Transcript Prevention of infectious diseases in school children

Prevention of infectious diseases
in school children
Tereza Kopřivová Herotová
Dagmar Schneidrová
Dept. of Child and Youth Health
Infectious diseases
in the Czech Republic in 2011
(Institute of Health Statistics and Information, CR 2012)
• Structure and incidence of infectious diseases
by age groups
(see p. 16 - ÚZIS infnem2012.pdf)
Antibiotic use: evolution of penicillin
resistance of Staphylococcus aureus
Total antibiotic use in European countries 2003
Ferech, M. et al. JAC 2006 58:401-407
Antibiotic use: outpatient penicillin usage correlated
with penicillin resistance, Europe, 2005
Source: Goossens et al. 2005
Prevalence of MRSA in Europe
Pneumococcus resistance to macrolides
Misunderstandings about antibiotics
Antibiotics work on most coughs & colds
Antibiotics can kill bacteria
Antibiotics can kill viruses
Antibiotics can kill bacteria that
normally live on the skin and gut
Bacteria that normally live on the skin
and in the gut are good for you
0
% respondents with wrong answer
20
40
% respondents don't know
And 16-24 year olds are less knowledgeable
60
ATB SELF MEDICATION (Europe)
Survey on ATB use in CR
( Dept. of Child Health, TH Bulovka, 2009)
• 18 % respondents used ATB without consulting a physician.
• 3 % parents gave ATB to the child without consulting
a physician.
• 15.7 % resp. have ATB at home.
• 59 % of Prague resp. and 48 % of resp. outside Prague have no
ATB leftovers at home.
• 55 % resp. expect ATB effect within 24 hours.
• 24 % resp. would prefer having medicaments in drugstores,
9 % resp. in shops.
• 10 % resp. would prefer PNC without prescription, 2 % resp.
all ATB without prescripton.
• 88.5 % health profs. does not consider resistance a serious
problem.
• 96.3 % resp. consider compulsory vaccination useful.
ATB are efficient against ?
( Dept. of Child Health, TH Bulovka, 2009)
Otázka č. 21 - Praha x Ostatní
38,2
41,5
45
40
31,5
35
24,5 24,9
30
%
27,6
25
20
15
10
6 5,8
5
0
jen virům
jen bakteriím
PRAHA
virům i
bakteriím
OSTATNÍ
všem
mikrobům
ATB are efficient against ?
( Dept. of Child Health, TH Bulovka, 2009)
Otázka č. 21 - Zdravotník x Nezdravotník
70
60
50
40
30
20
10
0
63,1
29,4
15,4
5,4
34,9
29,6
16,2
6
jen virům
jen bakteriím
virům i
bakteriím
%
Zdravotník
Nezdravotník
všem
mikrobům
The five key areas for prevention
of antimicrobial resistance
Rational drug use
and regulation
Infection
prevention
Surveillance
Research and
development
Animal husbandry,
agriculture,
aquaculture
Rational drug use and regulation
• Reduce ATB use (↓ prescription)
• Reduce spread of resistent strains (isolation)
• Intervention (education) activities
 focused on health profs in different fields
 focused on public
e-Bug
the EU initiative for school children
Tereza Kopřivová Herotová
National coordinator
What is an e-Bug project
• e-Bug is a European wide antibiotic and
hygiene teaching resource for junior (9-11 y.)
and senior (12-15 y.) school children
• Funded by DG Sanco (EU Commission)
• The project is lead by the Health Protection
Agency (HPA) Primary Care Unit in Gloucester,
UK and involves a consortium of 18 partner EU
countries: 10 associate and 8 collaborating
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10 Associate Partners
Belgium
Czech Republic
Denmark
France
Greece
Italy
Poland
Portugal
Spain
Great Britain
8 Collaborating Partners
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Croatia
Finland
Hungary
Ireland
Latvia
Lithuania
Slovakia
Slovenia
e-BUG project
18 European countries
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Great Britain
Czech Republic
France
Poland
Belgium
Denmark
Greece
Portugal
Italy
Spain
Lithuania
Latvia
Finland
Croatia
Hungary
Slovakia
Slovenia
Ireland
→ 62 % European population
E-Bug project
Associate partners
• 46 % of European
population
• 300 mil. people
Collaborative partners
• 15% of European
population
• 90 mil. people
• 62% of European Population
The aims of e-Bug project
• Increase awareness on benefits of compulsory and
elective vaccination
• Increase awareness on microbial resistance
• Increase compliance of patients related to ATB use
• Improve personal hygiene of school children
Teach:
– Prevention better than cure
– Benefits of antibiotics
– Overuse of antibiotics may have adverse effect
DH SMAC
Committee 1998:
Teaching about
antibiotics should be
included as part of the
National Curriculum
Reducing infection rates should
reduce antibiotic use in children!
