Kuwait National Action Plan on Antimicrobial Resistance 2022

Kuwait national action plan on antimicrobial resistance 2022 1 Kuwait National Action Plan On Antimicrobial Resistance 2022 Kuwait national action plan on antimicrobial resistance 2022 2 This document was prepared by: Dr. Rima Moghnieh, MD, FRCP (WHO consultant), Dr. Abeer Aly Omar (Head of Surveillance Department, Infection Control Directorate MOH-WHO NFP AMR Kuwait), Dr. Ahmed Al-Motawaa (Director of Infection Control Directorate-MOH, Coordinator of the National Committee for the Proper Use of Antimicrobials) along with professionals and stakeholders from Kuwait whose names are listed below (alphabetical order): 1. Ph. Alaa Al-Furaih, Pharmaceutical Services Directorate-WHO GLASS-AMC NFP -MOH 2. Dr. Abeer Albaho, Director of Health Promotion Department. MOH 3. Ph. Adel Al Salem, Director of Central Medical Stores Directorate-MOH 4. Ph. Abdullah Awadh Alenezi, Head of Tablet Department -Central Medical Stores Directorate MOH 5. Dr. Ahlam Jeragh, Head of Medical Laboratories Department Al Adan Hospital, Head of Microbiology and Virology Committee- Medical Laboratories Council MOH-WHO GLASS-AMR NFP 6. Dr. Ali Lairy, Senior Specialist-General Surgery-Jaber Al-Ahmed Hospital-MOH 7. Mrs. Anwar Ali, Environment Health department, Public Health Directorate MOH 8. Dr. Ayed Al-Shemmari, Director of Pharmaceutical Services Directorate- MOH 9. Dr. Deena Al Dhubaib, Director of Primary Healthcare Directorate -MOH 10. Dr. Emad Elsayed Younis, The Expertise of the national project for control of TB and Brucellosis in bovine in Kuwait 11. Dr. Hanan Al-Sarawi, Director of Research and Studies Office- Kuwait Environment Public authority (KEPA) 12. Ph. Jaber AL-Khaledi, Director of Pharmaceutical and Herbal Medicines Registration and Control Administration-MOH 13. Dr. Jenan Fakhra, Family Medicine Senior Registrar - Primary Healthcare Directorate MOH 14. Dr. Kholoud Al Fadhalah, Head of Infection Control Department. Infection Control Directorate MOH- WHO NFP IPC. 15. Ph. Maryam Al-Yaseen, Director of Drug Inspection Control-MOH 16. Dr. Mohammad Al Seaidan, Director of Public Health Directorate- MOH 17. Dr. Noufa Alshammari, Director of the Technical Directorate- MOH 18. Dr. Sarah Al-Qabandi, Head of Public Health Laboratories-Public Health Directorate MOH 19. Dr. Sherine Gaber, Public Health Directorate-MOH 20. Dr.Suad Abul, Director of Medical Licensing Department MOH 21. Dr. Yousef Saud Al Shridah, Director of Epidemiology and zoonosis diseases- Animal Health Department –PAAF Kuwait national action plan on antimicrobial resistance 2022 3 Contents Abbreviations and acronyms p.4 Foreword p.6 Executive summary p.7 Background p.11 Introduction p.11 Situation analyses and Assessment p.15 Country Response and Governance Plans p.25 AMR Awareness Operational and budget plan p.32 AMR Surveillance Operational and budget plan p.52 Infection prevention and Control Operational and budget plan p.79 Antibiotic Use Operational and budget plan p.113 References p.133 Annexes p.136 Annex 1: Governance: Strategic plan, and Monitoring and Evaluation plan p.137 Annex 2: AMR Awareness: Strategic plan, and Monitoring and Evaluation plan p.146 Annex 3: AMR Surveillance: Strategic plan, and Monitoring and Evaluation plan p.173 Annex 4: Infection prevention and Control: Strategic plan, and Monitoring and Evaluation plan p.210 Annex 5: Antibiotic Use: Strategic plan, and Monitoring and Evaluation plan p.258 Kuwait national action plan on antimicrobial resistance 2022 4 Abbreviations and acronyms AMC Antimicrobial consumption AMR Antimicrobial resistance AMS Antimicrobial Stewardship CAP College of American Pathologists CDC Centre for Disease Control CE Continuous Education CLSI Clinical and Laboratory Standards Institute CME Continuous medical education CMS Central Medical Stores CRE Carbapenem resistant Enterobacteriaceae EPA Environment Public Authority ESBL extended-spectrum beta-lactamases FAO Food and Agriculture Organization GLASS Global Antimicrobial Resistance and Use Surveillance System HAI Healthcare -associated infection HCWs Healthcare workers HIS Hospital Information System ICD Infection Control Directorate IPC Infection prevention and control KEPA Kuwait Environment Public authority KIMS Kuwait Institute of Medical Specializations KISR Kuwait Institute of Scientific Research LIS Laboratory Information System MDR Multidrug resistant MDROs Multidrug resistant organisms MOE Ministry of Education Kuwait national action plan on antimicrobial resistance 2022 5 MOH Ministry of Health MOHE Ministry of Higher Education MRSA Methicillin resistant Staphylococcus aureus NAP National Action Plan NFP National Focal point NGOs Non-Governmental Organizations NMCG National Multisectoral Coordinating Group OIE World Organization of Animal Health ToR Terms of reference TOT Training of trainers PAAET The Public Authority of Applied Education and Training PAAF The Public Authority of Agriculture Affairs and Fish Resources PAFN The Public authority for Food and nutrition PSD Pharmaceutical Services Directorate WHO World Health Organization Kuwait national action plan on antimicrobial resistance 2022 6 Forward This national action plan for Kuwait to combat antimicrobial resistance has been formulated in the line of the WHO strategic objectives. It addresses the involvement of all the related sectors including human and veterinary medicine, food chain, finance, environment, and the general public consumers. Therefore, the National Committee for the Proper Use of Antimicrobials was involved and technical subcommittees were established to prepare this plan. Kuwait national action plan on antimicrobial resistance 2022 7 Executive summary This national action plan for Kuwait to combat antimicrobial resistance has been formulated in the line of the WHO strategic objectives. It addresses the involvement of all the related sectors including human and veterinary medicine, agriculture, finance, environment, and the general public consumers. The AMR NAP was prepared over a period of three months covering the governance of the plan and the structure of the work to be done in AMR awareness, surveillance, infection prevention and control, rational antimicrobial use. Research and sustainability regarding AMR were included in the corresponding pillars. The preparation of the plan was done through meetings held by the WHO consultant and the WHO national AMR focal person at MOH (Dr. Abeer Aly) with stakeholders from the different ministries and authorities including the MOH, PAAF, and KEPA. The approach to the plan development was based on mapping the current situation regarding each pillar and then building on what is available a new plan to be executed over the coming five years. Regarding the situation analysis, Kuwait had already started its response regarding the AMR pandemic. Regarding country response and governance, an NMCG has already been formed and an AMR focal person and IPC focal person have already been appointed and are working. Major work on AMR prior to the plan development was concentrated on the its control in humans. AMR Awareness The MOH has already started few activities that improve general public awareness about AMR in human health. Short films, advertisements, SMS, posters, brochures and leaflets have already been prepared and distributed during the activities of National campaigns of proper use of antibiotics performed by the IPC Directorate. During the past 2 years, this material is broadcasted during the World Antimicrobial Awareness Week. Education about AMR is included in some human health related specialties but not in all and not in veterinary or agriculture professionals’ continuous