities The risk associated with AMR bacteria has been addressed by the United Nations therefore, putting drug resistance on a par with pandemic flu and terrorism as a significant civilian threat

4 National AMR committee in UAE In April 2014, UAE Higher Committee for Antimicrobial Resistance, was established In May 2015, a delegation from the UAE, led by H.E. Mr. Abdul Rahman Al Owais, UAE Minister of Health and Prevention, attended the 68 th World Health Assembly in Geneva, CH, where all Member States adopted the Global Action Plan on AMR (WHA68.7) In June 2015, MOHAP issued a resolution to implement the proposed actions for Member States in the Global Action Plan on Antimicrobial Resistance (GAP-AMR)

5 National AMR committee (cont.) In 2016, MOHAP appointed a UAE National Focal Point for AMR for the human health sector, and the UAE Ministry of Climate Change and Environment appointed a National Focal Point for AMR for the animal health sector December 2016, UAE Higher AMR Committee reformulated as National AMR Committee UAE National Action Plan on AMR (NAP-AMR) that is aligned with the GAP-AMR (MOHAP, 2015) to have in place by May 2017

6 National AMR action plan aligned with GAP-AMR 1. Improve awareness and understanding of AMR 2. Strengthen knowledge through surveillance and research 3. Reduce the incidence of infection through effective hygiene & IPC 4. Optimize the use of antimicrobial medicines in human & animal health 5. Ensure sustainable investment through research & development Risk Communication Education National AMR surveillance Laboratory capacities Research and development IPC in health care Community level prevention Animal health: prevention and control Access to qualified antimicrob ial medicines, regulation, AMS Use in veterinary and agriculture Measuring the burden of AMR Assessing investment needs Establishing procedures for participation

7 Relevant Stakeholders Federal Ministries Ministry of Health and Prevention (MOHAP) Ministry of Presidential Affairs (MOPA) Ministry of Climate Change and Environment (MOCCE) Regional Health Authorities Department of Health Abu Dhabi (DoHAD) Dubai Health Authority (DHA) Universities United Arab Emirates University (UAEU) Gulf Medical University (Ajman) Private sector

8 National AMR Committee Sub committees: AMR surveillance Antimicrobial Stewardship Programs (ASP) Infection Prevention and Control (IPC) Animal health

9 AMR surveillance sub committee

10 AMR surveillance In the UAE >200 labs are capable to detect and report AMR pathogens more than 100 surveillance sites, including 30 hospitals, from all seven Emirates of the country are involved

11 AMR Surveillance reports available at national level WHONET is the common tool used for AMR statistics

12 Priority Pathogens for National AMR Surveillance Phase I: Eight GLASS priority pathogens Now: Eighteen Pathogens are under enhanced AMR Surveillance, including eight global & UAE AMR priority pathogens, E. coli K. pneumoniae S. aureus S. pneumoniae Salmonella spp. Shigella spp. A. baumannii N. gonorrhoeae

13 Staphylococcus aureus, Antibiotic Resistance Trends (%R), Communicable Disease Bulletin, Q4/2017, Department of Health, Abu Dhabi (DoH, 2018) [6] 13

14 Carbapenem-resistant Enterobacteriaceae (CRE) are emerging in the UAE CRE, 6-Year Trend % CRE N (CRE) p< (Est) CRE by Organism 5% 3% 1% 1% K. pneumoniae E. coli 21% 21% 48% Enterobacter spp. Serratia spp. Citrobacter spp. Salmonella spp. Proteus spp. Morganella spp. Providencia spp. Pantoea spp. Carbapenem-resistant Enterobacteriaceae (CRE) are emerging globally, and in Gulf countries, including UAE 14 Abu Dhabi AMR Surveillance System, Department of Health ( )

15 Pseudomonas aeruginosa : Annual Resistance Trends (%R), Pseudomonas aeruginosa (percent resistant, by antibiotic) Communicable Disease Bulletin, Q4/2017, Department of Health, Abu Dhabi (DoH 2018) [6] 15

