2. Antimicrobial resistance in Finland
Antimicrobial resistance (AMR) situtation in Finland still rather
good.
– Certain multi-drug resistant (MDR) microbes are an increasing
threat such as MRSA, VRE, ESBL and CPE
Continiously clusters and outbreaks in healthcare facilities
Worsening of the resistance situation
Total consumption of antimicrobials has constantly
decreased.
– Wide-spectrum antimicrobials are used more compared to other
Nordic countries and the Netherlands
– Regional differences in consumption
– Gaps and problems in usage of surveillance data in action
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3. Controlling AMR
National action plan on AMR
– Ministry of Social Affairs and Health, 2017
– Tasks for National Institute for Health and
Welfare (THL)
Developing surveillance and surveillance
indicators
– Antimicrobial resistance
– Antimicrobial consumption
– Healthcare-associated infections (HAI)
Controlling spread and prevention of
infections
– Outbreak investigations
– Guidelines
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4. National expert group for AMR control
Set up by THL (2018–2020)
Tasks are to plan and follow up the implementation of the national plan as
well as to discuss current topics related to AMR which come up nationally
or internationnally.
Members (One health -approach):
– Ministries: Social Affairs and Health (STM), Agriculture and Forestry
(MMM) and Environment (YM)
– THL, Finnish Medicines Agency, Agency of Reimbursement for Medicine
expences, Finnish Food Authority, Zoonotic Center
– Experts: clinical microbiology laboratories, universities, infectious disease
physicians, infection control nurses
– Representatives: healthcare centers (general practitioners), specialty
care, long-term care, university and central hospitals
7/2/2019
https://thl.fi/fi/web/infektiotaudit/yhteystiedot/asiantuntijatyoryhmat/mikrobilaa
ke-resistenssin-torjunnan-kansallinen-asiantuntijaryhma
AMR and HAI, Finland 4
5. Surveillance of AMR
Communicable Diseases Act
(1227/2016) requires
comprehensive surveillance of
AMR.
Surveillance and developing
indicators are mainly THL’s
responsibility, mostly functioning.
All clinical microbiology
laboratories including private
laboratories are participating in
surveillance
Participation in EARS-net
conducted by ECDC
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6. Surveillance of antimicrobial consumption
Surveillance has been conducted
in Finland since 1997 in
collaboration with Finnish
Medicines Agency (Fimea)
So far based on sales data
Problems in surveillance and
usage of surveillance data
Separating consumption in
community vs. hospitals
Age and gender (prescription
data)
Indications (outpatient visits,
eletronic prescriptions)
Participation in ESAC-net
conducted by ECDC
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7. Surveillance of healthcare-associated infections
Finnish Hospital Infection Program (SIRO) collaborates with regional
authorities and experts and acute care hospitals and long-term care
facilities to increase awareness in HAIs and HAI prevention
– THL provides surveillance methods to identify HAI problems
– THL evaluates infection prevention and control activities in acute care
hospitals
– THL drews up guidelines to prevent most common HAIs
– THL support communication between different actors in outbreaks in order
to implement control measures timely
Specialty care/acute care hospitals (Communicable Disease Act 13§)
– National surveillance of certain HAIs
– Annual surveys in infection prevention and control activities
Specialty care/acute care hospitals and long-term care faciliteis
(Communicable Disease Act 13§)
– Prevalence surveys every 5 year in collaboration with ECDC/EU member
states
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8. Outbreak investigations
THL supports outbreak investigations
– Provides typing data for bacteria in order to detect outbreaks and trace
back transmission routes
– Typing done only by THL, no competence or interest elsewhere
– Consultation in control measures
News communication channel (HARVI): Aim is to support information
flow between different actors in order to implement appropriate control
measures timely and detect common threats.
Severe case and susptected outbreak caused by extremely drug-
resistant microbes when consultation is needed (Communicable
Disease Act 36§).
Notifyers: local or regional authority or expert (infectious disease
physician or infection control/public health nurse) or head of a long-
term care facility
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10. 7/2/2019
2 clusters 2013-2018: 20 cases, 16 found in
clinical specimens and four in screening
Cluster 1: 18 cases 5 HCFs, index case unknown
link abroad, 6/18 the same room different time ,
environmental specimens negative
HCF A: 3 cases 2013, 2016, 2017
HCF B: 1 case 2014
HCF C: 8 cases 2015-2017
HCF D: 4 cases 2016-2018
HCF E: 2 cases 2017, 2018
Cluster 2: 2 cases, index case transferred from
Italy, the same room different time (8 months),
contaminated toilet
HCF F: 2 cases 2015 and 2016
AMR and HAI, Finland 10
11. Infection prevention guidelines
Control of healthcare-
associated infections -text
book (publisher THL, 2018)
National guidelines
– Control of multi-drug
resistant microbes
Webinars
– Preventing and controlling
infections in long-term care
Infection prevention
guidelines to hospitals
– Peripheral venous catheters
– Surgical site infections
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12. Communication
Improve public awareness and knowledge in antibiotics and
antimicrobial resistance
Support infection control activities conducted by local and
regional authorities and experts
Annual meetings, webinars and awareness days
– WHO: Hand Hygiene Day in May
– Annually 2-day meeting with regional authorities and experts in
September: discussion on actual topics/problems
– ECDC: Euroepan Antibiotic Awareness Day in November
– Training related to surveillance such as European prevalence
surveys (ECDC-PPS and HALT)
– Training related to guidelines
– Infectious disease news
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