1 00:00:00,000 --> 00:00:13,600 Thanks for joining us again at the Canadian Breakpoint, a Canadian infectious diseases 2 00:00:13,600 --> 00:00:17,560 podcast by Canadian infectious diseases physicians. 3 00:00:17,560 --> 00:00:23,120 I'm Summer Stewart, back again with Dr. Rupeena Purewal, pediatric infectious diseases physician 4 00:00:23,120 --> 00:00:25,120 from Saskatoon. 5 00:00:25,120 --> 00:00:30,680 In this episode, we'd like to recognize World AMR Awareness Week, held November 18th to 6 00:00:30,680 --> 00:00:31,680 24th. 7 00:00:31,680 --> 00:00:37,400 It's a time to build awareness of the rising rates of AMR, discuss long-term plans to combat 8 00:00:37,400 --> 00:00:43,040 this rapidly growing issue, and encourage action on antimicrobial resistance. 9 00:00:43,040 --> 00:00:47,760 In Canada, we can do more, together, to address AMR. 10 00:00:47,760 --> 00:00:53,240 In honour of World AMR Awareness Week, the Canadian Breakpoint invites Dr. Terry Wurst 11 00:00:53,240 --> 00:00:58,920 to discuss the Manitoba AMR Awareness Campaign, as well as the importance of AMR awareness 12 00:00:58,920 --> 00:01:00,200 and having a plan. 13 00:01:00,200 --> 00:01:01,200 Dr. Purewal. 14 00:01:01,200 --> 00:01:02,200 All right. 15 00:01:02,200 --> 00:01:05,960 Welcome, everyone, to another episode of our podcast, the Canadian Breakpoint. 16 00:01:05,960 --> 00:01:11,420 We have a very special guest with us today, Dr. Terry Wurst, who is an assistant professor 17 00:01:11,420 --> 00:01:16,280 in adult infectious diseases and internal medicine at the University of Manitoba in 18 00:01:16,280 --> 00:01:18,000 Winnipeg, Canada. 19 00:01:18,000 --> 00:01:22,880 He completed his residency training in internal medicine at Dalhousie University, and in 20 00:01:22,880 --> 00:01:29,080 adult ID at the University of Manitoba, and later obtained a master's degree in epidemiology 21 00:01:29,080 --> 00:01:31,520 through the University of London. 22 00:01:31,520 --> 00:01:36,400 In addition to general infectious diseases, he also practices clinically in tuberculosis 23 00:01:36,400 --> 00:01:40,480 and on the general internal medicine teaching units in Winnipeg hospitals. 24 00:01:40,480 --> 00:01:47,160 Dr. Wurst has an interest in improving the way we use antibiotics in our healthcare system. 25 00:01:47,160 --> 00:01:53,000 Although Manitoba does not yet have a formal provincial antimicrobial stewardship program, 26 00:01:53,000 --> 00:01:58,380 he has spearheaded the creation of a website for healthcare providers to increase awareness 27 00:01:58,380 --> 00:02:05,000 of antimicrobial resistance and empower clinicians to practice wiser use of antibiotics in day-to-day 28 00:02:05,000 --> 00:02:07,000 practice. 29 00:02:07,000 --> 00:02:13,480 The public website called the Manitoba AMR Alliance was founded in November of 2022 and 30 00:02:13,480 --> 00:02:17,640 can be found at manitobamr.ca. 31 00:02:17,640 --> 00:02:19,280 So welcome Dr. Wurst. 32 00:02:19,280 --> 00:02:21,400 So nice to have you here today. 33 00:02:21,400 --> 00:02:23,600 Well thank you very much for having me here Lupina. 34 00:02:23,600 --> 00:02:25,200 That's perfect. 35 00:02:25,200 --> 00:02:31,280 And so obviously Terry and I know each other because he was actually my preceptor in infectious 36 00:02:31,280 --> 00:02:33,880 diseases when I did infectious disease in Manitoba. 37 00:02:33,880 --> 00:02:38,240 So I know a lot about Terry and the program there. 38 00:02:38,240 --> 00:02:46,280 And so it's always a pleasure to have our colleagues back on episodes like this. 39 00:02:46,280 --> 00:02:51,200 So today we're going to talk about a very important topic, which is antimicrobial resistance. 40 00:02:51,200 --> 00:02:57,520 And a lot of our listeners are quite aware of some of the antimicrobial resistance patterns. 41 00:02:57,520 --> 00:03:01,280 We've talked about the CARS report early on in the podcast as well. 42 00:03:01,280 --> 00:03:05,920 And so they can definitely tune into one of our first episodes for the most recent CARS 43 00:03:05,920 --> 00:03:11,000 report to kind of get some information about what and why we're actually talking about 44 00:03:11,000 --> 00:03:14,280 this today because it's very important. 