education. Besides the organization of the focal persons’ functions and the inter-ministerial communications, the plan targets general public awareness campaigns and yearlong awareness messages, regarding human and non-human health. AMR-related education is another target of this plan in basic primary education, undergraduate university education, postgraduate studies, as well as continuous Kuwait national action plan on antimicrobial resistance 2022 8 education of professionals. Collaboration with FAO, OIE and other regional/international NGOs that already have AMR education-related programs is strongly encouraged. Drug companies play a major role in promoting the use of antimicrobials, where both MOH and PAAF would demand in the future that these companies provide impartial education about AMR, along with its causes and consequences. The country will actively participate in the World Antimicrobial Awareness Week, however the efforts targeting AMR awareness will be spread throughout the yearly calendar. AMR Surveillance Public and private hospitals have well-equipped microbiology laboratories that provide reliable microbiology data. Individual facility-based AMR surveillance is being performed in some hospitals, that do issue their own antibiograms, yet this practice is not available throughout the country. A focus group has already been created at MOH and has started gathering data to be reported to WHO GLASS platform and the AMR data bank is increasing gradually. A central AMR laboratory is not available, yet a CDC laboratory is in the process of being built and its budget has already been assigned. In non-human health sectors, there is no real tangible data about AMR except for few research projects that cannot be counted as representative to these fields. The NAP started with an organizational effort to link hospitals to the central AMR surveillance unit at MOH, and to empower and enlarge this unit (that is the “GLASS Unit” now) to become the national AMR surveillance unit. This unit would enable hospitals to issue their own local antibiograms to be compiled at a later stage in a national AMR report, that will be periodically reviewed and updated. A central AMR reference laboratory is planned to be present within the new CDC, where confirmation of AMR as well as training and quality control of the laboratories in the country will be organized. Broader and more active participation in GLASS platform data feeding is also anticipated in the NAP, not to mention CAP accreditation for the laboratories in the country. AMR detection and surveillance represent in the non-human health sector is a major priority of the upcoming NAP. Mapping of available AMR data in these fields is planned, as well as improving the veterinary/agriculture laboratory capacity at PAAF to detect and ultimately report and surveil AMR. AMR-related research projects in agriculture, food safety and environment will be prioritized in universities or in grants and funds through KEPA research office. Kuwait national action plan on antimicrobial resistance 2022 9 Infection Prevention and Control The work in the IPC pillar has been quite advanced in the country with the presence of a central IPC directorate at MOH that coordinates IPC among the different hospitals. All hospitals (public and private) already have local functioning IPC offices with the supervision and coordination by the IPC directorate at MOH. IPC guidelines are available, but some need updating. IPC training is performed centrally and locally in the hospitals. Regarding the structural basis of the IPC in Kuwait, adequate hygiene and sanitation of drinking water is available in the country as well as proper waste management is under the authority of the Ministry of Public Works. Surveillance of healthcare associated infections is well established in hospitals, however, this work is still mostly manual and thus requires important resources in terms of time and workforce. IPC in the veterinary world is applied through biosecurity measures in farms under the authority of PAAF that makes sure that animals are vaccinated according to OIE guidelines. There is an infrastructure related to the safety and quality control of products in the food chain. Regarding the Governance in this pillar, more organization is required, whereby IPC focal persons in PAAF, KEPA and food safety authorities will be appointed. These functions will be assigned to existing employees and will be added to their TOR. This strategy was proposed by the stakeholders, since it is feasible considering the actual workload and it minimizes extra costs. Although a lot has already been done at MOH, the plan targets further improvement in IPC. In order to improve compliance with IPC principles in healthcare facilities, the plan suggests implementation of IPC through decrees and mandates. On the other hand, an update of the national IPC guidelines was suggested based on the latest WHO guidelines on core components of IPC programmed at the national and acute health care facility level. Since digitalization of hospital data and medical records is currently in process in Kuwaiti hospitals, it was suggested that HAI surveillance be linked directly from the hospitals to IPC directorate. Additionally, availability of a digital surveillance system has been suggested to minimize paper work, improve efficiency and save time. IPC education has already been touched upon in the plan at all levels in the human and non-human health sectors including basic undergraduate and continuous postgraduate education. National IPC guidelines in non-human health sectors including animal health, agriculture and environment will be developed. Rational Use of Antimicrobials The regulatory authorities of proper procurement legislation and control of importation and sale of registered medicines are well established in the country and well controlled by MOH authorities. There is a legislation that prohibit selling antimicrobials without a prescription of a certified health Kuwait national action plan on antimicrobial resistance 2022 10 professional. On the inpatient level, post-prescription review for appropriateness of antimicrobial agents 48 to 72 hours after administration is being performed in public hospitals, yet only depending on the presence of qualified personnel and ID physicians. In general, national authorities work with close communication with OIE, FAO and WHO, in addition to being part of GCC. The organization of the governance of this pillar is one of the priorities in the upcoming NAP through assigning its responsibilities to specific focal persons in MOH, PAAF and KEPA. Other priorities include establishing inter-ministerial communication and putting a high-priority list of antimicrobials that should not be used in veterinary medicine or as crop growth promoters. In human health, antimicrobial stewardship programs in hospitals will be implemented and they are planned to be controlled at a central unit in MOH with clear national antimicrobial usage guidelines that are regularly updated according to national antibiograms and AMR epidemiologic data. In order to achieve these aims, a national task force will be appointed to include professionals from the public and private sectors with the needed academic and scientific expertise. Likewise, antimicrobial use guidelines in the agriculture and veterinary fields are to be put and implemented, and their sale would be exclusively based upon veterinary prescriptions. Finally, training courses and workshops targeting rational antimicrobial use in human and non-human health sectors should be provided periodically. Kuwait national action plan on antimicrobial resistance 2022 11 Background Introduction