Thanks for joining us again at the Canadian Breakpoint, a Canadian infectious diseases
podcast by Canadian infectious diseases physicians.
I'm Summer Stewart, back again with Dr. Rupeena Purewal, pediatric infectious diseases physician
from Saskatoon.
In this episode, we'd like to recognize World AMR Awareness Week, held November 18th to
24th.
It's a time to build awareness of the rising rates of AMR, discuss long-term plans to combat
this rapidly growing issue, and encourage action on antimicrobial resistance.
In Canada, we can do more, together, to address AMR.
In honour of World AMR Awareness Week, the Canadian Breakpoint invites Dr. Terry Wurst
to discuss the Manitoba AMR Awareness Campaign, as well as the importance of AMR awareness
and having a plan.
Dr. Purewal.
All right.
Welcome, everyone, to another episode of our podcast, the Canadian Breakpoint.
We have a very special guest with us today, Dr. Terry Wurst, who is an assistant professor
in adult infectious diseases and internal medicine at the University of Manitoba in
Winnipeg, Canada.
He completed his residency training in internal medicine at Dalhousie University, and in
adult ID at the University of Manitoba, and later obtained a master's degree in epidemiology
through the University of London.
In addition to general infectious diseases, he also practices clinically in tuberculosis
and on the general internal medicine teaching units in Winnipeg hospitals.
Dr. Wurst has an interest in improving the way we use antibiotics in our healthcare system.
Although Manitoba does not yet have a formal provincial antimicrobial stewardship program,
he has spearheaded the creation of a website for healthcare providers to increase awareness
of antimicrobial resistance and empower clinicians to practice wiser use of antibiotics in day-to-day
practice.
The public website called the Manitoba AMR Alliance was founded in November of 2022 and
can be found at manitobamr.ca.
So welcome Dr. Wurst.
So nice to have you here today.
Well thank you very much for having me here Lupina.
That's perfect.
And so obviously Terry and I know each other because he was actually my preceptor in infectious
diseases when I did infectious disease in Manitoba.
So I know a lot about Terry and the program there.
And so it's always a pleasure to have our colleagues back on episodes like this.
So today we're going to talk about a very important topic, which is antimicrobial resistance.
And a lot of our listeners are quite aware of some of the antimicrobial resistance patterns.
We've talked about the CARS report early on in the podcast as well.
And so they can definitely tune into one of our first episodes for the most recent CARS
report to kind of get some information about what and why we're actually talking about
this today because it's very important.
And I think most of our listeners are involved in some form of stewardship at their hospitals
or have heard of stewardship programs.
And so I think today we really want to focus on especially how can we make things better?
And so why don't we talk a little bit about by telling our listeners what the AMR Awareness
Campaign really is and why was it so important to start this from your end?
Yeah, thanks.
So I mean, I think that one of the things that your listeners will be all too aware
of is that antibiotics really are a double-edged sword.
And so what it means is that antibiotics are extremely effective at treating certain bacterial
infections and they've saved millions of lives since their discovery.
It's so important that we have effective antibiotics so that our healthcare system can really continue
to function the way that it does.
They're a backbone for so much of what we do in healthcare today.
But on the other hand, antibiotic use leads to antimicrobial resistance or AMR.
So bacteria, as we use these antibiotics, bacteria find clever ways to become resistant.
So then those bacteria can pass on their genes to others and increase antibiotic resistance
in a population.
So we really need to continue to use antibiotics.
We want to use antibiotics.
We want to use the right antibiotics when they're needed, but we need to limit their
overuse which is speeding up growth of AMR.
And that's really where the AMR Awareness Campaign comes in.
The AMR is a global threat.
It's estimated in 2019 that 5 million deaths were associated with AMR infections.
And a lot of people might say, well, all right, that's for the world.
And it's true that in other countries, AMR is a bigger current global threat than in
Canada, but it's here.
AMR is vocal, right?
In 2019, there was 13,000 deaths associated with AMR here and it's a growing issue.
So we need to take it seriously.
We need to know that it's a current issue and we need to know what to do about it.
So the World Antimicrobial Awareness Week, World AMR Awareness Week, I should say, is
a global campaign and it's designed to raise awareness and understanding about AMR, make
it more visible.
What can we do to prevent it?
And that's what it's really all about.
Yeah.
And so, and you talked a lot about our introduction here.
We just heard that you created the Manitoba website that obviously encompasses some of
the resources as part of the AMR campaign.
