Session 1: Welcome to the programme Facilitator notes: Control of Multidrug Resistant Micro-Organisms in Health Care Settings Session 1: Welcome to the programme Version: June 2011

Overall objectives of the programme: Introduction to Programme Explore the level of knowledge and expertise within the group  Consolidate advanced knowledge of mechanisms in relation to the emergence and spread of MDROs in hospital settings and the epidemiological local, national and international consequences Review knowledge of the microbiological background on resistance to anti- infective agents and collateral damage from antibiotic prescribing

Overall objectives of the programme: Laboratory Investigations, Diagnostics & Susceptibility Testing Critically evaluate the clinical effectiveness and costs effectiveness of currently available laboratory based MDRO tests Discuss the importance of the rapid and accurate communication of laboratory results to key personnel involved immediate patient management

Overall objectives of the programme: Good Laboratory Practice Critically review the clinical importance of quality and safety issues surrounding current laboratory practice Demonstrate an ability to communicate and report effectively with public health departments related to the management of MDROs . Critically appraise the role of the diagnostic laboratory in outbreak management.  This topic is especially challenging to review or discuss from EU perspective, as each MS has its own system; the UK system should not be taken as generally applicable here  

Overall objectives of the programme: Antibiotic Stewardship With critical insight, scrutinise the impact of prescribing on the prevention and control of MDROs With critical insight, interpret the impact of local and national policies for antibiotic prescribing in relation to prevention and control of MDRO HAIs in acute settings Critically analyse the content, availability and dissemination of policies and guidelines for antibiotic prescribing in the hospital Discuss the relative merits of persuasive, restrictive and structural interventions Critically review measures for improvement of prescribing in terms of process and outcome

Overall objectives of the programme: Infection Control Critically analyse the principles of infection prevention and control practices in relation to MDRO in a hospital setting Critically review the evidence base for local policies and protocols including preventative strategies Demonstrate the importance to MDRO of preventing all hospital acquired infections Critically evaluate the effectiveness of different interventions in minimising the transmission of MDROs

Overall objectives of the programme: Surveillance Identify surveillance systems both local and national in each member state  Critically evaluate methods of surveillance for MDRO acquired infections in healthcare settings Critically review systems for local microbiological surveillance and early warning systems; propose strategies for use in clinical areas Critically review surveillance of antimicrobial consumption and drug utilisation review

Overall objectives of the programme: Application to Practice 1 Critically appraise systems to prevent transmission of MDRO infections including patient isolation, in hospital settings. With critical insight, review the potential barriers to successful implementation of these systems Demonstrate transparent reporting of outbreak control including role of laboratory Apply the ORION check list to identify the threats to validity in relation to outbreak reporting Critically review the dissemination of MDRO control reporting and the impact on practice Produce an action plan for the application of MDRO outbreak control

Overall objectives of the programme: Application to Practice 2 Critically review and apply in practice the strategies and mechanisms to manage and prevent inappropriate antibiotic prescribing Critically appraise systems to prevent transmission of MDRO infections including patient isolation, in hospital settings. With critical insight, review the potential barriers to successful implementation of these systems Demonstrate transparent reporting of planned intervention measures Application of ORION and COCRANE, EPOCH risk of bias check lists to identify threats to validity of planned interventions Critically review the dissemination of planned interventions and their application to practice

Teaching and learning methods The programme uses a range of approaches, including interactive lectures, group seminar discussions and scenario based learning sessions. These methods are participatory and appropriate for professionals who bring a wealth of experience to the programme. A participatory approach enables individuals to draw on their own experience and learn in an active way. It also enables a more equal relationship between participants and facilitators

Ground rules for participatory learning Treat everyone with respect at all times, regardless of gender, age or cultural differences Ensure and respect confidentiality so that facilitators and participants are able to discuss issues without fear of repercussions Agree to respect and observe time-keeping and to begin and end the sessions on time Ensure everyone has the opportunity to be heard Be willing to accept and give constructive feedback Draw on the expertise of other participants in difficult situations. Adherence to the above rules will ensure an effective and enjoyable learning experience.

Introducing each other using the shield technique

Day 1 Session 1: Introduction to Programme and consolidation of pre- programme materials Introduction to MDRO education programme Consolidation and review of microbiological and epidemiological perspectives   Session 2: Laboratory Investigations Diagnostics typing and susceptibility testing Good laboratory practice Session 3 Antibiotic Stewardship Antibiotic policies

Day 2 Session 3: Antibiotic Stewardship Measures for improvement of prescribing   Session 4 Infection Control Principles and evidence based practice Effective infection control interventions Session 5: Surveillance

Day 3 Session 6: Application to Practice Application of interventions to control MDROs in health care settings Transparent reporting of outbreaks and interventions   Session 7: Evaluation

Acknowledgements The creation of this training material was commissioned in 2011 by ECDC to Health Protection of Scotland, National Services Scotland, University of Chester and University of Dundee with the direct involvement of Eastaway A, C Wiuff, A Seaton, J Reilly, M Rivett., P Davey, A Bryan, D Robertson. Adapted / modified by: S. Rosales Klintz, Karolinska Institutet, Stockholm, Sweden, 2015, ECDC MDRO course Diamantis Plachouras, ECDC, 2015, ECDC MDRO course Oliver Kacelnik, Norwegian Institute of Public Health, 2016, ECDC MDRO course The revision and update of this training material was commissioned in 2017 by ECDC to Transmissible (Netherlands) with the direct involvement of Rita Szabo, Remco Schrijver and Arnold Bosman

This work is licensed under the Creative Commons (http://creativecommons.org) Attribution 2.0 Generic license (http://creativecommons.org/licenses/by/2.0/deed.en). ---- This last slide or page must always be included with this work ---- Authors: Dr Anne Eastaway, C Wiuff, A Seaton, J Reilly, Miss Michelle Rivett, P Davey, A Bryan, D Robertson (2011) Original creator of the document. {Author, affiliation, date, event} May be “Unknown” or “Various.” ATTENTION AUTHORS & ADAPTERS: All external sources should be mentioned on individual pages, diagrams, tables, photos within the work.  Adapted / Modified by: S. Rosales Klintz, Karolinska Institutet, Stockholm, Sweden, 2015, ECDC MDRO course Diamantis Plachouras, ECDC, 2015, ECDC MDRO course Oliver Kacelnik, Norwegian Institute of Public Health, 2016, ECDC MDRO course Rita Szabo, Remco Schrijver in collaboration with Transmissible (Netherlands), 2018 If you make any modifications to this work, enter your name, organization, date, and event here. ATTENTION READER: The original author may not have endorsed modifications. You are free: to share – to copy, distribute and transmit the work to remix – to adapt the work Under the following conditions: attribution – You must attribute the work in the manner specified by the author or licensor but not : in any way that suggests that they endorse you or your use of the work. In any way that suggests you are author of the work The authors of this slide/page encourage educators, trainers, and professionals to include this slide within their documents and presentations for rightful attribution of their works and thus also allow it to be easily shared. (ECV1-29/9/11)