45 00:03:14,280 --> 00:03:19,920 And I think most of our listeners are involved in some form of stewardship at their hospitals 46 00:03:19,920 --> 00:03:22,120 or have heard of stewardship programs. 47 00:03:22,120 --> 00:03:30,000 And so I think today we really want to focus on especially how can we make things better? 48 00:03:30,000 --> 00:03:35,480 And so why don't we talk a little bit about by telling our listeners what the AMR Awareness 49 00:03:35,480 --> 00:03:41,000 Campaign really is and why was it so important to start this from your end? 50 00:03:41,000 --> 00:03:42,000 Yeah, thanks. 51 00:03:42,000 --> 00:03:45,560 So I mean, I think that one of the things that your listeners will be all too aware 52 00:03:45,560 --> 00:03:48,640 of is that antibiotics really are a double-edged sword. 53 00:03:48,640 --> 00:03:54,440 And so what it means is that antibiotics are extremely effective at treating certain bacterial 54 00:03:54,440 --> 00:03:59,120 infections and they've saved millions of lives since their discovery. 55 00:03:59,120 --> 00:04:04,140 It's so important that we have effective antibiotics so that our healthcare system can really continue 56 00:04:04,140 --> 00:04:06,840 to function the way that it does. 57 00:04:06,840 --> 00:04:10,080 They're a backbone for so much of what we do in healthcare today. 58 00:04:10,080 --> 00:04:15,240 But on the other hand, antibiotic use leads to antimicrobial resistance or AMR. 59 00:04:15,240 --> 00:04:21,920 So bacteria, as we use these antibiotics, bacteria find clever ways to become resistant. 60 00:04:21,920 --> 00:04:28,320 So then those bacteria can pass on their genes to others and increase antibiotic resistance 61 00:04:28,320 --> 00:04:29,320 in a population. 62 00:04:29,320 --> 00:04:33,120 So we really need to continue to use antibiotics. 63 00:04:33,120 --> 00:04:34,720 We want to use antibiotics. 64 00:04:34,720 --> 00:04:37,600 We want to use the right antibiotics when they're needed, but we need to limit their 65 00:04:37,600 --> 00:04:40,160 overuse which is speeding up growth of AMR. 66 00:04:40,160 --> 00:04:43,200 And that's really where the AMR Awareness Campaign comes in. 67 00:04:43,200 --> 00:04:45,360 The AMR is a global threat. 68 00:04:45,360 --> 00:04:51,600 It's estimated in 2019 that 5 million deaths were associated with AMR infections. 69 00:04:51,600 --> 00:04:55,040 And a lot of people might say, well, all right, that's for the world. 70 00:04:55,040 --> 00:05:00,320 And it's true that in other countries, AMR is a bigger current global threat than in 71 00:05:00,320 --> 00:05:01,880 Canada, but it's here. 72 00:05:01,880 --> 00:05:03,920 AMR is vocal, right? 73 00:05:03,920 --> 00:05:10,640 In 2019, there was 13,000 deaths associated with AMR here and it's a growing issue. 74 00:05:10,640 --> 00:05:12,520 So we need to take it seriously. 75 00:05:12,520 --> 00:05:17,480 We need to know that it's a current issue and we need to know what to do about it. 76 00:05:17,480 --> 00:05:24,040 So the World Antimicrobial Awareness Week, World AMR Awareness Week, I should say, is 77 00:05:24,040 --> 00:05:29,920 a global campaign and it's designed to raise awareness and understanding about AMR, make 78 00:05:29,920 --> 00:05:30,920 it more visible. 79 00:05:30,920 --> 00:05:32,480 What can we do to prevent it? 80 00:05:32,480 --> 00:05:34,040 And that's what it's really all about. 81 00:05:34,040 --> 00:05:35,040 Yeah. 82 00:05:35,040 --> 00:05:37,960 And so, and you talked a lot about our introduction here. 83 00:05:37,960 --> 00:05:44,080 We just heard that you created the Manitoba website that obviously encompasses some of 84 00:05:44,080 --> 00:05:47,600 the resources as part of the AMR campaign. 85 00:05:47,600 --> 00:05:52,720 So in terms of this initiative, so obviously it's, I guess your one year anniversary is 86 00:05:52,720 --> 00:05:57,200 coming up for the website and the initiative creation. 87 00:05:57,200 --> 00:06:04,560 So what led you guys to kind of consider launching this initiative and can you give our audience 88 00:06:04,560 --> 00:06:07,560 a bit of a glimpse of kind of what this entails? 89 00:06:07,560 --> 00:06:08,560 Yeah, for sure. 90 00:06:08,560 --> 00:06:12,560 Canada actually has an action plan for combating AMR. 91 00:06:12,560 --> 00:06:19,320 So the four pillars that they recommend we address include the surveillance, better surveillance 92 00:06:19,320 --> 00:06:26,040 of AMR in Canada, boosting infection control, prevention, strengthening research and innovation. 