Antimicrobial (including antibiotic, antiviral, antifungal and antiprotozoal) agents are critical tools for fighting infectious diseases in humans, terrestrial and aquatic animals and plants, but they are becoming ineffective.1 Alarming levels of resistance have been reported in countries of all income levels, with the result that common diseases are becoming untreatable, and lifesaving medical procedures riskier to perform. Drug-resistant infections already cause at least 700,000 deaths globally a year, including 230,000 deaths from multidrug-resistant tuberculosis, a figure that could increase to 10 million deaths globally per year by 2050 under the most alarming scenario if no action is taken. Around 2.4 million people could die in high-income countries between 2015 and 2050 without a sustained effort to contain antimicrobial resistance (AMR).1 The emergence of AMR is a complex problem driven by many interconnected factors, in particular the use and misuse of antimicrobials. Antimicrobial use, in turn, is influenced by an interplay of the knowledge, expectations and interactions of prescribers and patients, economic incentives, characteristics of the health system and the regulatory environment.2 AMR will affect everybody, regardless of where they live, their health, economic circumstances, lifestyle or behavior. It will affect sectors beyond human health, such as animal health, agriculture, food security and economic development.3 In the light of this complexity, coordinated interventions are needed that simultaneously target the behavior of healthcare providers and patients and change important features of the environments in which they interact.2 Alert to this crisis, the May 2015 World Health Assembly endorsed a global action plan to tackle AMR. All Member States are urged to have in place, national action plans on antimicrobial resistance that are aligned with the global action plan with Whole-of-society engagement including a one health approach.3 Situation analyses and Assessment AMR in Kuwait is a serious problem resulting in increases in morbidity, mortality and healthcare costs. Similar to other countries, Kuwait faces challenges to combat AMR. Resistant organisms are implicated in several outbreaks in hospitals for example Methicillin resistant Staphylococcus aureus (MRSA), Multi drug resistant (MDR) Acinetobacter spp, MDR. Pseudomonas. aeruginosa and Carbapenem resistant Enterobacteriaceae (CRE). Kuwait national action plan on antimicrobial resistance 2022 12 There is no nationwide surveillance of AMR, data are available from individual studies from some hospitals. The prevalence of extended spectrum beta lactamase (ESBL) & CRE isolates in positive blood cultures of patients in a teaching hospital in Kuwait over a 2-year period were studied. 24.9% of Enterobacteriaceae were ESBL producers and 5.2% were CRE. 4 There is an alarming high prevalence (11.3%) of colistin-resistant Enterobacteriaceae among healthy food handlers in community while the fecal carriage rate of CRE was (5.3%)5. According to single center study, there was a high burden of Acinetobacter. baumannii (A. baumannii) related infections among Intensive care units (ICU) patients and multiple outbreaks were detected during the study period.6 Data from Kuwait National Healthcare-associated infections surveillance system (KNHSS) 7,8 reported alarming results. The most common organisms isolated from Healthcare associated infections (HAIs) in 2019 and 2020 were Klebsiella pneumoniae(K.pneumoniae). In 2019 CR K.pneumoniae represented 26.7 % from all K.pneumoniae isolated from different types of HAIs. However, in 2020 it is doubled to reach 50.1 %. A. baumannii which is the 4th common organisms causing HAIs in both 2019 and 2020 shows increasing MDR rates. In 2019, MDR A.baumannii represented 82.9 % and increased to reach 88.5 % in 2020. Kuwait is a low tuberculosis (TB) incidence (~ 24 cases/100 000 population) country with low (~ 1.1%) incidence of MDR-TB. Nearly 85% of all TB cases and > 90% of MDR-TB cases occur in expatriate population. These cases mainly arise due to reactivation of latent TB infection acquired previously by TB patients in their respective countries.9,10Until recently, rifampicin-resistant TB/MDR-TB among Kuwaiti subjects were infrequently detected and transmission of DR-TB was rarely reported in Kuwait.11-14 A fourfold increase in the detection of MDR-TB among Kuwaiti subjects was noted in recent years (2014–2017); however, the factors responsible for this sudden increase remained unknown and transmission of MDR-TB within Kuwait was not apparent from routine surveillance studies.15 Kuwait has a low-prevalence of HIV-1 infection. However, the detection of major mutations conferring resistance to nucleoside and non-nucleoside reverse transcriptase inhibitors (NNRTIs) in 12.5% of ART-naive patients, and about 30% of treatment-experienced patients.16 Misuse of the antibiotics in the healthcare setting is a big challenge. In 2008, a national study to assess the physicians, adherence to the local hospital antibiotic guidelines was conducted in 9 Ministry of Health (MOH) hospitals. The results revealed that 25% of the prescriptions were unnecessary (not indicated) while only 30.4% of the prescriptions were fully adherent to the guidelines.17 https://journals.sagepub.com/doi/full/10.1177/2040206620927908 Kuwait national action plan on antimicrobial resistance 2022 13 Misuse of antibiotics by public plays an important role in driving the emergence and dissemination of resistance. Understanding patients’ knowledge and practices concerning antibiotics can help to mitigate antibiotic resistance and sustain antibiotic effectiveness.18Communication to public on the association between unnecessary antimicrobial use and the emergence and spread of AMR seems an important component of strategies to control AMR.19-20 A cross-sectional survey was performed using a pretested self-administered questionnaire on a sample of 770 randomly selected Kuwaiti individuals. Nearly three-quarters (72.8%) of respondents had been prescribed antibiotics within 12 months prior to the study period, and 36% of them had not finished the course of treatment. Over one-quarter (27.5%) were self-medicated with antibiotics to treat mainly common cold, sore throat and cough. Self-medication was more prevalent among those who were prescribed antibiotics and those who had attitudes towards using and accessing antibiotic inappropriately. Almost 47% of participants had low knowledge regarding action, use, safety and resistance of antibiotics. Forty one percent of respondents had attitudes towards using and accessing antibiotic inappropriately.21 During the activities of Kuwait National Campaign for the Proper Use of Antimicrobials 2019, assessment of the level of knowledge, attitudes and practices towards antibiotic use among public attending Kuwait MOH Healthcare facilities was performed by using a questionnaire. The results revealed insufficient knowledge regarding the antibiotic utilization (median knowledge score was 60%, IQR=80-40) with poor attitude (median attitude score was 40%, IQR=60-20) however, the practice was better (median practice score was 77.8%, IQR= 88.9-55.6)22 The environmental dimension of antimicrobial resistance has received comparatively less focus than AMR in human or animal health. However, the natural environment is an important reservoir of antimicrobial resistance. Drug-resistant microbes are in people, animals, food, and the environment (in water, soil and air)23. Due to demographic and environmental factors, the marine environment of the Gulf Cooperation Council (GCC) region may be particularly susceptible to the threat of