1. 2 global travel – who goes? 3 global links of ndm to the uk kumarasamy et al., lancet infect...
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Global Travel – who goes?
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Global Links of NDM to the UK
Kumarasamy et al., Lancet Infect Dis 2010 10:597-602
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15 million Visitors to the UK 2011Country Rank (by
number)Visitors (000)
USA 1 2,484
Italy 7 1,526India 16 350Brazil 19 276
Greece 25 225Israel 31 164China 33 149Nigeria 34 142Pakistan 48 65
0
2,000
4,000
6,000
8,000
10,000
12,000
14,000
2005 2006 2007 2008 2009 2010 2011
Year
Vis
ito
rs (
000)
Holiday
VFR
Business
Other
Visitors to the UK by Purpose – potential for MDR GN household spread
Patient Number Patient No’s
Total completed NHS admission episodes in England 2011*
14,890,844
Total admissions UCLH** 127,364
Total overseas** 1631
Total transferred from another NHS provider**
19
Total transferred from a private provider**
8
Total overseas patients transferred from private provider**
0
Total projected overseas patient admissions 190,751
*HES Data** P. Wilson Pers Comm
Potential Impact of Overseas Patients
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Carbapenemase-producing Enterobacteriaceae
in the UK (n = 1659)
Neil Woodford: AMRHAI, Unpublished data
Early cases often imported
Imported & ‘home grown’
Currently very limited knowledge on basic epidemiology.
CRO carriage rates in specific high risk groups allowing targeted screening?
Duration of carriage? Optimal method of patient screening – rectal
swabs – reliability of self swabbing? Optimal laboratory screening method? Transmission rates in home/hospital? Efficacy of decolonisation and isolation? Cost effectiveness of interventions?
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PoliticalCommitment & Investment
Aggressive Infection ..Control• Screening• Isolation• Reinforced Hand ..Hygiene• Contact precautions
SurveillanceTargeted & Structured
Concerted Action Required: ALL Sectors
Focussed Clinical Research
Cross CuttingAntibiotic Policy
AntimicrobialStewardship
Simpler cheaper
laboratory tests
Centralised Reporting
•incl private sector
Unified Strategic Policy in DH/NHS
RenewedDrug Pipeline
Improved GlobalIntelligence
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What is the key priority ?
Refocus NHS Infection Prevention and Control onto MDR GNB
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Serious threat to routine care in the NHS