93 00:06:26,040 --> 00:06:28,880 The fourth pillar is antibiotic stewardship. 94 00:06:28,880 --> 00:06:34,240 And so the AMR Alliance Manitoba, it's an initiative on that fourth point, which is 95 00:06:34,240 --> 00:06:35,800 stewardship. 96 00:06:35,800 --> 00:06:40,360 So we want to raise awareness for AMR among healthcare providers, but we also want to 97 00:06:40,360 --> 00:06:44,960 give them really good tools for stewardship that they can use in their day-to-day practice. 98 00:06:44,960 --> 00:06:50,240 So I'd like to say that the website, it's really a grassroots campaign that we started 99 00:06:50,240 --> 00:06:52,940 just out of conversations with colleagues. 100 00:06:52,940 --> 00:06:58,680 We had this idea that we were really committed to wanting to be able to talk about antibiotic 101 00:06:58,680 --> 00:07:02,520 stewardship, to start something in Manitoba. 102 00:07:02,520 --> 00:07:07,420 And at the same time, we didn't have a provincial program, a clinical program for antibiotic 103 00:07:07,420 --> 00:07:08,740 stewardship. 104 00:07:08,740 --> 00:07:16,040 So the website is something that we wanted to bring to number one, raise awareness. 105 00:07:16,040 --> 00:07:18,280 Number two, provide some resources. 106 00:07:18,280 --> 00:07:21,720 Number three, create a community so that we could actually have a community where we could 107 00:07:21,720 --> 00:07:28,000 share resources, talk about what we're doing as people in healthcare providers in the province 108 00:07:28,000 --> 00:07:33,320 that are interested in antibiotic stewardship and talk about what's working, where we need 109 00:07:33,320 --> 00:07:34,840 to go from here. 110 00:07:34,840 --> 00:07:39,000 And the other idea behind the website was the idea of a pledge. 111 00:07:39,000 --> 00:07:45,760 So you have this concept in psychology actually, that if you want to promote a behavior in 112 00:07:45,760 --> 00:07:50,280 yourself, stating it publicly is a very good way to do that. 113 00:07:50,280 --> 00:07:57,520 So if you want to talk about New Year's resolutions, going to the gym five days a week, one of 114 00:07:57,520 --> 00:08:03,080 the steps on January 1st that will help you to achieve that goal is to go ahead and state 115 00:08:03,080 --> 00:08:04,320 that publicly. 116 00:08:04,320 --> 00:08:05,760 I will be doing this. 117 00:08:05,760 --> 00:08:11,000 You can shout it to social media or to your friends or announce it at, I don't know, at 118 00:08:11,000 --> 00:08:12,000 family dinners. 119 00:08:12,000 --> 00:08:17,040 In this case, we want to promote antibiotic stewardship and bring that level of commitment 120 00:08:17,040 --> 00:08:19,400 to this day-to-day clinical practice. 121 00:08:19,400 --> 00:08:22,320 So that's some of the ideas creating the website. 122 00:08:22,320 --> 00:08:23,320 Perfect. 123 00:08:23,320 --> 00:08:24,320 Yeah. 124 00:08:24,320 --> 00:08:27,240 So you kind of talk about this accountability, right, to AMR. 125 00:08:27,240 --> 00:08:31,800 And so I think on a day-to-day basis, all of us feel like we're doing or we're trying 126 00:08:31,800 --> 00:08:35,960 to do a good job with antibiotic and anti-microbial use. 127 00:08:35,960 --> 00:08:42,120 But obviously, I think these types of awareness campaigns really bring out that initiative 128 00:08:42,120 --> 00:08:44,900 to actually look back and reflect upon ourselves, right? 129 00:08:44,900 --> 00:08:50,380 So as healthcare providers, are we really doing everything possible that we can to reduce 130 00:08:50,380 --> 00:08:55,080 these resistance rates and focus on really, is this the best decision? 131 00:08:55,080 --> 00:09:00,320 And I think sometimes it becomes difficult because when you have that clinician hat on 132 00:09:00,320 --> 00:09:08,200 and then you kind of have to switch gears to thinking about more of global or even if 133 00:09:08,200 --> 00:09:13,240 we think it is a national effect that we're creating, it can sometimes be a bit difficult 134 00:09:13,240 --> 00:09:15,080 as healthcare providers, I think. 