THE ANTIBIOTIC RESISTANCE CRISIS THE ANTIBIOTIC RESISTANCE CRISIS

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THE ANTIBIOTIC RESISTANCE CRISIS

THE ANTIBIOTIC RESISTANCE CRISIS

THE ANTIBIOTIC RESISTANCE CRISIS • • • HISTORY OF BACTERIA HISTORY OF ANTIBIOTICS RESISTANCE

THE ANTIBIOTIC RESISTANCE CRISIS • • • HISTORY OF BACTERIA HISTORY OF ANTIBIOTICS RESISTANCE THE PROBLEM NOW NEVADANS FOR ANTIBIOTIC AWARENESS

HISTORY OF BACTERIA HAVE BEEN AROUND LONGER THAN ANY LIVING THING ON EARTH. FOSSIL

HISTORY OF BACTERIA HAVE BEEN AROUND LONGER THAN ANY LIVING THING ON EARTH. FOSSIL EVIDENCE DATES BACK 3. 5 BILLION YEARS.

HISTORY OF BACTERIA EARTH AS A DAY: 5: 00 AM - BACTERIA APPEAR 10:

HISTORY OF BACTERIA EARTH AS A DAY: 5: 00 AM - BACTERIA APPEAR 10: 00 PM - DINOSAURS APPEAR 11: 59 PM - HUMANS APPEAR

HISTORY OF BACTERIA REPRODUCTION BINARY FISSION CLONE OF ORIGINAL WITH SAME DNA FAST PROCESS

HISTORY OF BACTERIA REPRODUCTION BINARY FISSION CLONE OF ORIGINAL WITH SAME DNA FAST PROCESS ONE BACTERIUM CAN PRODUCE ONE BILLION CLONES IN TEN HOURS

HISTORY OF BACTERIA REPRODUCTION MUTATION A CHANGE, SO THAT THE “NEW” BACTERIA IS SLIGHTLY

HISTORY OF BACTERIA REPRODUCTION MUTATION A CHANGE, SO THAT THE “NEW” BACTERIA IS SLIGHTLY DIFFERENT THAN THE ORIGINAL

HISTORY OF BACTERIA REPRODUCTION IF THE ENVIRONMENT IS RIGHT, THE “NEW” BACTERIA MAY SURVIVE

HISTORY OF BACTERIA REPRODUCTION IF THE ENVIRONMENT IS RIGHT, THE “NEW” BACTERIA MAY SURVIVE BETTER AND REPRODUCE, PASSING ALONG THE MUTATION

HISTORY OF ANTIBIOTICS 1928 – DR. FLEMING DISCOVERS PENICILLIN FROM BREAD MOLD 1944 –

HISTORY OF ANTIBIOTICS 1928 – DR. FLEMING DISCOVERS PENICILLIN FROM BREAD MOLD 1944 – U. S. MILITARY TAKES PENICILLIN TO THE BATTLEFIELD 1945 – BACTERIA WITH RESISTANCE TO PENICILLIN ISOLATED

HISTORY OF ANTIBIOTICS RESISTANCE 1960 s – METHICILLIN INTRODUCED 1991 – 29% OF STAPH

HISTORY OF ANTIBIOTICS RESISTANCE 1960 s – METHICILLIN INTRODUCED 1991 – 29% OF STAPH AUREUS RESISTANT 2001 – 62% OF STAPH AUREUS RESISTANT

