National Mandate

To decrease antibiotic prescriptions in respiratory tract infections by 25%

1997- Canadian Committee Antibiotic Resistance (CCAR)

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

Pilot Project

GrandePrairie

value of educating pharmacists

12%↓ antibiotic prescriptions ↓ antibiotics / capita

value of educating children

↑use of first line antibiotics

A Community Project for Wise Use of Antibiotics

Capital Health

Population 1,000,000

Alberta Medical

Association

CapitalHealth

Alberta Lung

Association

University of

Alberta

Partners

Nursing Infection Control

Pharmacists

Physicians

Health Care Professionals

Dentists

Public Health

Website

Grade 2 StudentProgram

Daycare CentreProgram

Print Materials

MediaCampaign

Public Education Strategies

Pamphlet

Parent Guide

Project posterHandwashing signs

Stickers

Activity placemat

9 PRINT RESOURCES

Persian

Chinesesimplified

Arabic

French

Vietnamese

Chinesetraditional

Punjabi

Spanish

Translations

Distribution of Print Materials – Healthcare Professionals

DentistsPharmacists

Public Health

Healthcare Professionals

OccupationalHealth

Infection Control

Physicians

ContinuingCare

Distribution of Print Materials - Public

Public TransportRestaurants

Senior Centres

Schools

Recreation Centres

PublicDaycare Centres

Businesses

University of Alberta

Churches

Library

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

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

Children Programs

– Daycare Program– Assisted Living Program– Grade Two Program

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

Bugaloo glove puppet

“Prop Box”Bug Toss

Game

DAYCARES

Invisible Germs

Pick - a - bug

Wash the bugs away

Assisted Living Program

Target:Adults in assisted livingStaffRelatives

Taught by:Post secondary studentsHigh school students

Note: New program for 2006

Dark light, gel and powder

Bug Bingo

Assisted Living Program

Large print

Crossword Puzzle

Word Search

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

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

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

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

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

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

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”

Grade 2 presentation

Activity 4 ( 3 minutes )• Game with colouring sheets

Activity 5 (5 minutes)• Skit

– Bugsy in doctor’s office

videotape available

Grade 2 presentation

Optional Activities (2 minutes)

• Poems / Songs

– Those Bugs Don’t Need Drugs

– Do Bugs Need Drugs?

– Wash, Wash, Wash Your Hands

GRADE TWO KIT

Bugsy puppet

Overheads

Dark light and gel

Book

When to Wash Hands

How to Wash Hands

Student Education Program

Students• Children enrolled in Grade 2

Teachers • Students in healthcare faculties

– Interdisciplinary Course – University of Alberta

– Grant MacEwan College Nursing Program

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

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

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

Teachers

Evaluation of Program7 question survey post program– 119 teacher responses

• 50% responses:

5/5 for all questions

Overwhelmingly positive responses/comments

Post secondary students (P <0.01)

0102030405060708090

100

presurvey

postsurvey

expectantibiotics forcold/flucolds due toviruses

antibiotics nothelpful in flu

use ofantibacterialsoap

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

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%

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

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

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

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

Parents

p < 0.01

– less likely to expect antibiotics for cold/flu

– reduced use of antimicrobial soap

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

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

Program expansion

British Columbia

2006 - Michael Smith Foundation

$98,000 grant for evaluation of program

2007 – start of physician/pharmacist education programs

??funding

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

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

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

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

Sharon Mitchell

Deb Wilson

Mary Carson

Edith Blondel-

Hill

Marilyn Tomney

Susan Fryters

PARTNERS IN DEVELOPMENT