antimicrobial resistance. However, there is currently little information on the presence of AMR in the GCC marine environment to inform the design of appropriate targeted surveillance activities. To date no studies have addressed the issue of AMR in marine systems, which represents a key data gap in Kuwait. A baseline survey that is the first to obtain information on the prevalence of AMR within bacterial isolates collected from Kuwait’s marine environment. In GCC, the studies have identified the presence of AMR bacteria in fish and seawater collected from locations close to sewage discharges 24 and within the effluent itself 25. The presence of AMR bacteria has also been used as an indicator to monitor the exposure of green turtles (Chelonia mydas) to different marine pollutants 26 Kuwait national action plan on antimicrobial resistance 2022 14 Recently, a study objective was to develop27, implement and conduct a rapid regional baseline monitoring survey of the presence of AMR in the GCC marine environment, through the analysis of seawater collected from high-risk areas across four GCC states: (Bahrain, Oman, Kuwait, and the United Arab Emirates). 560 Escherichia coli strains were analyzed as part of this monitoring programme between December 2018 and May 2019. Multi-drug resistance (resistance to three or more structural classes of antimicrobials) was observed in 32.5% of tested isolates. High levels of reduced susceptibility to ampicillin (29.6%), nalidixic acid (27.9%), tetracycline (27.5%), sulfamethoxazole (22.5%) and trimethoprim (22.5%) were observed. Reduced susceptibility to the high priority critically important antimicrobials: azithromycin (9.3%), ceftazidime (12.7%), cefotaxime (12.7%), ciprofloxacin (44.6%), gentamicin (2.7%) and tigecycline (0.5%), was also noted. A subset of 173 isolates was whole genome sequenced, and high carriage rates of qnrS1 (60/173) and blaCTX-M 15 (45/173) were observed, correlating with reduced susceptibility to the fluoroquinolones and third generation cephalosporins, respectively. A base line survey study 28 had been conducted. In total, 598 isolates of Escherichia coli (351 seawater; 247 bivalves) were isolated from seawater and biota (Venus clam, Circenita callipyga) across Kuwait coastline, and screened for their potential for resistance against an array of commonly deployed frontline antibiotics frontline (23 antibiotics) by micro-dilution (48 h incubation) onto the custom dehydrated 96-well Sensititre™ GN2F panels (GN2F, Thermo Scientific, UK). Results demonstrate the resistant was widespread across all sites (seawater: summer 89 - 64%; winter 90 57% and biota: summer 77%; winter 88%). Ranking the resistance profiles for seawater and biota across both summer and winter periods suggests that the profile of resistance may be influenced by seasonal factors. For example, in strains of E. coli isolated from winter biota samples displayed a high-level of resistance to FOX (51.4%), which then dropped substantially in samples screened from the summer (7.7%). Likewise, the resistance profiles between seawater and biota samples didn’t always mirror each other and could point different drivers, within each matrix, being responsible for the promotion and maintenance of AMR. The dataset available doesn’t allow for definitive statements to be made about either of these subjects, but does point to future research lines to follow. This spread of observed resistances to older as well as new antibiotics, encompassing almost all tested classes and including antimicrobials used for a variety of clinical and veterinary applications is of some concern. Kuwait national action plan on antimicrobial resistance 2022 15 National SWOT analysis as per each pillar Governance and multisectoral “One Health” coordination Strengths • A national multisectoral coordinating group (NMCG) is already established that includes high-rank influential employees and professionals of the Kuwaiti government from all sectors. • It has strong political support, authority to act. It is accountable to the government. It is formed of and supported by technical experts. • This group is responsible to facilitate and coordinate development of the national AMR action plan, to facilitate and oversee implementation, monitoring and evaluation of the AMR action plan, and to ensure regular data collection and information sharing among all relevant sectors and stakeholders. • There are a few tools and data to form a basis for preparation of a national action plan on AMR such HAI surveillance in hospitals, reporting AMR to GLASS platform, as well as other audit tools for hand hygiene and other issues related to IPC in hospital settings. Weaknesses • Technical working groups are not available in all sectors except for a few in human health. Relevant groups will be formed at a later stage as per this NAP on AMR. • Focal persons for the coordination between different ministries and authorities regarding the “One Health” approach are not available except in the MOH. Opportunities • A preliminary draft of situation analysis (SWOT), strategic objectives, interventions and activities for the NAP on AMR was put by the NMCG, yet, the operational and monitoring plans are to be developed. Threats • None Kuwait national action plan on antimicrobial resistance 2022 16 AMR Awareness Strengths • Regarding activities that target national awareness of AMR, only the Infection Control Directorate in MOH already prepared AMR-relevant information focusing on human health and this material is diffused to the general public only during the AMR/ABX awareness week. • On the public level, there was a study done by the Infection Control Directorate about the estimation of knowledge, attitudes and practice of the general public regarding antibiotic use in humans and the sample was randomly selected individuals from outpatient clinics. • Among professional in human health, workshops and educational activities targeting AMR in human health are sometimes offered by MOH, scientific societies, drug companies, hospitals, and universities, but it is not regular or structured. • Regarding the inclusion of AMR and related topics in quality assurance programs, only IPC is included in accreditation standards of healthcare facilities. Weaknesses • Regarding activities that target national awareness of AMR, public communication programs targeting the general audiences in human health practice, animal health practice, plant production and crops, food chain and in the environmental sector are not available. • Material prepared by the Infection Control Directorate MOH targeting the general public (mentioned above) is not diffused all yearlong and does not include AMR information based in the One Health approach. • Education and information on AMR is not available in school curricula. • There is a weak communication between ministries and authorities regarding the importance of AMR, where each one works alone. • There are no undergraduate studies/specialties in animal health and agriculture, in Kuwait. These professionals receive their degrees and training outside the country. • For those who should be licensed to work in Kuwait, they should undergo an interview and licensing exam that do not include questions related to AMR. • AMR and related topics in special targeted modules are only included in undergraduate curricula in Medical Schools and not in other related fields. • AMR and related topics are not mandatory in continuing education programs in any field. CE is not mandatory for obtaining work licenses for newcomers to Kuwait or for license renewal. However, CME is needed for promotion of physicians and dentists. • In the veterinary/agriculture fields, there