HISTORY OF ANTIBIOTICS RESISTANCE BACTERIA MUTATE TO PROTECT THEMSELVES FROM ANTIBIOTICS

HISTORY OF ANTIBIOTICS RESISTANCE BACTERIA MUTATE TO PROTECT THEMSELVES FROM ANTIBIOTICS

HISTORY OF ANTIBIOTICS RESISTANCE THE MUTATED BACTERIA SURVIVE AFTER THE ANTIBIOTICS ARE GONE

HISTORY OF ANTIBIOTICS RESISTANCE THE MUTATED BACTERIA SURVIVE AFTER THE ANTIBIOTICS ARE GONE

HISTORY OF ANTIBIOTICS RESISTANCE EVENTUALLY THERE ARE MORE ANTIBIOTICRESISTANT BACTERIA THAN NON-RESISTIANT

HISTORY OF ANTIBIOTICS RESISTANCE EVENTUALLY THERE ARE MORE ANTIBIOTICRESISTANT BACTERIA THAN NON-RESISTIANT

HISTORY OF ANTIBIOTICS RESISTANCE THE MUTATED BACTERIA REPRODUCE, PASSING ALONG THE RESISTANCE TO THEIR

HISTORY OF ANTIBIOTICS RESISTANCE THE MUTATED BACTERIA REPRODUCE, PASSING ALONG THE RESISTANCE TO THEIR OFFSPRING

HISTORY OF ANTIBIOTICS RESISTANCE BACTERIA CAN ALSO SWAP GENES, UNDER THE RIGHT CONDITIONS, SO

HISTORY OF ANTIBIOTICS RESISTANCE BACTERIA CAN ALSO SWAP GENES, UNDER THE RIGHT CONDITIONS, SO DRUG-RESISTANT GERMS CAN SHARE THEIR RESISTANCE MECHANISMS

THE PROBLEM NOW 1991 1999 2000 2001

THE PROBLEM NOW 1991 1999 2000 2001

THE PROBLEM NOW 2000 2001

THE PROBLEM NOW 2000 2001

THE PROBLEM NOW > 50% OF HOSPITAL ACQUIRED BLOODSTREAM INFECTIONS ARE CAUSED BY METHICILLIN-RESISTANT

THE PROBLEM NOW > 50% OF HOSPITAL ACQUIRED BLOODSTREAM INFECTIONS ARE CAUSED BY METHICILLIN-RESISTANT STAPH AUREUS (MRSA) > 70% OF NURSING HOME STAPH INFECTIONS ARE CAUSED BY MRSA

THE PROBLEM NOW “THERE ARE PATIENTS TODAY IN HOSPITALS FOR WHOM THERE ARE NO

THE PROBLEM NOW “THERE ARE PATIENTS TODAY IN HOSPITALS FOR WHOM THERE ARE NO EFFECTIVE THERAPIES. ” Gary Doern Director of Clinical Microbiology University of Iowa

NEVADANS FOR ANTIBIOTIC AWARENESS • WHO WE ARE • • WHAT WE HAVE DONE

NEVADANS FOR ANTIBIOTIC AWARENESS • WHO WE ARE • • WHAT WE HAVE DONE WHAT WE ARE DOING RESULTS HOW CAN YOU HELP

NEVADANS FOR ANTIBIOTIC AWARENESS WHO WE ARE A STATEWIDE TASK FORCE THAT HAS BEEN

NEVADANS FOR ANTIBIOTIC AWARENESS WHO WE ARE A STATEWIDE TASK FORCE THAT HAS BEEN IN EXISTENCE SINCE FEBRUARY 2001 3 SUBCOMMITTEES • PUBLIC AWARENESS • PROVIDER EDUCATION • INFECTION CONTROL AND SURVEILLANCE

NEVADANS FOR ANTIBIOTIC AWARENESS WHAT WE HAVE DONE PUBLIC AWARENESS • TV, RADIO SPOTS

NEVADANS FOR ANTIBIOTIC AWARENESS WHAT WE HAVE DONE PUBLIC AWARENESS • TV, RADIO SPOTS IN SPANISH AND ENGLISH AIRING 400 -500 TIMES PER MONTH • NEVADA LEGISLATURE PASSED A BILL SUPPORTING NAA • GOVERNOR GUINN ISSUED A PROCLAMATION SUPPORTING NAA

NEVADANS FOR ANTIBIOTIC AWARENESS WHAT WE HAVE DONE PUBLIC AWARENESS • EDUCATION PROGRAMS WERE

NEVADANS FOR ANTIBIOTIC AWARENESS WHAT WE HAVE DONE PUBLIC AWARENESS • EDUCATION PROGRAMS WERE COMPLETED FOR ALL CLARK AND WASHOE COUNTY SCHOOL NURSES AND THEIR AIDES • A 9 TH AND 10 TH GRADE SUPPLEMENTAL CURRICULUM BASED ON THE SURVIVOR SERIES IS BEING USED IN CLARK AND WASHOE COUNTIES

NEVADANS FOR ANTIBIOTIC AWARENESS WHAT WE HAVE DONE PUBLIC AWARENESS • > 10, 000

NEVADANS FOR ANTIBIOTIC AWARENESS WHAT WE HAVE DONE PUBLIC AWARENESS • > 10, 000 BOOKMARKS HAVE BEEN DISTRIBUTED BY THE WASHOE COUNTY LIBRARY SYSTEM • MAJOR PHARMACY CHAINS HAVE DISTRIBUTED > 100, 000 BOOKMARKS

