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2. 2 Global Travel – who goes?

3. 3 Global Links of NDM to the UK Kumarasamy et al., Lancet Infect Dis 2010 10:597-602

4. 4 15 million Visitors to the UK 2011 Country Rank (by number) Visitors (000) USA12,484 Italy71,526 India16350 Brazil19276 Greece25225 Israel31164 China33149 Nigeria34142 Pakistan4865

5. Visitors to the UK by Purpose – potential for MDR GN household spread

6. 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

7. 7 Carbapenemase-producing Enterobacteriaceae in the UK (n = 1659) Neil Woodford: AMRHAI, Unpublished data Early cases often imported Imported & ‘home grown’

8. Currently very limited knowledge on basic epidemiology. CRO carriage rates in specific high risk groups allowing targeted screening? CRO carriage rates in specific high risk groups allowing targeted screening? Duration of carriage? Duration of carriage? Optimal method of patient screening – rectal swabs – reliability of self swabbing? Optimal method of patient screening – rectal swabs – reliability of self swabbing? Optimal laboratory screening method? Optimal laboratory screening method? Transmission rates in home/hospital? Transmission rates in home/hospital? Efficacy of decolonisation and isolation? Efficacy of decolonisation and isolation? Cost effectiveness of interventions? Cost effectiveness of interventions?

9. 9 Political Commitment & Investment Aggressive Infection..Control Screening Isolation Reinforced Hand..Hygiene Contact precautions Surveillance Targeted & Structured Concerted Action Required: ALL Sectors Focussed Clinical Research Cross Cutting Antibiotic Policy Antimicrobial Stewardship Simpler cheaper laboratory tests Centralised Reporting incl private sector Unified Strategic Policy in DH/NHS Renewed Drug Pipeline Improved Global Intelligence

10. 10 What is the key priority ? Refocus NHS Infection Prevention and Control onto MDR GNB

11. 11 Serious threat to routine care in the NHS