Establish a system Bacaan Penuh ( bersaiz 5.5 MB)

Policies and Procedures on Infection Control Ministry of Health Malaysia 171

1. Each hospital shall send report on DDD every 6 months to National Infection

Control and Antibiotic Control Committee. Data on DDD aggregated from all hospitals will be used as national benchmark data aggregated from all hospitals as a comparison to individual local data.

2. However, individual local data shall be reported according to discipline

department on regular basis

3. It is recommended to have a national benchmark data specifically for Intensive

Care Unit ICU, considering its high usage of antimicrobial and higher incidence of antimicrobial resistance

4. It is also beneficial if each state have their own benchmark data from their

secondary and tertiary hospitals which can be used to compare the prescribing pattern

5. A report of local monitoring data for hospital compared with national

benchmark i.e aggregate summary data from all hospital in this program should be disseminated to all hospital

6. The aggregate benchmark data included numeric presentation of pooled

means, medians, and key percentile distributions of prevalence of selected antimicrobial-resistant organisms and maybe stratified by certain specific discipline, such as ICU.

7. This report shall recognized excessive use of specific antimicrobial agents

against problematic pathogen. Upon receiving the report, the respective hospital; through Hospital Infection and Antibiotic Control Committee HIACC shall give feedback and report to the main committee on any antimicrobial control practice and strategies to improve their control on specific antimicrobial of concern.

12.3.3 Correlation between antimicrobial use and resistance rate

Recent reports from the special task force of the American Society for Microbiology and from a joint committee of the Society of Healthcare Epidemiology of America and the Infectious Disease of America advocate that individual hospitals monitor the relationship between antimicrobial use and resistance within specific patient-care areas Reports of the ASM Task Force on Antibiotic Resistance, 1995. A graphic analysis done by Harbath et al 2001 can be used as an example to assess this relationship, it is done by plotting DDDs per 1000 patients days for specific antibiotic class of interest agains susceptibility percentages of unique nosocomial isolates, according to time and space i.e year and ward, third generation cephalosporin was plotted against Enterobacteriaceae for example refer to Appendix 1. Since we are monitoring both data of antimicrobial use and resistance rate, it will be more meaningful if we can plot both data in one graph. Therefore the committee have to select which antimicrobial use is to be plotted against which resistance rate of concern. Here are a few suggestions : • Third generation cephalosporins and ESBL • Cefoperazonesulbactam and Acinetobacter spp