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 value of educating children pharmacists 12% ↓ antibiotics / capita ↓ antibiotic prescriptions ↑ use of first line antibiotics
A Community Project for Wise Use of Antibiotics Capital Health Population 1,000,000
Alberta University Medical of Association Alberta Partners Alberta Capital Lung Health Association
Physicians Public Health Health Care Pharmacists Professionals Dentists Nursing Infection Control
Media Campaign Public Education Print Website Strategies Materials Grade 2 Student Daycare Centre Program Program
9 PRINT RESOURCES Parent Pamphlet Guide Stickers Handwashing signs Activity placemat Project poster
Punjabi French Spanish Persian Arabic Translations Chinese Chinese simplified traditional Vietnamese
Distribution of Print Materials – Healthcare Professionals Pharmacists Dentists Occupational Healthcare Health Professionals Physicians Public Health Infection Control Continuing Care
Distribution of Print Materials - Public Churches Restaurants Public Transport Daycare Centres University of Alberta Public Senior Centres Recreation Centres Library Businesses Schools
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
Website file use Daycare * Public Occupational 3.0% 3.5% health Parents 0.3% 5.1% Teachers 8.5% Healthcare Multilingual professionals 10.5% 54.5% Kids 14.5% * 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
DAYCARES Pick - a - bug Bugaloo glove puppet “Prop Box” Bug Toss Game Wash the bugs away Invisible Germs
Assisted Living Program Target: Adults in assisted living Staff Relatives Taught by: Post secondary students High school students Note: New program for 2006
Assisted Living Program Dark light, gel and powder Large print Crossword Puzzle Word Search Bug Bingo
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) 100% 21.8 80% 60 60.5 60% 78.2 40% 39.5 40 20% 0% Pre-Project Public Mid-Project Pre-Project Public < 45 yr (n =979) Grade (n=618) 2 Parents Yes No (n = 408)
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 Book Overheads Bugsy puppet Dark light and gel
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) 100 expect 90 antibiotics for 80 cold/flu 70 colds due to 60 viruses 50 40 antibiotics not 30 helpful in flu 20 10 use of 0 antibacterial pre post soap survey survey
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. 95.0 * * 90.0 % List Handwashing 85.0 Pre intervention Post intervention 80.0 75.0 70.0 A B C CONTROL * p=<0.05 Study Group
Daycares Are colds caused by bacteria or viruses? 85.0 * 80.0 * % Answer Viruses 75.0 Pre intervention Post intervention 70.0 65.0 60.0 A B C CONTROL Study Groups * p=<0.05
Daycares If you had a cold, would an antibiotic help you get better? 16.0 14.0 * 12.0 10.0 * % Yes Pre intervention 8.0 Post intervention 6.0 4.0 2.0 0.0 A B C CONTROL Study Group * p=<0.05
Daycares Use an antibacterial soap at home? 45.0 40.0 * 35.0 30.0 * 25.0 % Yes Pre intervention Post intervention 20.0 15.0 10.0 5.0 0.0 A B C CONTROL Study Groups * 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
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