1. Anti-Microbial Resistance (AMR) and Health Care Associated Infections (HAI)
Norway is among the European countries with the lowest levels of antibiotic resistance (EARS-net and NORM publications ). With increased travel and trade and increased use of antibiotics, the development of resistant strains of bacteria and viruses could rapidly increase in Norway as well.
50,000 patients who are admitted each year to Norwegian hospitals will contract a hospital infection. Infection lengthens a patient’s hospital stay by four days on the average, i.e. a total of 200,000 days per year. 20-30% of such infections can be prevented by effective efforts to control communicable diseases.
Norwegian health authorities have during the last 20 years implemented various programmes in order to counteract antimicrobial resistance (AMR) and to prevent health care associated infections (HAI). Norway has had in place different strategies for combating antibiotic resistance and our latest National strategy for prevention of infections in the health service and antibiotic resistance (2008–2012) just expired.
The strategy included relevant measures in many sectors and at various levels that should enable us to continue to maintain a favourable situation in Norway. Goals for the period 2008 – 2012 included:
1. The occurrence of antibiotic resistance in Norway shall not increase
2. The occurrence of infections acquired in the health service in Norway shall be reduced
3. Knowledge about occurrence, causal relations and effects of measures to prevent infections in the health service and antibiotic resistance shall be improved
Surveillance structures have been established for infectious diseases (MSIS), antibiotic resistance (NORM), use of antibiotics and health care associated infections (NOIS) and of prescribed antibiotics (Norwegian Prescription Database). It is mandatory for all health care institutions to have an infection control programme, and organizations that provide support service for antibiotic use in primary health care as well as in specialized medical services have been established.
Identified challenges by the end of the strategy period were:
• Lack of robustness of infectious disease control programmes in the health services in general and in particular at municipality level
• Lack of standardized computer systems for monitoring antibiotic use and health care associated infections throughout the country
• Vaccine coverage among healthcare employees and vulnerable groups is too low with regards to seasonal influenza
• Better national coordination regarding the work against antibiotic resistance is needed.
• More and better international cooperation on antimicrobial research is needed.
2. Role of different actors in AMR and HAI
Role of government
• The Ministry of Health and Care Services has the overall responsibility for all health services in Norway including Anti-Microbial Resistance (AMR) and Health Care Associated Infections (HAI). The Directorate of Health shall ensure that approved policies are implemented in the health and care. The Norwegian Board of Health Supervision shall ensure that health and social services are provided in accordance with national acts and regulations. Most hospitals are owned by the government through Regional Health Authorities and Local Hospital Trusts.
Role of public health authorities
• The Norwegian Institute of Public Health is responsible for surveillance and expert advice to the Ministry and the Directorate, but has no direct line of command to local hospital trusts.
Role of hospital management (national level)
• Hospitals are managed according to directives from the Regional Health Authorities and the Norwegian Directorate of Health. Local hospital managers should comply with overall governmental policies for reducing AMR and HAI, but in practice it is difficult to benchmark their compliance. Budgetary discipline is presently a priority in many institutions.
Role of healthcare payer
• Hospitals are financed through a regular budget and an activity-based reimbursement system. Both sources of financing are controlled by the government.
Support of surveillance programmes
• Surveillance of AMR and HAI are financed and run by governmental institutions. The Norwegian Institute of Public Health has an overall responsibility for coordination of all surveillance of communicable diseases including AMR and HAI. All parts of the healthcare system are legally obliged to contribute to surveillance programmes. Some activities have separate financing whereas others are included in the basic activities of the institutions.
Role of hospital accreditation programmes
• Hospitals in Norway do not generally participate in formal accreditation programmes, but the government will ensure compliance with quality standards through inspections by the Norwegian Board of Health Supervision.