is no central structured training for professionals by PAAF regarding AMR. Some activities related to antibiotic use are offered by drug companies for promotional purposes. Opportunities • A general CE program is going to be built soon for pharmacists (needs time to expand and encompass aspects of AMR) • In the veterinary/agriculture fields, PAAF closely communicates with FAO/OIE and concerned professionals attend few educational activities/workshops organized by FAO/OIE. Kuwait national action plan on antimicrobial resistance 2022 17 • Regarding the Country participation in international or regional AMR awareness campaigns, the IPC directorate regularly participate with the WHO regarding human health. Otherwise in non-human health sector, the country participates in some meetings organized by FAO or OIE however; this is not structured or systematic. Kuwait is part of the GCC AMR group and participates in all its activities. • Now AMR is recognized a national priority where there will be inter ministerial collaboration and commitment through this national action plan to combat AMR. • Relation between PAAF, MOH, FAO, OIE, WHO and KEPA is an opportunity to enhance AMR awareness in different fields based on the One Health approach, in addition to being part of GCC. Threats • None AMR Surveillance Strengths • Surveillance of AMR in isolates from humans has already started in one hospital through reporting its AMR data to GLASS platform. Now reporting to WHO GLASS will extend to 8 hospitals from the country. • As for the incidence and prevalence of AMR in humans, some hospitals report their own AMR data on an individual basis. • On the hospital level, a strength is the presence of national healthcare associated infections surveillance system with the capability of detection of MDROs isolated from HAIs. • Surveillance of infectious diseases such as brucellosis, TB, etc. is present. • There is an existing tailored program for routine monitoring of the environment, as well as a chemical and biological focused marine monitoring program for environmental pollutants. • Monitoring of antibiotic residues is done for milk, meat, poultry, eggs and vegetables • A strength is the availability of a well-equipped microbiology laboratories in MOH and in other healthcare facilities, as well as new technologies to detect and identify AMR. • Some of the functions of a national reference laboratory exist but in different places and not in one single place. For example, external Quality Control (QC) schemes are done by the central entity of medical labs services at MOH, and this central entity plays role in distributing external QC samples and getting the results. • The Lab council requested from MOH for accrediting the labs in the country. This council takes into consideration the presence of a qualified microbiologist in the lab as well as the success in QC schemes, in addition to abiding by CLSI guidelines. • Despite that there is no training for lab personnel regarding AMR surveillance, but all personnel should be qualified (education/degrees). All labs in the country unanimously follow CLSI guidelines in the country, and thus there is no need to put new lab practice guidelines. • Sporadic research on AMR exists in the humans and animals. Kuwait national action plan on antimicrobial resistance 2022 18 • National authorities work with close communication with OIE, FAO and WHO, in addition to being part of GCC. Weaknesses • National AMR surveillance and antimicrobial use monitoring systems are not available. • As for the incidence and prevalence of AMR in humans, there are no national reports on this issue. • Regarding surveillance of AMR in isolates from animals, plants, food and environment, it is unavailable, thus the incidence and prevalence of AMR in these fields is unavailable too. • Monitoring of use of antimicrobial agents in humans is almost not available except for a national study that is starting and did not expand yet. • Monitoring of use of antimicrobial agents in animals, plants and environment does not exist except for monitoring antibiotic residue in food products like milk, meat, poultry, eggs and vegetables. • In addition, data on the extent and impact of AMR such as human morbidity, mortality and other health outcomes in relation to AMR, as well as data on economic impact of AMR in humans, animals, plants, food, and the environment are not available. • A national mechanism coordinates the different national AMR surveillance and antimicrobial use monitoring systems is not available. • A National Reference Lab for antimicrobial resistance for human and animal sectors is not available. • A national research agenda for AMR surveillance is not available. Opportunities • An opportunity is the enrolment of Kuwaiti MOH in GLASS- AMC and utilization of this platform. • It is economically feasible to increase manpower to perform AMR surveillance activities and report data in all sectors. • There is one laboratory that is assigned for reporting AMR data to GLASS platform and this can be extended for national AMR surveillance. • There is a proposal for the accreditation of 2 laboratories in the country by The College of American Pathologists (CAP) and if this pilot project succeeds, this will extend to other labs in the country. • There is an opportunity to conduct AMR-related research in these fields: a decree regarding environment protection in Kuwait exists to support the recommendation from KEPA and PAAF for the need to conduct AMR research in these fields. The presence of this decree facilitates submitting research proposals and projects and getting funded. • Another opportunity is the ppresence of research centres that are interested in performing studies on AMR and expanding it throughout the country (KEPA, KISR and Kuwait University) • Relation between PAAF, MOH, FAO, OIE, WHO is an opportunity to enhance AMR surveillance in different fields based on the One Health approach Threats • None Kuwait national action plan on antimicrobial resistance 2022 19 IPC Strengths Human Health • On the national level in Kuwait, there is a national central IPC directorate/national office in the MOH, established since 1980. This national office communicates with all IPC teams in public and private healthcare facilities across the country. This directorate has national IPC guidelines that are being regularly updated, plus checklists and audit tools. • On the hospital level, each hospital has an IPC office that consists of at least 1 Medical Doctor (MD) and around 5 to 10 nurses depending on the hospital size/number of hospital beds, and this office is in close communication with the central IPC directorate. IPC policies and procedures are included in hospital accreditation standards and are being regularly audited by accreditation bodies. • Regarding IPC professionals in healthcare facilities, they have usually an MD degree and an advanced degree in public health or microbiology. Their IPC/AMR training is mandatory for a period of 2 months before joining the job. It is condensed and well-structured prepared by the MOH central IPC directorate. Training for the HAI surveillance is done at the IPC directorate while the IPC training is done in MOH hospitals. Regular in-service training is done for the IPC professionals in the Central IPC directorate. Additionally, targeted training is performed when there is any updates or new policies/ guidelines. • Upon hiring in hospitals, nurses who will work at IPC offices receive mandatory training for 3 months in the form of in-hospital training by IPC professionals as per specific material prepared and supplied by the central IPC directorate. Recently, they receive HAI surveillance training in