135 00:09:15,080 --> 00:09:20,120 But I think these types of pledges and certain tools and knowing that your colleagues across 136 00:09:20,120 --> 00:09:28,320 either interprovincially or in the province are doing something to raise awareness towards 137 00:09:28,320 --> 00:09:31,440 this, I think really helps with that accountability. 138 00:09:31,440 --> 00:09:32,440 So this is fantastic. 139 00:09:32,440 --> 00:09:35,160 I'm actually really excited to hear more about it. 140 00:09:35,160 --> 00:09:40,600 So in terms of discussing some of the tools that you've created, so how can people or 141 00:09:40,600 --> 00:09:45,280 is it only like, is it people really from Manitoba, like healthcare providers in Manitoba 142 00:09:45,280 --> 00:09:48,760 currently that can access some of the tools there? 143 00:09:48,760 --> 00:09:53,280 We created this campaign for healthcare providers in Manitoba, Rupina, but there's absolutely 144 00:09:53,280 --> 00:09:56,440 no reason that others can't access it. 145 00:09:56,440 --> 00:10:02,440 So we have a number of places on the website that providers can go. 146 00:10:02,440 --> 00:10:03,980 So the first one is the pledge. 147 00:10:03,980 --> 00:10:05,600 I think this is good for anyone to do. 148 00:10:05,600 --> 00:10:10,000 I mean, I think I'd like to see as many healthcare providers as possible, you know, sign the 149 00:10:10,000 --> 00:10:11,280 pledge. 150 00:10:11,280 --> 00:10:12,840 You don't have to be from Manitoba. 151 00:10:12,840 --> 00:10:20,960 We'll definitely keep you on our regular mail out list for any new resources that are added 152 00:10:20,960 --> 00:10:22,520 to the website. 153 00:10:22,520 --> 00:10:27,200 The other things that we have on the website so far, we've developed a number of cases. 154 00:10:27,200 --> 00:10:33,000 So clinical cases and they are not real cases, but they're common clinical scenarios that 155 00:10:33,000 --> 00:10:39,600 may come up, whether it be a viral upper respiratory tract infection, you know, how do you communicate 156 00:10:39,600 --> 00:10:44,600 best management plan to your patients and, you know, give them really concrete advice 157 00:10:44,600 --> 00:10:49,640 and something that they're going to walk away feeling, you know, okay, this is, they feel 158 00:10:49,640 --> 00:10:54,840 very satisfied and happy with the plan and know when to come back. 159 00:10:54,840 --> 00:10:58,000 And they're not walking away feeling like, oh, maybe they should have got antibiotics, 160 00:10:58,000 --> 00:11:03,720 for example, because that can be, you know, other cases around urinary tract infections, 161 00:11:03,720 --> 00:11:06,320 sepsis and we've got more coming out all the time. 162 00:11:06,320 --> 00:11:09,400 And then we have a third section on resources. 163 00:11:09,400 --> 00:11:12,600 So linking other good work that people are doing. 164 00:11:12,600 --> 00:11:18,560 You know, we have one resource that's actually developed in Saskatchewan, which is the viral 165 00:11:18,560 --> 00:11:23,120 prescription pad, which I think is a fantastic resource, you know, so there's evidence to 166 00:11:23,120 --> 00:11:29,520 suggest that when people take something away from their medical appointment, details, advice 167 00:11:29,520 --> 00:11:36,240 about what to do, you know, as opposed to just verbal advice, that that increases understanding 168 00:11:36,240 --> 00:11:39,960 of what the medical instructions and also increases their satisfaction. 169 00:11:39,960 --> 00:11:43,920 So again, they're not coming away feeling shortchanged in some way. 170 00:11:43,920 --> 00:11:48,600 So I think these kinds of resources are really useful and they just help day to day. 171 00:11:48,600 --> 00:11:52,480 And I think it kind of goes back to that same psychology, right, that you were talking about. 172 00:11:52,480 --> 00:11:57,760 So from like a patient standpoint, also, they always want to feel, you know, included in 173 00:11:57,760 --> 00:12:01,240 their management plan, they want to be involved in their care. 174 00:12:01,240 --> 00:12:07,400 And so also bringing out these tools and describing something or having like a descriptive analysis 175 00:12:07,400 --> 00:12:12,920 or a figure, for instance, like these tools, when we take them to our clinic visits, I 176 00:12:12,920 --> 00:12:15,800 think is more helpful than just using words. 