So in terms of this initiative, so obviously it's, I guess your one year anniversary is
coming up for the website and the initiative creation.
So what led you guys to kind of consider launching this initiative and can you give our audience
a bit of a glimpse of kind of what this entails?
Yeah, for sure.
Canada actually has an action plan for combating AMR.
So the four pillars that they recommend we address include the surveillance, better surveillance
of AMR in Canada, boosting infection control, prevention, strengthening research and innovation.
The fourth pillar is antibiotic stewardship.
And so the AMR Alliance Manitoba, it's an initiative on that fourth point, which is
stewardship.
So we want to raise awareness for AMR among healthcare providers, but we also want to
give them really good tools for stewardship that they can use in their day-to-day practice.
So I'd like to say that the website, it's really a grassroots campaign that we started
just out of conversations with colleagues.
We had this idea that we were really committed to wanting to be able to talk about antibiotic
stewardship, to start something in Manitoba.
And at the same time, we didn't have a provincial program, a clinical program for antibiotic
stewardship.
So the website is something that we wanted to bring to number one, raise awareness.
Number two, provide some resources.
Number three, create a community so that we could actually have a community where we could
share resources, talk about what we're doing as people in healthcare providers in the province
that are interested in antibiotic stewardship and talk about what's working, where we need
to go from here.
And the other idea behind the website was the idea of a pledge.
So you have this concept in psychology actually, that if you want to promote a behavior in
yourself, stating it publicly is a very good way to do that.
So if you want to talk about New Year's resolutions, going to the gym five days a week, one of
the steps on January 1st that will help you to achieve that goal is to go ahead and state
that publicly.
I will be doing this.
You can shout it to social media or to your friends or announce it at, I don't know, at
family dinners.
In this case, we want to promote antibiotic stewardship and bring that level of commitment
to this day-to-day clinical practice.
So that's some of the ideas creating the website.
Perfect.
Yeah.
So you kind of talk about this accountability, right, to AMR.
And so I think on a day-to-day basis, all of us feel like we're doing or we're trying
to do a good job with antibiotic and anti-microbial use.
But obviously, I think these types of awareness campaigns really bring out that initiative
to actually look back and reflect upon ourselves, right?
So as healthcare providers, are we really doing everything possible that we can to reduce
these resistance rates and focus on really, is this the best decision?
And I think sometimes it becomes difficult because when you have that clinician hat on
and then you kind of have to switch gears to thinking about more of global or even if
we think it is a national effect that we're creating, it can sometimes be a bit difficult
as healthcare providers, I think.
But I think these types of pledges and certain tools and knowing that your colleagues across
either interprovincially or in the province are doing something to raise awareness towards
this, I think really helps with that accountability.
So this is fantastic.
I'm actually really excited to hear more about it.
So in terms of discussing some of the tools that you've created, so how can people or
is it only like, is it people really from Manitoba, like healthcare providers in Manitoba
currently that can access some of the tools there?
We created this campaign for healthcare providers in Manitoba, Rupina, but there's absolutely
no reason that others can't access it.
So we have a number of places on the website that providers can go.
So the first one is the pledge.
I think this is good for anyone to do.
I mean, I think I'd like to see as many healthcare providers as possible, you know, sign the
pledge.
You don't have to be from Manitoba.
We'll definitely keep you on our regular mail out list for any new resources that are added
to the website.
The other things that we have on the website so far, we've developed a number of cases.
So clinical cases and they are not real cases, but they're common clinical scenarios that
may come up, whether it be a viral upper respiratory tract infection, you know, how do you communicate
best management plan to your patients and, you know, give them really concrete advice
and something that they're going to walk away feeling, you know, okay, this is, they feel
very satisfied and happy with the plan and know when to come back.
And they're not walking away feeling like, oh, maybe they should have got antibiotics,
for example, because that can be, you know, other cases around urinary tract infections,
sepsis and we've got more coming out all the time.
And then we have a third section on resources.
So linking other good work that people are doing.
You know, we have one resource that's actually developed in Saskatchewan, which is the viral
prescription pad, which I think is a fantastic resource, you know, so there's evidence to
suggest that when people take something away from their medical appointment, details, advice
about what to do, you know, as opposed to just verbal advice, that that increases understanding
of what the medical instructions and also increases their satisfaction.
So again, they're not coming away feeling shortchanged in some way.
So I think these kinds of resources are really useful and they just help day to day.
