Transcript Slide 1
1 Global Travel – who goes? 2 Global Links of NDM to the UK 3 Kumarasamy et al., Lancet Infect Dis 2010 10:597-602 15 million Visitors to the UK 2011 Country USA Italy India Brazil Greece Israel China Nigeria Pakistan Rank (by number) 1 7 16 19 25 31 33 34 48 Visitors (000) 2,484 1,526 350 276 225 164 149 142 65 4 Visitors to the UK by Purpose – potential for MDR GN household spread 14,000 12,000 Visitors (000) 10,000 8,000 Holiday VFR Business Other 6,000 4,000 2,000 0 2005 2006 2007 2008 Year 2009 2010 2011 Potential Impact of Overseas Patients Patient Number Total completed NHS admission episodes in England 2011* Total admissions UCLH** Total overseas** 14,890,844 127,364 1631 Total transferred from another NHS provider** 19 Total transferred from a private provider** 8 Total overseas patients transferred from private provider** 0 Total projected overseas patient admissions *HES Data ** P. Wilson Pers Comm Patient No’s 190,751 Carbapenemase-producing Enterobacteriaceae in the UK (n = 1659) Imported & ‘home grown’ Early cases often imported 7 Neil Woodford: AMRHAI, Unpublished data Currently very limited knowledge on basic epidemiology. CRO carriage rates in specific high risk groups allowing targeted screening? Duration of carriage? Optimal method of patient screening – rectal swabs – reliability of self swabbing? Optimal laboratory screening method? Transmission rates in home/hospital? Efficacy of decolonisation and isolation? Cost effectiveness of interventions? Concerted Action Required: ALL Sectors Cross Cutting Antibiotic Policy Improved Global Intelligence Antimicrobial Stewardship Surveillance Targeted & Structured Centralised Reporting •incl private sector Simpler cheaper laboratory tests Aggressive Infection ..Control • Screening • Isolation • Reinforced Hand ..Hygiene • Contact precautions Unified Strategic Policy in DH/NHS Renewed Political Drug Pipeline Commitment & Investment Focussed Clinical Research 9 What is the key priority ? Refocus NHS Infection Prevention and Control onto MDR GNB 10 Serious threat to routine care in the NHS 11