177 00:12:15,800 --> 00:12:20,400 So I think those are fantastic tools and I look forward to using some of those as well 178 00:12:20,400 --> 00:12:25,360 in my clinic, definitely incorporating them, especially with this viral season that's coming 179 00:12:25,360 --> 00:12:26,360 up, right. 180 00:12:26,360 --> 00:12:32,480 So remembering that even in like I'm in pediatrics and majority of our infections usually start 181 00:12:32,480 --> 00:12:36,280 off as viral, right, even ear infections. 182 00:12:36,280 --> 00:12:41,240 So cold flu and COVID season is upon us. 183 00:12:41,240 --> 00:12:42,240 And so very timely. 184 00:12:42,240 --> 00:12:43,240 It's really great. 185 00:12:43,240 --> 00:12:50,200 So in terms of, I think obviously like our overall goal is to reduce or to create awareness, 186 00:12:50,200 --> 00:12:56,040 enhance the surveillance and really decrease the resistance patterns over time. 187 00:12:56,040 --> 00:13:00,520 Do you have like specific checkpoints or specific goals that you're trying to achieve through 188 00:13:00,520 --> 00:13:01,700 the program? 189 00:13:01,700 --> 00:13:03,480 Our goals are pretty modest, Rapina. 190 00:13:03,480 --> 00:13:07,520 We just want to reach a large community of healthcare workers and get people to sign 191 00:13:07,520 --> 00:13:09,360 up to be AMR champions. 192 00:13:09,360 --> 00:13:15,640 That helps us to be able to deliver, you know, all the resources to a bigger audience. 193 00:13:15,640 --> 00:13:20,840 And we, yeah, we want to just continue to be able to provide kind of high quality antibiotic 194 00:13:20,840 --> 00:13:25,240 stewardship resources for people to use on a day to day basis. 195 00:13:25,240 --> 00:13:27,000 So pretty modest, I think. 196 00:13:27,000 --> 00:13:31,560 But as we go, we continue to ask, you know, what is the most useful thing? 197 00:13:31,560 --> 00:13:35,240 So we may ban that over time just based on feedback. 198 00:13:35,240 --> 00:13:40,880 And so I know a lot of people are aware of like the WHO awareness campaigns and so really 199 00:13:40,880 --> 00:13:46,440 haven't probably thought too much about the provincial or even national campaigns. 200 00:13:46,440 --> 00:13:50,720 So how does this kind of tie in with the WHO awareness? 201 00:13:50,720 --> 00:13:58,800 Yeah, so the World Health Organization also is interested in promoting AMR awareness and 202 00:13:58,800 --> 00:14:00,000 antibiotic stewardship. 203 00:14:00,000 --> 00:14:05,840 So they have an international campaign that Canada is a part of. 204 00:14:05,840 --> 00:14:14,080 And so Go Blue is a color campaign that takes place every year during World AMR Awareness 205 00:14:14,080 --> 00:14:15,120 Week. 206 00:14:15,120 --> 00:14:19,480 And so that falls November 18th to 24th this year. 207 00:14:19,480 --> 00:14:24,680 In Canada, actually the National Collaborating Center for Infectious Disease, the NCCID, 208 00:14:24,680 --> 00:14:31,920 who have been really instrumental in supporting the AMR Alliance website, they are helping 209 00:14:31,920 --> 00:14:34,280 to collaborate the national effort. 210 00:14:34,280 --> 00:14:37,200 So it's a national campaign. 211 00:14:37,200 --> 00:14:40,480 We're trying to do our part locally just to promote that. 212 00:14:40,480 --> 00:14:44,200 And as part of the campaign, we're just trying to increase visibility. 213 00:14:44,200 --> 00:14:49,200 So one of the things that is going to happen is there's landmarks across Canada that are 214 00:14:49,200 --> 00:14:54,800 going to be lit up in blue during World Anti-Microbial Awareness Week, usually kind of towards the 215 00:14:54,800 --> 00:14:57,440 end, either November 23rd or 24th. 216 00:14:57,440 --> 00:15:04,000 So we'll have places like the CN Tower, Canada Place, and then Manageable Legislature in 217 00:15:04,000 --> 00:15:06,560 Winnipeg that will be lit up in blue. 218 00:15:06,560 --> 00:15:12,480 So the idea is, you know, you can support the campaign by going and visiting all of 219 00:15:12,480 --> 00:15:17,760 these places that are lit up in blue, take your picture, post it on social media. 220 00:15:17,760 --> 00:15:18,760 That's really great. 