the IPC directorate. IPC nurses receive regular refreshing training while targeted training is performed when there is any updates or new policies/ guidelines. • Regarding general HCWs training, there is a training program in each hospital for HCWs and the IPC team in the hospital is responsible for it. All newly employed HCWs receive an IPC training and nurses should receive an IPC training on a yearly basis, but this issue is not very well structured or followed, and this should be worked on and improved. • Healthcare-associated infections (HAI): National HAI surveillance is being implemented in all MOH hospitals. It is prospective patient based facility wide includes all types of infections in all inpatient locations with calculation of risk adjusted rates. Dialysis surveillance for chronic outpatient hemodialysis patients is also done. Surveillance is based on CDC/NHSN methodology. For MDROs, Kuwait national action plan on antimicrobial resistance 2022 20 incidence density/1000 patient days and % of the total isolates of 8 groups of MRDOs are calculated. Reports and feedback are disseminated and discussed with the relevant stockholders. National data base and benchmarks of HAI are prepared in the IPC directorate. • Healthcare waste management: There is a structured management program of the hazardous waste generated from healthcare systems (solid and liquid waste). The MOH has guidelines for both types of wastes. There are incinerators with KEPA’s authority to oversee the functioning of these incinerators. (Responsible entities: Hotel service Directorate, Health Licence Directorate, special committee in KEPA) • Waste water management system: There is a structured management program under the authority of the Ministry of public works and being monitored from KEPA & Ministry of Public Works. • On the healthcare facility level, there is a presence of safe sufficient drinking water and adequate sanitation and hygiene, where there is regular testing of the quality of water used in healthcare. • Food handling in healthcare facilities and community: o regular testing of food handlers by MOH, o presence of health cards; o guidelines for food handling in healthcare facilities depending on department plus general guidelines for cooking, storage…. etc. • Vaccination programs: o availability of up-to-date guidelines and vaccines for the pediatric and adult population o robust vaccination coverage for the pediatric population o adult vaccination guidelines stratified by age, occupation, comorbidities especially respiratory diseases, seasonal events like Pilgrimage. Non-human health sectors (food production/animal husbandry/ veterinary/ agriculture/ environmental fields) • Animal Husbandry/Agriculture/Food Production: o Biosecurity measures are present in the farms under the responsibility of PAAF o There are guidelines for vaccinating, isolating and treating animals against infectious diseases (based on OIE guidelines) monitored and audited by PAAF. o All animals should be registered and there is a veterinary laboratory at PAAF. o Infrastructure related to the safely securing/auditing/quality control of products in the food chain is present, whether Kuwait national action plan on antimicrobial resistance 2022 21 being the food produced in the country or imported. The responsible entities are the PAFN and PAAF. o Food is examined chemically and microbiologically according to GSO standards in public health labs in MOH. • Environment: o Disposal of diseases animals and waste is well organized and controlled and closely monitored by PAAF. Weaknesses Human Health • Regarding IPC education in the country in general, there are no opportunities of learning about IPC outside the formal teaching provided by the central IPC directorate. There no courses given at universities or masters degrees or structured continuous education programs. • Regarding HAI surveillance, HAI data is collected manually intra hospital and reported to MOH IPC directorate manually and this represents a gap. Responsible authorities believe that it is better that this work becomes computerized. This issue should be imposed on hospitals to shift from manual to electronic work. Yet, even in hospitals that already have electronic medical records, IPC data is not linked to these records and there is still a lot of manual work to link between the two. • Healthcare waste management: disposal is not optimized similar to the public sector; it needs monitoring and better implementation. • Long term care facilities (LTCF): There isn’t a proper structure or specialized manpower and no specific IPC guidelines for LTCF. • Vaccination Programs: vaccination uptake in adults is weak and needs to be improved, thus raise adult awareness regarding the importance of vaccination for the prevention of many vaccine preventable diseases. Non-human health sectors • Animal Husbandry/Agriculture/Food Production: o Absence of National guidelines for infection control biosecurity measures in animal husbandry. o There are no research projects directly related to IPC/AMR in animal husbandry or agriculture • Veterinary Education and Training: o There are no veterinary schools or education in Kuwait o Veterinarians receive their degrees and training outside the country. o Absence of centrally oriented courses or education for veterinary professionals regarding IPC/AMR. • Research: A gap is the absence of IPC/AMR research in these fields. Opportunities Human Health Kuwait national action plan on antimicrobial resistance 2022 22 • In healthcare facilities, IPC bundles of care are already available and implemented but need updating by including new evidence-based recommendations from the medical literature. • Healthcare-associated infections: this data should become automatically retrievable from the computerized system to be implemented in healthcare facilities similar to other information in medical records, not to mention to link all relevant lab data to IPC data. And from another side, this IPC data should be digitally linked and available in real time on the network of central IPC directorate. • Long term care facilities (LTCF): o Under the responsibility of Public Authority of Disability Affairs which is a separate authority from MOH and which is recently supervised by the Minister of Health. o There are two large centers and several satellite centers linked together. o The team responsible for supervision of the IPC program in LTCF centers constitutes of a part time doctor and four full time nursing staff with basic knowledge of IPC. Non-human health sectors: • Animal Husbandry/Agriculture/Food Production: o Surveillance of infectious diseases such as brucellosis, TB, etc. is present. o There are veterinary testing laboratories at PAAF. • Veterinary Education and Training: o In order to be licensed to work in Kuwait, professionals who are hired from outside the country should undergo an interview and licensing exam. This procedure should be repeated every 2 years to renew the license. The exam and interview do not include questions related to IPC/AMR. o The continuous education on IPC and AMR is only provided by drug companies. • Environment: o Presence of sewage effluent monitoring guidelines but not targeting the spread of AMR. This represents a potential or opportunity to perform studies aiming at monitoring the presence of resistant organisms in sewage effluent. • Research: o There is an opportunity to conduct AMR-related research in these fields: a decree regarding environment protection in Kuwait exists to support the recommendation from KEPA and PAAF for the need to conduct IPC/AMR research in these fields. The presence of this decree facilitates submitting research proposals