NEVADANS FOR ANTIBIOTIC AWARENESS WHAT WE HAVE DONE PUBLIC AWARENESS • EMERGENCY ROOMS AND

NEVADANS FOR ANTIBIOTIC AWARENESS WHAT WE HAVE DONE PUBLIC AWARENESS • EMERGENCY ROOMS AND QUICK-CARE CENTERS ARE DISPLAYING OUR POSTERS AND BROCHURES (SPANISH & ENGLISH) • RECENT ANTIBIOTIC RESISTANCE INFORMATION HAS BEEN SENT TO ALL CLARK COUNTY CHILD CARE CENTERS

NEVADANS FOR ANTIBIOTIC AWARENESS WHAT WE HAVE DONE PROVIDER EDUCATION • PROVIDER PACKETS WERE

NEVADANS FOR ANTIBIOTIC AWARENESS WHAT WE HAVE DONE PROVIDER EDUCATION • PROVIDER PACKETS WERE SENT TO ALL PRIMARY CARE PHYSICIANS IN 2002 AND 2003 • A CME PROGRAM WAS CONDUCTED FOR > 150 PHYSICIANS IN NORTHERN NEVADA • A HOSPITALIST EDUCATION PROGRAM HAS BEEN IMPLEMENTED IN CLARK COUNTY

NEVADANS FOR ANTIBIOTIC AWARENESS WHAT WE HAVE DONE PROVIDER EDUCATION • PRESENTATIONS TO UMC

NEVADANS FOR ANTIBIOTIC AWARENESS WHAT WE HAVE DONE PROVIDER EDUCATION • PRESENTATIONS TO UMC SECOND-YEAR RESIDENTS HAVE BEEN MADE • INDIVIDUAL PROVIDER OFFICE VISITS IN ELKO AND PAHRUMP HAVE BEEN COMPLETED • A PRESENTATION REGARDING NAA WAS MADE AT A CDC CONFERENCE

NEVADANS FOR ANTIBIOTIC AWARENESS WHAT WE ARE DOING • EXPANDING EFFORTS TO IMPROVE INFECTION

NEVADANS FOR ANTIBIOTIC AWARENESS WHAT WE ARE DOING • EXPANDING EFFORTS TO IMPROVE INFECTION CONTROL AND SURVEILLANCE WITH THE CDC 12 -STEP PROGRAM • FINISHING DEVELOPMENT OF NAA WEB SITE • DEVELOPING AND IMPLEMENTING CHILD CARE PROFESSIONAL PROGRAM • INCREASING MEDICAL SCHOOL/RESIDENCY INVOLVEMENT

NEVADANS FOR ANTIBIOTIC AWARENESS WHAT WE ARE DOING • INCREASING PHARMACY SCHOOL INVOLVEMENT •

NEVADANS FOR ANTIBIOTIC AWARENESS WHAT WE ARE DOING • INCREASING PHARMACY SCHOOL INVOLVEMENT • EXPANDING EFFORTS TO IMPROVE INFECTION CONTROL IN LONG TERM CARE AND SKILLED NURSING FACILITIES • CONTINUING MEDIA CAMPAIGN AND ALL OTHER CURRENT EFFORTS TOWARD PUBLIC AND PROVIDER EDUCATION

NEVADANS FOR ANTIBIOTIC AWARENESS RESULTS Number of Antibiotic Scripts Filled per Member per Month

NEVADANS FOR ANTIBIOTIC AWARENESS RESULTS Number of Antibiotic Scripts Filled per Member per Month HPN Consolidated (Commercial and Medicare) 2000 – 2002

NEVADANS FOR ANTIBIOTIC AWARENESS HOW YOU CAN HELP • CONTINUE WORKING WITH THE INFECTION

NEVADANS FOR ANTIBIOTIC AWARENESS HOW YOU CAN HELP • CONTINUE WORKING WITH THE INFECTION CONTROL/SURVEILLANCE COMMITTEE • INVITE US TO MAKE A PRESENTATION TO YOUR PHARMACY AND THERAPEUTIC COMMITTEE • WORK WITH HEALTHINSIGHT IN OUR SURGICAL INFECTION PREVENTION PROGRAM