• Spread of infection is
mainly via
sneezing/coughing and
contaminated hands
• Handwashing interventions
reduce illnesses and
absenteeism in schools
3 key topics
1. Microorganisms
• Useful and dangerous microbes
• Viruses vs. Bacteria vs. Fungi
• ATB have no effect against viral and
fungal infections
• Compulsory and elective vaccination
• Natural microflora and its importance
3 key topics
2. Personal hygiene
• 80% common infections are spread via
dirty hands
• Hand washing = effective prevention of
infections of upper and lower
respiratory tract and GIT (alimentary infections)
• Timing and technique of hand washing
3 key topics
3. Antibiotic resistance
• Misuse and overuse of ATB
• Mechanism of developing
resistance
• Risks of resistance
• Prevention of resistance
• Negative effects of ATB on health
Developing e-Bug style & content
Brainstorming sessions with teachers &
partners:
• Suit range of teaching styles
• Have IT links
• Be student friendly
• MUST link closely to National Curriculums
Development
of Junior and Senior Characters
‘Girly look’
Hair styles
Clothing
Amy and Harry
Development of bug characters
Junior bugs
Good Bugs
Senior bugs
Bad Bugs
Bacteria
Fungus
Viruses
e-Bug Lesson Plan for Junior Schoolchildren
1. Introduction to microbes
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They are found everywhere even though you can’t see them.
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There are three types of micro-organisms.
2. Good Microbes
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Good bacteria keep us healthy.
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Bacteria can be put to good use.
3. Bad Microbes
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Sometimes microbes can make us sick.
4. Prevention of Infection
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Prevention when possible is better than cure.
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Keep your bad microbes to yourself.
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Our body helps defend against microbes.
Hand hygiene
How, When and Why to wash your hands
Respiratory hygiene
Cover your coughs and sneezes
Vaccines
Vaccines are important to prevent a range of infections (including the flu).
There are not vaccines for ALL infections.
5. Treatment of Infection
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Most common infections get better on their own through time, bed rest, liquid intake
and healthy living.
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Antibiotics : If you have antibiotics, finish the course!
Junior Microbe activity
Respiratory Hygiene activity
Best part:
sneezing
because you get
to use the snot
gun
Holding a tissue in
front of your nose
spreads less germs
Junior antibiotic activity
It really hurts
and I think
I’m getting a
cough.
Don’t you have any
antibiotics at home you
can take?
Best part:
Reading
the comic
What we learnt:
Not to use
someone elses
antibiotics
All antibiotics
are different
e-Bug Lesson Plan for Senior Schoolchildren
1. Introduction to microbes
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There are three different types of microorganisms (bacteria, viruses, fungi).
They are found everywhere even though you can’t see them.
They are found in your body.
2. Good Microbes
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Good bacteria can help keep us healthy.
Most microbes are good for us. They can be put to good use.
We need bacterial colonisation to live a healthy life (normal flora). Protect your flora.
3. Spread and Prevention of Infection
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Sometimes microbes can make us sick.
Prevention where possible is better than cure.
Don’t spread your bad microbes to others.
Our body helps defend against microbes.
Different routes of infection are hands, water, air, blood.
1.
2.
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Hand hygiene - How, When and Why to wash your hands.
Respiratory hygiene - Cover your coughs and sneezes .How and why this is important.
Vaccines - Vaccines help prevent a range of bacterial and viral infections .Previously common infections are rare due to vaccines .There
are not vaccines for all infections. Most common infections are not prevented by vaccines.
4.
Sexually transmitted infections
4. Treatment of Infection
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Most common infections get better on their own through time, bed rest, liquid intake and healthy living.
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Antibiotics - If you have antibiotics, finish the course. Do not use leftover or other people antibiotics.