and projects and getting funded. Kuwait national action plan on antimicrobial resistance 2022 23 o Relation between PAAF, MOH, FAO, OIE, WHO is an opportunity to enhance IPC in different fields based on the One Health approach, in addition to being part of GCC. Threats • None Rational Use of Antimicrobials Strengths • There is a national human/animal/plant drug regulatory authority (Pharmaceutical and Herbal Medicines Registration and Control Administration in MOH) that works using international standards and guidelines, not to mention that they have their own protocols for drug marketing authorization to ensure that antimicrobial agents are quality assured, safe and effective. • Pharmaceutical and Herbal Medicines Registration and Control Administration in MOH is responsible for quality management system for the antimicrobial agents supply chain as well as the preservation of antimicrobial agents. • Pharmaceutical and Herbal Medicines Registration and Control Administration and The Dug Inspection Control in MOH are responsible for detecting and combating counterfeit antimicrobial agents. • Pharmaceutical and Herbal Medicines Registration and Control Administration in MOH is responsible for regulating and controlling drug promotional practices (humans/animals). This entity does not allow drug promotion outside what is written in the brochure. But in the veterinary field, this issue is not being audited. • As for the reimbursement lists for human health, this is under the authority of Pharmaceutical and Herbal Medicines Registration and Control Administration and no reimbursement occurs outside the protocols of this entity. • There is a legislation that prohibit selling of antimicrobials without a prescription of a certified health professional. • Veterinarians prescribe mass antimicrobial prophylactic therapy for herds or for treatment purposes, in addition to mass vaccination as prophylaxis when necessary according to guidelines of OIE • Antibiotic residue is detected in milk, meat, poultry, eggs and vegetables. There is a washout period during which the animal does not receive any antimicrobials (prior to the milking process or slaughtering). • Post-prescription review for appropriateness of antimicrobial agents 48– 72 h after administration is done in public hospitals only depending on the presence of qualified personnel and ID physicians. • National authorities work with close communication with OIE, FAO and WHO, in addition to being part of GCC. Kuwait national action plan on antimicrobial resistance 2022 24 Weaknesses • Pharmaceutical and Herbal Medicines Registration and Control Administration in MOH) does not systematically audit drug promotional practices in the animal field. • Identifying/addressing economic incentives that encourage inappropriate use of antimicrobial agents does not exist, as well as that optimize the use of antimicrobial agents in all sectors do not exist. • Regarding the purchasing and prescribing of antimicrobial agents, a national essential medicine list is not available. On the institutional level, some healthcare facilities have their own essential medicine lists and others don’t. • There are standard treatment guidelines for use of antimicrobial agents in humans, but they need to be expanded and updated. These guidelines are present in public and private hospitals. These guidelines and their application are not properly audited. • Standard treatment guidelines for use of antimicrobial agents in animals do not exist. Veterinary practitioners follow OIE guidelines and practice from what they have learned during their basic education. Responsible governmental authorities don’t teach these guidelines and audit its proper practice or not; guidelines workshops do not exist. There is no follow-up on updated versions of these guidelines in animal health. • There are no legislations to prevent the use of antibiotics used in humans and animals’ therapy as growth promotors in animals and for crop protection • There is no list or policies for the use of critically important antimicrobials. These legislations need to be activated. Policies on reduction in nontherapeutic use of antimicrobial agents in animal health are not available. • Well-established Antimicrobial stewardship programs are not available in healthcare facilities (primary, secondary and tertiary care, private and public). However, Some activities are available in some healthcare settings. • Qualified human resources are very scarce; the available infectious diseases specialists and clinical microbiologists are not enough to run Antimicrobial Stewardship program in all facilities. Same issue with clinical pharmacists in addition to that these pharmacists need to be trained on AMS. • Direct communication of the results of audits and reviews to all sectors using antimicrobial agents needs to be activated. • A national research agenda for antimicrobial use and stewardship is not available. Opportunities • Authorities are working on formulating an essential medicine list. • Relation between PAAF, MOH, FAO, OIE, WHO is an opportunity to enhance antimicrobial stewardship in different fields based on the One Health approach Threats • None Kuwait national action plan on antimicrobial resistance 2022 25 Country response Governance A National Committee for the proper use of antimicrobials was formulated by a ministerial decree signed by His Excellency the Minister of Health. This committee has members representing different specialties and sectors all over the country and headed by the Assistant Undersecretary of technical affairs and coordinated by the Director of Infection Control Directorate with the following as members: 1. WHO National Focal point of AMR-MOH 2. Director of Public Health Directorate -MOH 3. Director of Pharmaceutical Services Directorate -MOH 4. Director of Central Medical Stores Directorate-MOH 5. Director of Technical Directorate-MOH 6. Director of Primary Healthcare Directorate-MOH 7. Director of Medical Licensing Department-MOH 8. Director of Health Promotion Department-MOH 9. Director of Drug Inspection Control-MOH 10. Director of Pharmaceutical and Herbal Medicines Registration and Control Administration MOH 11. Head of Public Health Laboratories-MOH 12. Head of Microbiology and Virology Committee- Council of Medical Laboratories-MOH 13. Director of Research and Studies Office- Kuwait Environment Public authority (KEPA) 14. Representative from The Public authority for Food and nutrition (PAFN) 15. Representative of Animal Health Department-The Public Authority of Agriculture Affairs and Fish Resources (PAAF) 16. Representative of Agriculture Sector -Public Authority of Agriculture Affairs and Fish Resources (PAAF) The purpose of this committee is to oversee and, when necessary, to coordinate AMR-related activities in all sectors Kuwait national action plan on antimicrobial resistance 2022 26 Governance Operational and Budget Plan Activity Sub activity Sub-sub activity Sub-sub sub activity Unit Quantity Date Location Responsib le entity Cost Source Of funding Indicator Strategic Objective G1. National coordination between focal points in the different sectors and different pillars G1.1 Identify the needed AMR focal points in human health, animal health, welfare, and productio n, food safety and security, Plants and agricultur e, and environm ent. The TOR should include coordinati on among the different ministries and G1.1.1 Define the TOR of focal points in each of these sectors G1.1.1 TOR G1.1.1 5 G1.1.1 Done G1.1.1 NMCG G1.1.1 None G1.1.1 None G1.1.1 TOR are put Kuwait national action plan on antimicrobial resistance 2022 27 authoritie s along with a yearly meeting of the different focal persons. G1.1.2 