Pilot Project Grande Prairie value of educating value of - - PowerPoint PPT Presentation

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

Grande Prairie 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 Capital Health Alberta Lung Association University

• f

Alberta Partners

Nursing Infection Control Pharmacists Physicians Health Care Professionals Dentists Public Health

Website Grade 2 Student Program Daycare Centre Program Print Materials Media Campaign Public Education Strategies

Pamphlet Parent Guide Project poster Handwashing signs Stickers Activity placemat

9 PRINT RESOURCES

Persian Chinese simplified Arabic French Vietnamese Chinese traditional Punjabi Spanish Translations

Distribution of Print Materials – Healthcare Professionals

Dentists Pharmacists Public Health Healthcare Professionals Occupational Health Infection Control Physicians Continuing Care

Distribution of Print Materials - Public

Public Transport Restaurants Senior Centres Schools Recreation Centres Public Daycare Centres Businesses University of Alberta Churches Library

Website www.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%

Kids 14.5% Multilingual 10.5% Teachers 8.5% Parents 5.1% Occupational health 0.3% Daycare * 3.0% Public 3.5%

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 living Staff Relatives

Taught by: Post secondary students High 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 1998-1999 Pilot 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 teaching

Inter 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 teaching

Grant 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 kits

Teaching

• 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 Program

7 question survey post program – 119 teacher responses

• 50% responses:

5/5 for all questions Overwhelmingly positive responses/comments

Post secondary students

(P <0.01)

10 20 30 40 50 60 70 80 90 100 pre survey post survey expect antibiotics for cold/flu colds due to viruses antibiotics not helpful in flu use of antibacterial soap

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%

Daycares Handwashing 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 % List Handwashing Pre intervention Post 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 % Answer Viruses Pre intervention Post 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 % Yes Pre intervention Post 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 % Yes Pre intervention Post intervention * p=<0.05

Parents

p < 0.01

– less likely to expect antibiotics for cold/flu – reduced use of antimicrobial soap

Program expansion

2005 - 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 expansion

2006 - 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 communities compensated 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