221 00:15:18,760 --> 00:15:25,360 I think it's nice to incorporate some of these provincial landmarks and just make it more 222 00:15:25,360 --> 00:15:27,400 of a social event as well. 223 00:15:27,400 --> 00:15:28,960 So it kind of makes it more fun too. 224 00:15:28,960 --> 00:15:34,360 So are there other provinces that have also done similar websites or pledges that you're 225 00:15:34,360 --> 00:15:38,000 aware of, or has Manitoba been the leader in this right now? 226 00:15:38,000 --> 00:15:43,760 I mean, a lot of provinces have probably much more formal anti-microbial stewardship programs 227 00:15:43,760 --> 00:15:45,960 than Manitoba right now. 228 00:15:45,960 --> 00:15:50,980 But as far as websites, you know, I mean, I think Ontario has a really great website, 229 00:15:50,980 --> 00:15:54,200 but that's as a part of their anti-microbial stewardship program. 230 00:15:54,200 --> 00:15:56,280 They've got tons of great resources on there. 231 00:15:56,280 --> 00:15:57,920 BC does the same. 232 00:15:57,920 --> 00:16:01,920 I think there's lots of really great work that's being done across the country, not 233 00:16:01,920 --> 00:16:03,800 as much in terms of pledges. 234 00:16:03,800 --> 00:16:08,920 So we kind of went a little bit of a different direction there, but in terms of, you know, 235 00:16:08,920 --> 00:16:15,080 just good resources and in some cases, you know, that's tied to, where it is tied to 236 00:16:15,080 --> 00:16:17,360 the antibiotic stewardship programs. 237 00:16:17,360 --> 00:16:23,080 You can even find some information about statistics on what sort of antibiotics are being used, 238 00:16:23,080 --> 00:16:26,560 what are the rates, what are the outcomes they're seeing in the initiatives. 239 00:16:26,560 --> 00:16:28,160 So I think those are all really great. 240 00:16:28,160 --> 00:16:29,160 That's fantastic. 241 00:16:29,160 --> 00:16:33,080 And just a reminder to our listeners too, you know, if you're in a place where you're 242 00:16:33,080 --> 00:16:37,520 only practicing community practice, let's say, you can still access these tools and 243 00:16:37,520 --> 00:16:39,000 use that there as well. 244 00:16:39,000 --> 00:16:42,840 And so I think a lot of our anti-microbial stewardship programs, which I always hear 245 00:16:42,840 --> 00:16:49,040 from our colleagues out in the community, is that a lot of them are geared towards in-hospital 246 00:16:49,040 --> 00:16:50,040 services. 247 00:16:50,040 --> 00:16:55,560 And so, but obviously any of these resources can be used in that outpatient community as 248 00:16:55,560 --> 00:16:56,560 well. 249 00:16:56,560 --> 00:16:57,560 So just remember that. 250 00:16:57,560 --> 00:16:58,560 That's true. 251 00:16:58,560 --> 00:17:02,480 And we've got on our resources page, we've got an eye towards that too. 252 00:17:02,480 --> 00:17:07,960 Rapina, so for each resource, we sort of highlight this is more applicable for acute care or 253 00:17:07,960 --> 00:17:12,960 whether it be primary care, such as the viral prescription pad, or even in the long-term 254 00:17:12,960 --> 00:17:14,360 care setting as well. 255 00:17:14,360 --> 00:17:18,440 I know there is probably some provinces out there and people who will be listening who 256 00:17:18,440 --> 00:17:22,400 probably haven't created or don't know about an initiative that's been done locally or 257 00:17:22,400 --> 00:17:26,760 would like to start something like a platform to share resources. 258 00:17:26,760 --> 00:17:32,160 So what are, I think some of the, what advice can you give them or any tips if they are 259 00:17:32,160 --> 00:17:34,280 looking to start this on their end? 260 00:17:34,280 --> 00:17:37,960 Really, what you need is an idea and the passion to do it. 261 00:17:37,960 --> 00:17:45,040 This is really not something that I would have done if I wasn't very committed to the 262 00:17:45,040 --> 00:17:47,160 idea. 263 00:17:47,160 --> 00:17:51,960 But I think, if you're interested in doing it, talk to colleagues, talk to others that 264 00:17:51,960 --> 00:17:58,480 might be similarly interested for me, like finding an organization, like the NCCID that 265 00:17:58,480 --> 00:18:04,480 was looking for partners that was able to provide the support, for example, for the website. 266 00:18:04,480 --> 00:18:06,440 That was a real bonus. 267 00:18:06,440 --> 00:18:11,880 So I think you never know who else might be out there and looking to collaborate until 268 00:18:11,880 --> 00:18:13,680 you start asking. 