Overuse of antibiotics can damage our normal / good bacteria. Bacteria are becoming resistant to
antibiotics due to overuse.
Food hygiene activity
Seeing the
microbes was
really cool
It was a
different type
of lesson
It was really hard
to keep the
bacteria off the
salad
Germs can
spread very
easily
Always wash
hands when
dealing with food
I never knew
bacteria were
alive
Hand hygiene activity
There are loads of
bacteria on your
body
I learnt to wash my
hands all the time
I learnt how to
stop microbes
spreading
Proper handwashing
10 teps
1. Water your hands in pouring warm water.
2. Soap all your hands.
3. Soap your palms.
4.
Soap between fingers.
5.
Soap back of your hands
6.
Soap your nails and under nails.
7.
Soap your wrists.
8.
Water your hands and dry them with a paper towel.
9.
Close the water tap with the towel.
10. Open the door with the paper towel and
throw it to the basket!
Senior antibiotic activity
That’s amazing
– this bug’s
killed by all of
them
Development of Website
www.e-Bug.eu
– All pack content
– Teacher presentations to aid lesson plans
– Games for classroom or home play
– Revision sections for students
e-Bug Time-lines
1-3m
Jun 06 - Aug 06 appoint UK staff
3-12m
Sep 06 - May 07 research across Europe
13-21m Jun 07 - Feb 08 pack and website in England
22-27m Mar 08 - Aug 08 translation in 9 AP countries
27-39m Aug 08 - Aug 09 dissemination in AP countries
22-39m Mar 08 - Aug 09 evaluation in 3 AP countries
36m
May 09
presentation to collaborating
countries
2010
final version translated to all
European languages and distributed
Pack Evaluation
• France, Czech Republic and England
• Control and Intervention schools
– 86 schools and 6290 students (52% senior)
– Questionnaires pre and 2-4 weeks post activities
• Significant increase in knowledge in all activity
areas
Where e-Bug fits into the Curriculum
Primary
Secondary
Belgium
Science
Science
Czech Republic
Science*
Science
Biology
Chemistry
Homeland study
Denmark
Science
Science
France
Science
Science
Great Britain
Science
Science
Biology
PSHE
Greece
Science
Science
Italy
Science
Science
Poland
Science
Science
Perio
Religion
Portugal
Science
Science
Spain
Science
Science
* And in Slovenia, Slovakia and Latvia science (natural and social) account for the
largest portion of time in the curriculum.
e-Bug in the Czech Republic
Implementation
• Review - adaptation to the CR school system
• Translation - pack and website (available Sept. 09)
• Promotion
- Teachers fairs and science fairs (2008 - 2010).
− Links in packs to related websites and vice versa.
− Information letter to all primary and secondary schools (August ’09).
− Teachers magazines and websites
− Science teachers networks
• Endorsement - Project supported by Ministries of Health and Education
and Johnson&Johnson
• Printing – All Czech primary and secondary schools received a free printed
copy (4,000 primary and 3,600 secondary schools)
Prevention of Infections
Role of the Public Health Officer
(CR – Hygiene of Children and Youth)
Law No.258/2000 on public health protection
• Regular assessment of school environment
according to hygienic standards and regulations
(microclimate – temperature, ventilation,
cleanliness of the facility, etc.)
• Consultant or coordinator of school health
promotion programmes
Construction, technical and microclimatic
conditions
• Law No.183/2006 on district planning and
construction regulations
• Directive No.268/2009 on general technical
requirements on buildings
• CSN 73 4108 – cloakrooms, washrooms and
toilets
Hygiene of school facilities
MoH Directives No. 410/2005, No. 343/2009
on hygienic requirements on facilities and
regimen of educational facilities for children and
youth:
- incl. requirements on hygienic facilities (toilets,
washrooms – e.g. 1 washbasin/20 children, soap
container, hand dryer or paper towels)
Ambient temperature
Direct. No. 343/2009
• defines requirements on ventilation and
parameters of microclimatic conditions
(temperature, circulation velocity, relative
moisture of air)
• defines measures in higher values
(ventilation, heating regulation) and lower
values in the classroom (3 days below 18oC or
1 day below 16oC – school attendance is
stopped)
Air quality
Directive No. 268/2009
• max. concentration of CO2 acceptable for
ambient environment – 1000 ppm.
• regular ventilation recommended
www.e-Bug.eu