Annelin Lyshoel Section leader of «Smittevernsenteret», University Hospital of Northern Norway. UNN, Tromsø
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1 Annelin Lyshoel Section leader of «Smittevernsenteret», University Hospital of Northern Norway 1 UNN, Tromsø
2 Smittevernsenteret Infection control personel, UNN Infection control nurse Primary Health Care One big happy family Regional Resource Centre for Infection Control, Helse Nord RHF Senior Consultant Infection Control, Finnmarksykehuset HF Tuberculosis coordinator UNN/regional Pharmacist Secretary UNN: University Hospital of Northern Norway 2
3 Northern Norway Finnmarkssykehuset HF Universitetssykehuset Nord-Norge HF 3 counties 87 municipalities persons 4 helseforetak 140 nursing homes Nordlandssykehuset HF Helgelandssykehuset HF 3
4 Organizations in Communicable Diseases in Norway Norwegian Directory of Health Ministry of Health and Care Services National Institute of Public Health (NIPH) Regional Health Authority (Helse Nord RHF) Regional Resource Centre for Infection Control Hospital Infection Control personel Advisory Infection control nurse for Primary Health Care County Governor (Nordland, Troms og Finnmark): County Medical Officer Head physician for each municipality Nursing Home Physician 4
5 Communicable Disease Legislation Smittevernloven (1995) o Smittevernforskriften Spesialisthelsetjenesteloven (1997) Helsepersonelloven (1999) Helse- og omsorgstjenestelovern (2011) Helseberedskapsloven (2000) Helseregisterloven o MSIS - forskriften o NOIS - registerforskriften o Forskrift om tuberkulosekontroll o Forskrift om forhåndsundersøkelse av arbeidstakere innen helsevesenet antibiotikaresistente bakterier o Forskrift om nasjonalt vaksinasjonsprogram 5
6 Regional plan for infection control in hospitals & tuberculosis control 6
7 Health Care Services Area of application for Smittevernforskriften Yes (Infection Control Program) Gray area No Hospitals Centre for primary health care Care homes (different types) services (Helsehus) Outpatient surgery clinics Rehabilitation Centres in the Home care services municipality Nursing homes Municipal nursery Retirement home Acute beds in primary health Personal assistance (home) care Rehabilitation institutions General practitioner services Ambulance services Emergency services in primary care Public health nurse services Midwife services School health services Foto: Jan Fredrik Frantzen, UNN HF Living facilities for children with serious disease 7
8 Infection control personel Hospitals Infection control physician Infection control nurse (Advisory infection control nurse for primary care) Tuberculosis coordinator Primary care Head physician for each municipality Foto: Jan Fredrik Frantzen, UNN HF 8
9 Infection control program in hospitals & nursing homes Infection surveillance and measures to prevent health care associated infections Management and monitoring of outbreaks Collection of infection control procedures Antibiotic use antibiotic stewardship National guidelines for hospitals Separate guidelines for nursing homes (part of primary care) 9
10 Interaction between specialist care and local health services The Coordination Reform (2012) Modified hospital management Shorter hospital stays and increased outpatient treatment/day treatment Local health services take care of a higher number of pasients with more serious disease Pasients are more frequently moved between different levels of health care Increased risk for spread of infections Frequent interaction regarding infection control 10
11 Interaction in infection control 11
12 Infectious disease epidemiology NOIS: Continuous surveillance of selected surgical site infections Prevalence of health care associated infections (HAI) and antibiotic use x2 yearly (hospitals and nursing homes) MSIS: National surveillance system for communicable diseases 12
13 Surgical site infections SSI 13
14 Prevalence of HAI in hospitals 14
15 Prevalence of HAI in nursing homes 15
16 Norwegian surveillance system for communicable diseases (MSIS) The Norwegian Institute of Public Health (NIPH) is responsible for surveillance of infectious diseases in Norway Informs and contributes to international surveillance Reports on infectious disease epidemiology Collaborates in outbreak of infectious diseases and multiresistant bacteriae ESBL KARBA TB 16
17 MRSA 17
18 VRE 18
19 Tuberkulose 19
20 ESBL Carba in Norway 20
21 Antibiotic use in Norway National strategy against antibiotic resistance in health care Antibiotic stewardship hospitals are required to have it National intervention for antibiotic use in nursing homes (led by Antibiotic Centre for Primary Care) 21
22 Antibiotic use in primary care 2015 (sales statistics) Kilde: NORM NORM-VET
23 Proportions of selected antibacterial agents for systemic use in Norway, presented per hospital/health trust, in
24 Screening for multiresistant bacteriae MRSA, ESBL og VRE Isolation depending of several factors Patients outside or within the Nordic countries Risk factors Carriers or infection 24
25 From Russia with 5584 asylum seekers crossed the border at Storskog in 2015 (42 different nationalities) Mostly in September- November people had active tuberculosis 2 large lookbacks including 140 persons 4 of 27 (15%) admitted to Hospital of Kirkenes tested MRSA-positive Large work load to forward documents on TB-screening and results Sent by mail (no electronic records) Difficult to find the location for each person personer søkte asyl i Norge i 2014, 324 TB meldt personer søkte asyl i Norge i 2015, 317 TB meldt personer søkte asyl i Norge i 2016, 293 TB meldt (foreløpig)
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