269 00:18:13,680 --> 00:18:18,880 Usually like in your guys's team right now, and part of your initiative, do you have like 270 00:18:18,880 --> 00:18:21,960 a multidisciplinary team that's working with you? 271 00:18:21,960 --> 00:18:27,720 Yeah, I got, we've got a number of other, you know, infectious disease doctors, also, 272 00:18:27,720 --> 00:18:32,640 you know, family doctors that help advise, but really it's being mostly driven by myself 273 00:18:32,640 --> 00:18:38,400 and a team of very interested medical students that are helping to kind of bring some energy 274 00:18:38,400 --> 00:18:40,560 and been really fantastic. 275 00:18:40,560 --> 00:18:41,680 That sounds great. 276 00:18:41,680 --> 00:18:47,560 Definitely a great opportunity for, let's say, a QI project or an initiative at a local 277 00:18:47,560 --> 00:18:48,560 center. 278 00:18:48,560 --> 00:18:52,280 So definitely, I think some of our, and we have lots of medical students listening to 279 00:18:52,280 --> 00:18:57,600 the podcast, so I think that's a good opportunity for them to bring up with their center. 280 00:18:57,600 --> 00:19:01,480 So in terms of what's the future, so this is a great initiative. 281 00:19:01,480 --> 00:19:06,960 I think having such a website and having these resources, and you mentioned like obviously 282 00:19:06,960 --> 00:19:10,880 having ongoing tools and getting some feedback from healthcare providers who are using the 283 00:19:10,880 --> 00:19:15,120 tools to see if there's anything that you can update. 284 00:19:15,120 --> 00:19:20,440 But what else can we do or what are you planning on doing with the future of this campaign? 285 00:19:20,440 --> 00:19:27,440 So what we're planning to do is in the next three months, we want to promote world antimicrobial 286 00:19:27,440 --> 00:19:28,440 awareness week. 287 00:19:28,440 --> 00:19:31,320 So that's coming up November 18th to 24th. 288 00:19:31,320 --> 00:19:35,080 We'll be putting out some links to the national campaign. 289 00:19:35,080 --> 00:19:40,120 There'll be some further information coming out to our mail out group. 290 00:19:40,120 --> 00:19:41,720 And really that's our focus. 291 00:19:41,720 --> 00:19:46,960 But beyond that, we're just going to keep working on developing more resources, a few 292 00:19:46,960 --> 00:19:50,960 more that we'd really like to highlight, especially around choosing wisely. 293 00:19:50,960 --> 00:19:54,820 That's been a really fantastic resource in Canada. 294 00:19:54,820 --> 00:19:57,440 So that's something that we want to highlight. 295 00:19:57,440 --> 00:20:03,320 And beyond that, I think we've got a lot of energy and a lot of people that are listening. 296 00:20:03,320 --> 00:20:05,640 So we're always open to new ideas. 297 00:20:05,640 --> 00:20:09,960 And then has there been, because I know like sometimes we'll start a campaign or we'll 298 00:20:09,960 --> 00:20:16,560 start an initiative and then have kind of research or combined evaluation of let's say 299 00:20:16,560 --> 00:20:18,120 like antimicrobial use rates. 300 00:20:18,120 --> 00:20:24,500 Now obviously we know that with the CARS reports yearly and the updates, we look into a lot 301 00:20:24,500 --> 00:20:26,280 of the main details there. 302 00:20:26,280 --> 00:20:30,320 And some of the stewardship programs are definitely probably doing a lot of more audit and feedback 303 00:20:30,320 --> 00:20:33,840 and then evaluating their use rates locally. 304 00:20:33,840 --> 00:20:38,620 But is that something that you're doing more provincially from this awareness campaign 305 00:20:38,620 --> 00:20:40,200 or thought about doing it? 306 00:20:40,200 --> 00:20:45,640 I think we'd love to do that in the long term or even in the intermediate short term. 307 00:20:45,640 --> 00:20:53,480 What I'd love to see is a provincial program where we can really track all those outcomes 308 00:20:53,480 --> 00:20:54,480 that we're interested in. 309 00:20:54,480 --> 00:20:59,040 So whether it be antimicrobial use and outcomes in the hospitals. 310 00:20:59,040 --> 00:21:02,840 So for our patients, are they seeing increased length of stay? 311 00:21:02,840 --> 00:21:05,280 Are they seeing mortality? 