16 National Reference Lab for AMR (NRL-AMR) Currently no NRL-AMR in place Proposed functions and required methods have been identified National reference laboratory including AMR is underway Meanwhile, we are working on possible lab to act as national AMR in the intrem, DoH AD has proposed to asign a laboratory as national AMR UAEU has propsed to do CRE genotyping in 2018

17 Antimicrobial Stewardship sub committee

18 Antibiotic stewardship program currently ASPs are implemented at varying levels in different healthcare facilities across UAE Some hospitals have advanced ASPs established, others are at early stages Some facilities have implemented ASPs for more than a decade Most facilities are applying some core elements of ASPs There is no Coordination within and across facilities International accreditation have ASP as a requirement now

19 Establish a National Antimicrobial Stewardship Program National Action Plan on ASP developed (draft) ASP regulatory standard/ policy developed (draft) Emirate/ Authority Level Standard ASP mandated (Abu Dhabi) March 2016 Proposed Mandate ASP implementation in facilities across UAE Phase 1- Implement ASP in hospitals (on-going) Phase 2- Expand mandate to one day surgery centers

20 ASP plan An updated comprehensive national policy/ standard to mandate implementation of ASPs is at the finalization stage as part of the Ministerial cabinet degree for hospital standards Delineates requirements of effective management of antibacterial utilization through prudent prescribing

21 ASP Standard/ Policy - Highlights ASP team representing competent multidisciplinary healthcare professionals Management of Antimicrobial utilization through facility pharmacy and therapeutics Encourage development of standard treatment protocols Develop and publish facility-based antibiograms Continuous relevant education & trainings for healthcare professionals Regular monitoring and tracking Infection Prevention and Control Clinical Microbiology Infectious Diseases ASP Nursing Pharmacy

22 Possible ASP Strategies Prospective Audit with Intervention and Feedback Pre-authorization of antimicrobials Facility Specific Clinical Practice Guidelines Optimizing Dosing of Antimicrobials Rapid Diagnostics Computerized Clinical Decision Support IV to PO Therapy Conversion Education and Training

23 Infection Prevention and Control sub-committee

24 National IPC committee Goals to achieve a coordinated multidisciplinary, multisector partnerships to co-develop and amplify key messages, increase the adoption of recommended IPC practices To serve as local and national leaders in a coordinated effort to eliminate HAIs

25 National IPC program Our National program is be based on the WHO guidelines on core components of infection prevention and control Core Components 1. IPC programs 2. IPC guidelines 3. IPC education and training 4. HAI surveillance 5. Multimodal strategies 6. Monitoring/audit of IPC practices and feedback 7. Workload, staffing and bed occupancy for acute care facilities 8. Built environment, materials and equipment for IPC at facility level

26 HAIs IPC Programs at Designated Hospitals Component MOHAP HAAD DHA Availability of functioning IPC policy& SOPs Availability of isolation units at tertiary hospitals. Availability of guidelines for the protection of HCW from HAI Availability of surveillance within high risk groups to detect cluster of HAI Availability of designated IPC professionals in all tertiary hospitals. Availability of system to regularly evaluate the effectiveness of IPC program

27 Proposed National KPIs The initial phase 4 KPIs will be mandatory to report by all health care facilities, under development Catheter Associated Urinary Tract Infection (CAUTI) MRSA (Colonization/Infection rates) Surgical Site Infection (SSI) Hand hygiene compliance Prevention /Reduction /Elimination of health care associated infections should be on top of quality goals for each facility

28 AMR in animal health sub committee One Health approach so Coordination with animal health, food, and environment sectors has been started Draft action plan is developed and under discussion and approval

29 Summary AMR is a problem in UAE as part of global problem National AMR committee has drafted a plan The Plan is based on WHO GAP AMR and has one health approach The plan is in its final stages of being a ministerial decree Together will fight AMR

30 References WHO Global Action Plan on AMR CDC Core Elements of Hospital Antibiotic Stewardship Programs guidelines on core components of infection prevention and control AD AMR Surveillance System, AD public healthcare facilities (SEHA),

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