And I think it kind of goes back to that same psychology, right, that you were talking about.
So from like a patient standpoint, also, they always want to feel, you know, included in
their management plan, they want to be involved in their care.
And so also bringing out these tools and describing something or having like a descriptive analysis
or a figure, for instance, like these tools, when we take them to our clinic visits, I
think is more helpful than just using words.
So I think those are fantastic tools and I look forward to using some of those as well
in my clinic, definitely incorporating them, especially with this viral season that's coming
up, right.
So remembering that even in like I'm in pediatrics and majority of our infections usually start
off as viral, right, even ear infections.
So cold flu and COVID season is upon us.
And so very timely.
It's really great.
So in terms of, I think obviously like our overall goal is to reduce or to create awareness,
enhance the surveillance and really decrease the resistance patterns over time.
Do you have like specific checkpoints or specific goals that you're trying to achieve through
the program?
Our goals are pretty modest, Rapina.
We just want to reach a large community of healthcare workers and get people to sign
up to be AMR champions.
That helps us to be able to deliver, you know, all the resources to a bigger audience.
And we, yeah, we want to just continue to be able to provide kind of high quality antibiotic
stewardship resources for people to use on a day to day basis.
So pretty modest, I think.
But as we go, we continue to ask, you know, what is the most useful thing?
So we may ban that over time just based on feedback.
And so I know a lot of people are aware of like the WHO awareness campaigns and so really
haven't probably thought too much about the provincial or even national campaigns.
So how does this kind of tie in with the WHO awareness?
Yeah, so the World Health Organization also is interested in promoting AMR awareness and
antibiotic stewardship.
So they have an international campaign that Canada is a part of.
And so Go Blue is a color campaign that takes place every year during World AMR Awareness
Week.
And so that falls November 18th to 24th this year.
In Canada, actually the National Collaborating Center for Infectious Disease, the NCCID,
who have been really instrumental in supporting the AMR Alliance website, they are helping
to collaborate the national effort.
So it's a national campaign.
We're trying to do our part locally just to promote that.
And as part of the campaign, we're just trying to increase visibility.
So one of the things that is going to happen is there's landmarks across Canada that are
going to be lit up in blue during World Anti-Microbial Awareness Week, usually kind of towards the
end, either November 23rd or 24th.
So we'll have places like the CN Tower, Canada Place, and then Manageable Legislature in
Winnipeg that will be lit up in blue.
So the idea is, you know, you can support the campaign by going and visiting all of
these places that are lit up in blue, take your picture, post it on social media.
That's really great.
I think it's nice to incorporate some of these provincial landmarks and just make it more
of a social event as well.
So it kind of makes it more fun too.
So are there other provinces that have also done similar websites or pledges that you're
aware of, or has Manitoba been the leader in this right now?
I mean, a lot of provinces have probably much more formal anti-microbial stewardship programs
than Manitoba right now.
But as far as websites, you know, I mean, I think Ontario has a really great website,
but that's as a part of their anti-microbial stewardship program.
They've got tons of great resources on there.
BC does the same.
I think there's lots of really great work that's being done across the country, not
as much in terms of pledges.
So we kind of went a little bit of a different direction there, but in terms of, you know,
just good resources and in some cases, you know, that's tied to, where it is tied to
the antibiotic stewardship programs.
You can even find some information about statistics on what sort of antibiotics are being used,
what are the rates, what are the outcomes they're seeing in the initiatives.
So I think those are all really great.
That's fantastic.
And just a reminder to our listeners too, you know, if you're in a place where you're
only practicing community practice, let's say, you can still access these tools and
use that there as well.
And so I think a lot of our anti-microbial stewardship programs, which I always hear
from our colleagues out in the community, is that a lot of them are geared towards in-hospital
services.
And so, but obviously any of these resources can be used in that outpatient community as
well.
So just remember that.
That's true.
And we've got on our resources page, we've got an eye towards that too.
Rapina, so for each resource, we sort of highlight this is more applicable for acute care or
whether it be primary care, such as the viral prescription pad, or even in the long-term
care setting as well.
I know there is probably some provinces out there and people who will be listening who
probably haven't created or don't know about an initiative that's been done locally or
would like to start something like a platform to share resources.
So what are, I think some of the, what advice can you give them or any tips if they are
looking to start this on their end?
Really, what you need is an idea and the passion to do it.
This is really not something that I would have done if I wasn't very committed to the
idea.