312 00:21:05,280 --> 00:21:11,360 We need to track all these outcomes and then know where we can be better directing our 313 00:21:11,360 --> 00:21:16,080 resources, not only in the hospitals, but in our long-term care and in the community. 314 00:21:16,080 --> 00:21:21,020 So I think there's a lot of things that are being done and that we'd like to do here, 315 00:21:21,020 --> 00:21:22,720 but we're just not quite there yet. 316 00:21:22,720 --> 00:21:26,440 So I think there's a lot more that could be done there. 317 00:21:26,440 --> 00:21:30,560 And then on your guys' website, do you guys have a contact us link or anything like that 318 00:21:30,560 --> 00:21:33,960 where other healthcare professionals can reach out to you guys? 319 00:21:33,960 --> 00:21:37,800 Yeah, we've got contact information on the website. 320 00:21:37,800 --> 00:21:42,720 And if you have other ideas that can make the website either better or if you have a 321 00:21:42,720 --> 00:21:47,080 project that we could work together on, any of your listeners, I'd really love to hear 322 00:21:47,080 --> 00:21:48,080 from you. 323 00:21:48,080 --> 00:21:49,080 That sounds awesome. 324 00:21:49,080 --> 00:21:50,500 Thanks so much, Terry. 325 00:21:50,500 --> 00:21:55,080 Is there anything else that we kind of missed about talking about the AMR awareness campaign 326 00:21:55,080 --> 00:21:59,120 or any last few messages that you want to send to our listeners today? 327 00:21:59,120 --> 00:22:05,720 No, I think that if we're going to have one message, it's really that we want to keep 328 00:22:05,720 --> 00:22:09,960 antibiotics effective for now and for the future. 329 00:22:09,960 --> 00:22:15,520 And the best way that we can do that is by using them to their best ability. 330 00:22:15,520 --> 00:22:23,440 So I think having the resources that will support how do we effectively communicate 331 00:22:23,440 --> 00:22:28,600 when an antibiotic might not be indicated or even diagnostic strategies that can help 332 00:22:28,600 --> 00:22:33,480 us to know when antibiotics are best indicated. 333 00:22:33,480 --> 00:22:37,760 This is obviously a work in progress, but it's something we're really committed to. 334 00:22:37,760 --> 00:22:39,680 So have a look at the website. 335 00:22:39,680 --> 00:22:41,760 If you have an idea, let me know. 336 00:22:41,760 --> 00:22:42,760 That sounds fantastic. 337 00:22:42,760 --> 00:22:45,880 Well, thank you so much for taking the time to come on the podcast. 338 00:22:45,880 --> 00:22:51,800 I'm sure this is going to be a super hit episode and I'm excited to do follow-up episodes, 339 00:22:51,800 --> 00:22:58,200 even after the awareness campaigns or if other centers are involved in creating a similar 340 00:22:58,200 --> 00:22:59,200 initiative. 341 00:22:59,200 --> 00:23:06,280 And so I think it's a great opportunity for us, all of us to kind of think about AMR, 342 00:23:06,280 --> 00:23:09,480 remind ourselves, because I think all of us try our best to do it. 343 00:23:09,480 --> 00:23:14,440 And being in infectious diseases, it's a little bit more helpful when you're always prescribing 344 00:23:14,440 --> 00:23:19,240 antibiotics or taking away antibiotics to do this on a daily basis, but really remembering 345 00:23:19,240 --> 00:23:22,240 that the tools are there and they're out there for everybody. 346 00:23:22,240 --> 00:23:26,960 So starting early in your careers, for our medical students, remembering that this isn't 347 00:23:26,960 --> 00:23:32,200 something where you have to do once you're a staff, just remembering that you can use 348 00:23:32,200 --> 00:23:34,400 these tools early on. 349 00:23:34,400 --> 00:23:35,400 Thanks so much. 350 00:23:35,400 --> 00:23:38,160 We really appreciate you coming on the podcast and thanks for taking the time. 351 00:23:38,160 --> 00:23:39,880 Rapina, thanks again for having me. 352 00:23:39,880 --> 00:23:40,880 It's been great. 353 00:23:40,880 --> 00:23:41,880 Take care. 354 00:23:41,880 --> 00:23:45,400 Thank you, Dr. Pirwal and Dr. Wirtz for the discussion. 355 00:23:45,400 --> 00:23:47,280 Have a topic suggestion? 356 00:23:47,280 --> 00:23:55,920 Email us at thecanadianbreakpoint at gmail.com and follow us on ex-formerly twitter at cabbreakpoint. 357 00:23:55,920 --> 00:24:08,800 See you again soon at the Canadian Breakpoint.