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National Mandate
To decrease antibiotic prescriptions in respiratory tract infections by 25%
1997- Canadian Committee Antibiotic Resistance (CCAR)
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3 Key Messages
Handwashing
- most important way to prevent infection
Not all bugs are created equal- bacteria and viruses are different
Antibiotic resistance is a problem - use antibiotics wisely
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Pilot Project
GrandePrairie
value of educating pharmacists
12%↓ antibiotic prescriptions ↓ antibiotics / capita
value of educating children
↑use of first line antibiotics
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A Community Project for Wise Use of Antibiotics
Capital Health
Population 1,000,000
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Alberta Medical
Association
CapitalHealth
Alberta Lung
Association
University of
Alberta
Partners
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Nursing Infection Control
Pharmacists
Physicians
Health Care Professionals
Dentists
Public Health
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Website
Grade 2 StudentProgram
Daycare CentreProgram
Print Materials
MediaCampaign
Public Education Strategies
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Pamphlet
Parent Guide
Project posterHandwashing signs
Stickers
Activity placemat
9 PRINT RESOURCES
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Persian
Chinesesimplified
Arabic
French
Vietnamese
Chinesetraditional
Punjabi
Spanish
Translations
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Distribution of Print Materials – Healthcare Professionals
DentistsPharmacists
Public Health
Healthcare Professionals
OccupationalHealth
Infection Control
Physicians
ContinuingCare
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Distribution of Print Materials - Public
Public TransportRestaurants
Senior Centres
Schools
Recreation Centres
PublicDaycare Centres
Businesses
University of Alberta
Churches
Library
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Websitewww.dobugsneeddrugs.org
All programs on-line
Translations
Kid’s section with games
Tips of the week
Links
Over 2,000,000 hits per year
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Healthcare professionals
54.5%
Kids14.5%
Multilingual10.5%
Teachers8.5%
Parents5.1%
Occupational health0.3%
Daycare *3.0%
Public3.5%
Website file use
* Introduced March 2003
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Children Programs
– Daycare Program– Assisted Living Program– Grade Two Program
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Daycare Program
Target:Daycare children
Staff
Parents
Disseminated by:Pharmacists and public health nurses
Nursing students
Train the trainer program
→ Instruction for early childhood education students
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Bugaloo glove puppet
“Prop Box”Bug Toss
Game
DAYCARES
Invisible Germs
Pick - a - bug
Wash the bugs away
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Assisted Living Program
Target:Adults in assisted livingStaffRelatives
Taught by:Post secondary studentsHigh school students
Note: New program for 2006
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Dark light, gel and powder
Bug Bingo
Assisted Living Program
Large print
Crossword Puzzle
Word Search
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Grade Two Program
Target:Grade two children
Parents
Teachers
Taught by:Post secondary students in healthcare fields
Public health nurses, pharmacists, physicians
Older children in the same school
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Development of Grade 2 program
Grande Prairie 1998-1999Pilot project• Handwashing presentation to Grade 2 students
– No formal presentation of other key messages– Presented by community and hospital pharmacists,
public health nurses• Survey sent home for parents
– Prize for classroom returning the most surveys• Print materials
– Project poster, stickers “Bugsy Says Wash Your Hands” sign, tattoos
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Awareness of Handwashing as a Preventative Measure Comparison of General Public, Grade 2 Parents, and Age-Matched Cohort
(P<0.001)
39.5
78.2
40
60.5
21.8
60
Pre-Project Public(n =979) Mid-Project
Grade 2 Parents
(n = 408)
Pre-Project Public < 45 yr
(n=618)
0%
20%
40%
60%
80%
100%
Yes No
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Development of Grade 2 Program
Capital Health
Print materials
– Parent guide – Project poster– Program pamphlet– Activity Placemat– “Bugsy Says Wash Your Hands” sign– Stickers
• “Tell Germs to Bug Off ”• Bugsy
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Development of Grade 2 program
Capital Health Grade 2 program
– Development of formal presentation for Grade 2 students – 1 hour
– Program packaged into easily transported kit
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Grade 2 presentation
Activity 1 (20 minutes)• Do Bugs Need Drugs? Interactive dialogue with
Bugsy hand puppet – (15 min)
• Resource book – 5 minutes
– “Germs Make Me Sick”
Berger,Melvin and Marilyn Hafner: Harper Collins New York 1995
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Grade 2 presentation
Activities 2/3 (20-25 minutes)
• “Bacteria and Viruses are Different”
– Four coloured overheads
• Handwashing demonstration
– fluorescent lotion and black light
» Glogerm Company http://www.glogerm.com
– “Twinkle Twinkle Little Star”
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Grade 2 presentation
Activity 4 ( 3 minutes )• Game with colouring sheets
Activity 5 (5 minutes)• Skit
– Bugsy in doctor’s office
videotape available
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Grade 2 presentation
Optional Activities (2 minutes)
• Poems / Songs
– Those Bugs Don’t Need Drugs
– Do Bugs Need Drugs?