But I think, if you're interested in doing it, talk to colleagues, talk to others that
might be similarly interested for me, like finding an organization, like the NCCID that
was looking for partners that was able to provide the support, for example, for the website.
That was a real bonus.
So I think you never know who else might be out there and looking to collaborate until
you start asking.
Usually like in your guys's team right now, and part of your initiative, do you have like
a multidisciplinary team that's working with you?
Yeah, I got, we've got a number of other, you know, infectious disease doctors, also,
you know, family doctors that help advise, but really it's being mostly driven by myself
and a team of very interested medical students that are helping to kind of bring some energy
and been really fantastic.
That sounds great.
Definitely a great opportunity for, let's say, a QI project or an initiative at a local
center.
So definitely, I think some of our, and we have lots of medical students listening to
the podcast, so I think that's a good opportunity for them to bring up with their center.
So in terms of what's the future, so this is a great initiative.
I think having such a website and having these resources, and you mentioned like obviously
having ongoing tools and getting some feedback from healthcare providers who are using the
tools to see if there's anything that you can update.
But what else can we do or what are you planning on doing with the future of this campaign?
So what we're planning to do is in the next three months, we want to promote world antimicrobial
awareness week.
So that's coming up November 18th to 24th.
We'll be putting out some links to the national campaign.
There'll be some further information coming out to our mail out group.
And really that's our focus.
But beyond that, we're just going to keep working on developing more resources, a few
more that we'd really like to highlight, especially around choosing wisely.
That's been a really fantastic resource in Canada.
So that's something that we want to highlight.
And beyond that, I think we've got a lot of energy and a lot of people that are listening.
So we're always open to new ideas.
And then has there been, because I know like sometimes we'll start a campaign or we'll
start an initiative and then have kind of research or combined evaluation of let's say
like antimicrobial use rates.
Now obviously we know that with the CARS reports yearly and the updates, we look into a lot
of the main details there.
And some of the stewardship programs are definitely probably doing a lot of more audit and feedback
and then evaluating their use rates locally.
But is that something that you're doing more provincially from this awareness campaign
or thought about doing it?
I think we'd love to do that in the long term or even in the intermediate short term.
What I'd love to see is a provincial program where we can really track all those outcomes
that we're interested in.
So whether it be antimicrobial use and outcomes in the hospitals.
So for our patients, are they seeing increased length of stay?
Are they seeing mortality?
We need to track all these outcomes and then know where we can be better directing our
resources, not only in the hospitals, but in our long-term care and in the community.
So I think there's a lot of things that are being done and that we'd like to do here,
but we're just not quite there yet.
So I think there's a lot more that could be done there.
And then on your guys' website, do you guys have a contact us link or anything like that
where other healthcare professionals can reach out to you guys?
Yeah, we've got contact information on the website.
And if you have other ideas that can make the website either better or if you have a
project that we could work together on, any of your listeners, I'd really love to hear
from you.
That sounds awesome.
Thanks so much, Terry.
Is there anything else that we kind of missed about talking about the AMR awareness campaign
or any last few messages that you want to send to our listeners today?
No, I think that if we're going to have one message, it's really that we want to keep
antibiotics effective for now and for the future.
And the best way that we can do that is by using them to their best ability.
So I think having the resources that will support how do we effectively communicate
when an antibiotic might not be indicated or even diagnostic strategies that can help
us to know when antibiotics are best indicated.
This is obviously a work in progress, but it's something we're really committed to.
So have a look at the website.
If you have an idea, let me know.
That sounds fantastic.
Well, thank you so much for taking the time to come on the podcast.
I'm sure this is going to be a super hit episode and I'm excited to do follow-up episodes,
even after the awareness campaigns or if other centers are involved in creating a similar
initiative.
And so I think it's a great opportunity for us, all of us to kind of think about AMR,
remind ourselves, because I think all of us try our best to do it.
And being in infectious diseases, it's a little bit more helpful when you're always prescribing
antibiotics or taking away antibiotics to do this on a daily basis, but really remembering
that the tools are there and they're out there for everybody.
So starting early in your careers, for our medical students, remembering that this isn't
something where you have to do once you're a staff, just remembering that you can use
these tools early on.
Thanks so much.
We really appreciate you coming on the podcast and thanks for taking the time.
Rapina, thanks again for having me.
It's been great.
Take care.
Thank you, Dr. Pirwal and Dr. Wirtz for the discussion.
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