Thank you, Mr. Chair.
Good afternoon, everyone. My name is Suzanne Rhodenizer Rose, and I serve as past president of Infection Prevention and Control Canada. I am very pleased to be with you this afternoon to address the pressing issue of antimicrobial resistance, or AMR, in Canada. I am joined by my colleague, Jennifer Happe, who is an infection control professional and an officer of IPAC Canada.
IPAC Canada is a multidisciplinary association with over 1,600 members nationwide. It is committed to public wellness and safety by advocating for best practices in infection prevention and control across the continuum of care.
I want to begin by commending this committee for taking the time to study this issue, which deserves attention from elected officials and from the public they serve, though it's often reduced to a few short sound bites in the news. People who have heard of superbugs or pandemic influenza, for example, may be inclined to think that these issues are far removed from them, whether in the past or many continents away. However, that assertion is deeply flawed. AMR has been identified as a fundamental threat to the modern health care system. It creates challenges not just for the patients who endure its effects but also for the health care system as a whole. When the best medicines we have to combat illness cannot defeat the micro-organisms that infect people, illnesses become more easily spread and much harder to treat.
Additionally, the World Health Organization, which has shown exceptional leadership on this issue, has noted that antimicrobial resistance increases the cost of health care, with lengthier stays in hospital and more intensive care required. These are the facts of AMR, and they are the issues that our providers can find every day in Canada's hospitals, clinics, dental offices, and other care settings across the continuum. It is important to provide more detail on the pressure placed on hospitals and the health care system as antimicrobials become increasingly ineffective at treating certain pathogens.
In testimony to the U.S. House of Representatives in 2013, Dr. Tom Frieden, a CDC director, put the consequences very plainly. He said, “Patients with resistant infections are often much more likely to die, and survivors have significantly longer hospital stays, delayed recuperation, and long-term disability.” It should come as no surprise, then, that the overall capacity of our health care system declines daily as care providers find themselves using additional rounds of antibiotics and resorting to less commonly used, more toxic pharmaceuticals to treat the most prevalent antibiotic-resistant organisms such as MRSA or C. difficile, and the recent and concerning emergence of carbapenemase-producing organisms. At the same time, investments in new and improved treatments by pharmaceutical companies have declined, and professionals are not being equipped with the resources they need to effectively stem the tide.
Taken together, these facts make it more important than ever to ensure that appropriate infection prevention control measures are in place to limit the spread of antimicrobial-resistant organisms and to improve treatment when they are encountered in patients. Infection control professionals in Canada's hospitals, in public health roles, and in other care settings are working hard to ensure that this is the case. However, we have been fighting an uphill battle.
We believe Canada is well positioned to become a leader in the fight against antimicrobial resistance, but to get there for the good of our population, we will have to make significant investments that support national systems and provide funding for the adequate human resources to implement and encourage infection prevention and control practices across the care continuum.
Antimicrobial resistance is a very complex issue that cannot be addressed by a single policy change or advancement in medical practice and technology. Rather, the federal and provincial governments, health care professionals and administrators, the agricultural community, our international partners, and the public at large need to be aware of the pressing and global concern that has been echoed widely.
Steps have been taken by the federal and provincial governments and regional health authorities to address AMR challenges, including limiting the spread and occurrence of infections that are caused by antimicrobial-resistant organisms, and encouraging the responsible use of antimicrobials. However, there is one key area in which Canada remains behind other countries, and where the federal government needs to be a leader, and that is in tracking incidents of resistant bacteria and analyzing the success of our collective interventions.
The Government of Canada has published a document entitled “Antimicrobial Resistance and Use in Canada: A Federal Framework for Action”. There are four pillars of this framework that are strongly supported by IPAC Canada.
In order to effectively implement change, it's necessary to have the ability to measure whether steps taken are having the intended outcome. Through surveillance, which is one of the best measures of AMR, we have the number and the rate of antibiotic-resistant organisms in the health care setting.
In order to carry out surveillance effectively, measurement needs to occur in the same way, so that apples are compared to apples and oranges to oranges. When carried out in a uniform manner, surveillance provides a measure of the burden of illness, establishes benchmark rates for internal and external comparison, identifies potential risk factors, and allows for the assessment of specific interventions. As such, IPAC Canada urges the implementation of a national surveillance strategy for antimicrobial-resistant organisms.
Currently in Canada we largely measure the number and rate of resistant micro-organisms in different ways across the country. As such, the process is fragmented. AMR does not understand political and territorial boundaries. A fragmented approach defeats the goal of protecting the health of Canadians and does not align with the one health strategy or with the federal action plan.
We absolutely acknowledge that there are some measures in place to do this now, but we believe these piecemeal approaches are not suitable to address the growth threat of antimicrobial resistance that we face.
The Canadian nosocomial infection surveillance program, or CNISP, gathers data that is considered highly reliable yet covers only a very small fraction of the many health care facilities in Canada. Most hospitals and long-term care facilities are not currently able to participate in CNISP surveillance. CNISP also lacks the human resources support and technical infrastructure it needs to reach its full potential.
The existing Canadian Network for Public Health Intelligence, or CNPHI, is also gathering data, but could be better leveraged to support collection and integration with other data sources.
The Canadian Institute for Health Information, or CIHI, has recently explored the use of information and administrative data contained within individual patient medical records as a source of data on AMR and health care associated infections. While this electronic method of data collection is efficient and allows for global reach across the country, it cannot provide the level of reliability we need to accurately define the level of AMR in Canada.
The establishment of the Canadian antimicrobial resistance surveillance system, or CARSS, is a federal commitment to support the federal action plan on AMR and use in Canada and it has made an important first step in defining priority resistant organisms to conduct surveillance on; however, this is but one piece, and the potential data from this system can complement the data from a national repository for health care associated infections.
Strong integrated surveillance systems are needed to provide a comprehensive picture of AMR in Canada. We are not starting from scratch. Through a collaborative effort with other organizations, IPAC Canada has established standardized surveillance case definitions for long-term care and has participated in the advancement of the establishment of standardized surveillance definitions for acute care and a commitment to continue to seek options for a pan-Canadian adoption of these definitions.
There is also a groundswell of interest and commitment from partner organizations to explore options using infrastructure that's currently available to support a pan-Canadian approach. These goals align and support the achievement of the goals defined in the government's federal framework.
Canada has been recognized as a world leader in many aspects of health, yet we lag behind many international jurisdictions in the development and implementation of a national approach to address AMR. Federal engagement with provincial and territorial partners at the ministerial and deputy ministerial levels is needed to establish a consistent national surveillance system, with nationally approved case definitions, that is adequately funded. We need support to make the data being collected better integrated and more useful for the people and professionals working to fight AMR on a daily basis.
Thank you.