– Wash, Wash, Wash Your Hands
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GRADE TWO KIT
Bugsy puppet
Overheads
Dark light and gel
Book
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When to Wash Hands
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How to Wash Hands
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Student Education Program
Students• Children enrolled in Grade 2
Teachers • Students in healthcare faculties
– Interdisciplinary Course – University of Alberta
– Grant MacEwan College Nursing Program
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Student teachingInter D 410 course• University students enrolled in health related fields
– enrollment 700-900/year
Training (3 hours)• Classroom orientation by infectious diseases physician• Small group orientation to Grade 2 teaching kits
Teaching• Inter D staff schedules Grade 2 classes for teaching
– Teach Grade 2 classes as interdisciplinary team (3 hours)• Program now running for 6 years
– 60 Grade 2 classes / year
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Student teachingGrant MacEwan College• Partnership with nursing program
– enrollment 300 students
Training (2-3 hours)• Classroom orientation by pharmacy expert
Faculty of Pharmacy –University of Alberta• Small group orientation to Grade 2 teaching kitsTeaching• teach grade two students as part of community placement in
public health clinics– Scheduling in conjunction with Capital Health Public
Health Clinics• Teach in groups of 3-4
– Teach 200 classrooms / year
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Student Education Program
Endpoints:
1) Target parents through educational sessions for their children at school
2) Innovative partnership with post secondary institutions to train future healthcare professionals
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Teachers
Evaluation of Program7 question survey post program– 119 teacher responses
• 50% responses:
5/5 for all questions
Overwhelmingly positive responses/comments
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Post secondary students (P <0.01)
0102030405060708090
100
presurvey
postsurvey
expectantibiotics forcold/flucolds due toviruses
antibiotics nothelpful in flu
use ofantibacterialsoap
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The Effect of Hand Hygiene on Illness Rate Among Students in University Residence Halls
AJIC 2003;31:364-70
College dorms randomized :Alcohol hand rubs in various locations vs. no alcohol hand rub
Alcohol hand rub groups: 14.8% -39.9% reduction in respiratory illness symptoms 43% fewer sick days
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Daycare Centre Program
Funded by grant from Health Innovation Fund –Alberta Health ($220,000)
2001- 2003
– 101 daycares in Edmonton – 40.1%
– 65 daycares in Calgary (control) – 41.9%
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DaycaresHandwashing as a way to prevent the
spread of infection.
* *
70.0
75.0
80.0
85.0
90.0
95.0
A B C CONTROL
Study Group
% L
ist
Handw
ash
ing
Pre interventionPost intervention
* p=<0.05
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Daycares
Are colds caused by bacteria or viruses?
*
*
60.0
65.0
70.0
75.0
80.0
85.0
A B C CONTROL
Study Groups
% A
nsw
er
Vir
use
s
Pre interventionPost intervention
* p=<0.05
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Daycares
If you had a cold, would an antibiotic help you get better?
*
*
0.0
2.0
4.0
6.0
8.0
10.0
12.0
14.0
16.0
A B C CONTROL
Study Group
% Y
es
Pre interventionPost intervention
* p=<0.05
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Daycares
Use an antibacterial soap at home?
*
*
0.0
5.0
10.0
15.0
20.0
25.0
30.0
35.0
40.0
45.0
A B C CONTROL
Study Groups
% Y
es
Pre interventionPost intervention
* p=<0.05
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Parents
p < 0.01
– less likely to expect antibiotics for cold/flu
– reduced use of antimicrobial soap
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Program expansion2005 - British Columbia Pharmacare division of government
– Grant $1,300,000 for 3 years– Dissemination of Program
• Media campaign• Physician / pharmacist education
– Distribution of Bugs and Drugs book• Grade 2 program
– Coordinated by Public Health• Daycare program
– Fall 2006
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Program expansion
British Columbia Grade 2 program
– 150 nursing students
– Vancouver Coastal
» other regions coming on board
– 118 schools
» 209 Grade 2 classes
» 4218 children
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Program expansion
British Columbia
2006 - Michael Smith Foundation
$98,000 grant for evaluation of program
2007 – start of physician/pharmacist education programs
??funding
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Program expansion
2006 - Alberta
Alberta Health division of government– Grant $1,000,000 for 2 years– Further dissemination of program
• Train the trainer program – pharmacists• Target of 50 pharmacist trainers by end of
2007
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Program expansion2006 - Alberta
• Canadian Council Continuing Education in Pharmacy (CCCEP)
– 4 continuing education credits• 176 pharmacists attended course
50 trainers – achieved target in 4 months!– commit to 9 hours of teaching in their
communitiescompensated for their time
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Program expansion
2006/2007 - Alberta pharmacists
• Teach to nursing students→ Grade 2 program
• Early childhood education students→ Daycare program
• Nurses in long term care→ Assisted Living program
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Effect of Handwashing on Child Health: A Randomised Controlled Trial
Lancet 2005;366:225-233
Squatter settlements in Karachi, Pakistan• 50% reduction in pneumonia
• 53% reduction in diarrhea
• 34% reduction in impetigo
No difference between plain soap and antibacterial soap
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Sharon Mitchell
Deb Wilson
Mary Carson
Edith Blondel-
Hill
Marilyn Tomney
Susan Fryters
PARTNERS IN DEVELOPMENT