1. National Mandate To decrease antibiotic prescriptions in respiratory tract infections by 25% 1997- Canadian Committee Antibiotic Resistance (CCAR)

2. 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

3. Pilot Project Grande Prairie value of educating pharmacists 12% ↓ antibiotic prescriptions ↓ antibiotics / capita value of educating children ↑use of first line antibiotics

4. A Community Project for Wise Use of Antibiotics Capital Health Population 1,000,000

5. Alberta Medical Association Capital Health Alberta Lung Association University of Alberta Partners

6. NursingInfection Control Pharmacists Physicians Health Care Professionals Dentists Public Health

7. Website Grade 2 Student Program Daycare Centre Program Print Materials Media Campaign Public Education Strategies

8. Pamphlet Parent Guide Project poster Handwashing signs Stickers Activity placemat 9 PRINT RESOURCES

9. Persian Chinese simplified Arabic French Vietnamese Chinese traditional Punjabi Spanish Translations

10. Distribution of Print Materials – Healthcare Professionals Dentists Pharmacists Public Health Healthcare Professionals Occupational Health Infection Control Physicians Continuing Care

11. Distribution of Print Materials - Public Public Transport Restaurants Senior Centres Schools Recreation Centres Public Daycare Centres Businesses University of Alberta Churches Library

12. 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

14. Website file use * Introduced March 2003

15. Children Programs –Daycare Program –Assisted Living Program –Grade Two Program

16. 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

17. Bugaloo glove puppet “Prop Box” Bug Toss Game DAYCARES Invisible Germs Pick - a - bug Wash the bugs away

18. Assisted Living Program Target: Adults in assisted living Staff Relatives Taught by: Post secondary students High school students Note: New program for 2006

19. Dark light, gel and powder Bug Bingo Assisted Living Program Large print Crossword Puzzle Word Search

20. 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

21. 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

22. Awareness of Handwashing as a Preventative Measure Comparison of General Public, Grade 2 Parents, and Age-Matched Cohort (P<0.001) 39.5 78.2 40 60.5 21.8 60 Pre-Project Public (n =979) Mid-Project Grade 2 Parents (n = 408) Pre-Project Public < 45 yr (n=618) 0% 20% 40% 60% 80% 100% YesNo

23. 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

24. 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

25. 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

26. 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.comhttp://www.glogerm.com –“Twinkle Twinkle Little Star”

27. Grade 2 presentation Activity 4 ( 3 minutes ) Game with colouring sheets Activity 5 (5 minutes) Skit –Bugsy in doctor’s office videotape available

28. Grade 2 presentation Optional Activities (2 minutes) Poems / Songs –Those Bugs Don’t Need Drugs –Do Bugs Need Drugs? –Wash, Wash, Wash Your Hands

29. GRADE TWO KIT Bugsy puppet Overheads Dark light and gel Book

30. When to Wash Hands

31. How to Wash Hands

32. Student Education Program Students Children enrolled in Grade 2 Teachers Students in healthcare faculties –Interdisciplinary Course – University of Alberta –Grant MacEwan College Nursing Program

33. 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

34. 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

35. 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

36. Teachers Evaluation of Program 7 question survey post program –119 teacher responses 50% responses: 5/5 for all questions Overwhelmingly positive responses/comments

37. Post secondary students (P <0.01)

38. 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

39. 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%

40. Daycares Handwashing as a way to prevent the spread of infection. * p=<0.05

41. Daycares Are colds caused by bacteria or viruses? * p=<0.05

42. Daycares If you had a cold, would an antibiotic help you get better? * p=<0.05

43. Daycares Use an antibacterial soap at home? * p=<0.05

44. Parents p < 0.01 –less likely to expect antibiotics for cold/flu –reduced use of antimicrobial soap

45. 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

46. 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

47. Program expansion British Columbia 2006 - Michael Smith Foundation $98,000 grant for evaluation of program 2007 – start of physician/pharmacist education programs ??funding

48. 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

49. Program expansion 2006 - Alberta Canadian Council Continuing Education in Pharmacy (CCCEP) – 4 continuing education credits 176 pharmacists attended course 50 trainers – achieved target in 4 months! – commit to 9 hours of teaching in their communities compensated for their time

50. Program expansion 2006/2007 - Alberta pharmacists Teach to nursing students → Grade 2 program Early childhood education students → Daycare program Nurses in long term care → Assisted Living program

51. Effect of Handwashing on Child Health: A Randomised Controlled Trial Lancet 2005;366:225-233 Squatter settlements in Karachi, Pakistan 50% reduction in pneumonia 53% reduction in diarrhea 34% reduction in impetigo No difference between plain soap and antibacterial soap

52. Sharon Mitchell Deb Wilson Mary Carson Edith Blondel-Hill Marilyn Tomney Susan Fryters PARTNERS IN DEVELOPMENT