Employ and assign the functions of a focal person for each pillar and for AMR in general G1.1.2.1 Assign AMR focal points for each pillar in human health G1.1.2.1.1 one focal point for each of the following pillars: IPC, Surveillan ce, ABX, Awarenes s G1.1.2.1 Focal persons assigned G1.1.2.1 4 G1.1.2.1 3 months G1.1.2.1 MOH G1.1.2.1 NMCG G1.1.2.1 Assigned from existing ministry employee s G1.1.2.1 None G1.1.2 Focal persons for each pillar at MOH are assigned. Focal points in PAAF, and KEPA, and food safety are assigned G1.1.2.2 Assign the general focal person in MOH G1.1.2.2.1 Dr. Abeer Aly pending assignmen t/ New employee G1.1.2.2 Focal person assigned G1.1.2.2 1 G1.1.2.2 3 months G1.1.2.2 MOH G1.1.2.2 NMCG G1.1.2.2 Assigned from existing ministry/e mployees G1.1.2.2 None G1.1.2.3 Assign 1 focal G1.1.2.3.1 G1.1.2.3 Letter from G1.1.2.3 1 G1.1.2.3 3 months G1.1.2.3 PAAF G1.1.2.3 NMCG G1.1.2.3 Assigned from G1.1.2.3 None Kuwait national action plan on antimicrobial resistance 2022 28 person in animal health and agricultur e fields for all pillars including IPC, Surveillan ce, ABX, Awarenes s Represent ative in NMCG is the focal person or authoritie s appoint a person NMCG through MOH Undersecr etary General existing authority employee s G1.1.2.4 Assign 1 focal person in KEPA for all pillars including IPC, Surveillan ce, ABX, Awarenes s G1.1.2.4.1 Represent ative in NMCG is the focal person or authoritie s appoint a person G1.1.2.4 Focal person assigned G1.1.2.4 1 G1.1.2.4 3 months G1.1.2.4 KEPA G1.1.2.4 NMCG G1.1.2.4 Assigned from existing authority employee s G1.1.2.4 None G1.1.2.5 Assign 1 Focal person in food safety IPC: Surveillan ce: G1.1.2.5.1 leave the decision to ministries /authoriti es G1.1.2.5 Focal person assigned G1.1.2.5 1 G1.1.2.5 3 months G1.1.2.5 Food safety G1.1.2.5 NMCG G1.1.2.5 Assigned from existing ministry /authority employee s G1.1.2.5 None Kuwait national action plan on antimicrobial resistance 2022 29 ABX Awarenes s G1.1.2 Include inter ministerial communic ation and coordinati on with the general AMR focal person in the TOR of the focal points G1.1.2 TOR G1.1.2 5 G1.1.2 3 months G1.1.2 MOH G1.1.2 NMCG G1.1.2 None G1.1.2 None G1.1.2 None Strategic Objective G2. Provide legal and ministerial support for the realization of the activities listed in the plan G2.1 Form inter ministerial NMCG committe e G2.1.1 Nominate the members and have a ministerial decree about their appointm ent G2.1.1 One Health Committe e G2.1.1 1 G2.1.1 Already available G2.1.1 Already available G2.1.2 Write the TOR of the NMCG G2.1.2 TOR G2.1.2 1 G2.1.2 Already available G2.1.2 Already available Kuwait national action plan on antimicrobial resistance 2022 30 that include: to facilitate and oversee implemen tation, monitorin g and evaluation of the AMR action plan G2.1.3 The NMCG has dedicated funds for administr ative costs. G2.1.3.1 NMCG puts a budget for administr ative costs G2.1.3.1 Budget G2.1.3.1 1 G2.1.3.1 3 months G2.1.3.1 MOH G2.1.3.1 NMCG G2.1.3.1 To be assigned later G2.1.3.1 MOH G2.1.3.1 A budget is put and provided Strategic Objective G3. The plan is based on evidence-based medicine and put by professionals G3.1 Technical groups for specific activities are created when needed from all sectors G3.1.1 Mapping of profession als throughou t the country from public and private G3.1.1 Mapping of profession als G3.1.1 1 G3.1.1 3 months G3.1.1 MOH/PAA F/KEPA/P AFN G3.1.1 NMCG/ MOH Undersecr etary general /Director General in PAAF/KEP A/PAFN G3.1.1 None G3.1.1 None G3.1.1 Technical groups are formed for each pillar, including represent ative of One Kuwait national action plan on antimicrobial resistance 2022 31 sectors that could be part of technical groups when needed. Health approach Strategic Objective G4. Provide guidance and tools to form a basis for preparation of a national action plan on AMR G4.1 Formulate or endorse guidelines for the different topics, along with tools G4.1.1 Each technical group for each pillar will agree on existing guidelines or producing new guidelines or endorsing internatio nal guidelines and make them national G4.1.1 Guidelines as per each pillar need G4.1.1 4 G4.1.1 1 year G4.1.1 MOH/PAA F/KEPA/P AFN G4.1.1 Technical groups/ Focal persons of each pillar G4.1.1 None (Professio nals are from the ministries /authoriti es and will perform these consultan cies as part of their jobs) G4.1.1 None G4.1.1 Guideline s are available when needed N.B. Refer to Annex 1 for Governance Axis Strategic and Monitory plans Kuwait national action plan on antimicrobial resistance 2022 32 AMR Awareness Operational and Budget Plan Global action plan strategic objective 1: Improve awareness and understanding of antimicrobial resistance through effective communication, education and training. Activity Sub activity Sub-sub activity Sub-sub sub activity Unit Quantity Date Location Responsib le entity Cost Source Of funding Indicator Strategic Objective 1.1 Organize the activities of this axis and ensure a proper follow up 1.1.1 To designate a specific employee or post that is responsibl e of realizing the plan, do the proper communic ations and follow up on the progress of the plan 1.1.1 Assign one employee /post to overlook these activities in MOH, KEPA, PAAF, food safety 1.1.1 Employee or position 1.1.1 1 1.1.1 3 months 1.1.1 MOH 1.1.1 MOH , KEPA, PAAF, PAFN 1.1.1 New Employee Or assign the function to existing employee 1.1.1 MOH 1.1.1 Awarenes s Focal person assigned 1.1.2 Put TOR of employm ent 1.1.2 TOR for MOH focal person PAAF focal person 1.1.2 4 1.1.2 2 months 1.1.2 MOH 1.1.2 NMCG 1.1.2 None 1.1.2 None 1.1.2 TOR is put for all 4 focal persons. Kuwait national action plan on antimicrobial resistance 2022 33 KEPA Focal person PAFN Focal person 1.1.3 Letter of employm ent or assignmen t of Responsib ilities of focal persons in the 4 ministries /authoriti es 1.1.3 Letter 1.1.3 1 per ministry/a uthority 1.1.3 3 months 1.1.3 MOH PAAF KEPA PAFN 1.1.3 MOH, KEPA, PAAF, PAFN 1.1.3 None 1.1.3 None 1.1.3 Letter of employm ent or assignme nt of duties to specific focal persons in the 4 ministries /authoriti es is done Strategic Objective 1.2 Increase national public awareness of AMR as per One health approach through communication programs 1.2.1 Establish an evidence based public communic ations program targeting the general public in the 1.2.1.1 Estimate the knowledg e, attitude and practice of general public regarding AMR in humans, animals, agricultur e and 1.2.1.1 Already done on a random sample. in outpatient clinics on the use of antibiotics in humans 1.2.1.1 Done 1.2.1.1 Done Kuwait national action plan on antimicrobial resistance 2022 34 communit y environm ent 1.2.1.2 Conduct national public awareness campaigns based on the One health approach 1.2.1.2.1 Preparatio n of material regarding the awareness campaign based on the One health approach 1.2.1.2.1.1 Assign a team to formulate and design the public communic ation material regarding AMR 1.2.1.2.1.1 Already done 1.2.1.2.1.1 Done 1.2.1.2.1. 1 Done 1.2.1.2.1.2 Produce the public communic ation material regarding AMR 1.2.1.2.1.1 Already available for AMR in humans 1.2.1.2.1.1 Done 1.2.1.2.1. 1 Done 1.2.1.2.1.3 Update the communic ation material to cover all aspects of the One 1.2.1.2.1.3 Updated communic ation material 1.2.1.2.1.3 1 1.2.1.2.1.3 6 months 1.2.1.2.1.3 MOH/ PAAF/ KEPA/ PAFN 1.2.1.2.1.3 The awarenes s technical task force from MOH/PAA F/KEPA/P AFN 1.2.1.2.1.3 To be determine d by the responsibl e authoritie s 1.2.1.2.1.3 MOH/ PAAF/ KEPA/ PAFN 1.2.1.2.1. 3 The communic ation material covers all fields of One Health approach (Yes/No) Kuwait national action plan on antimicrobial resistance 2022 35 health approach: Animal Health, Agricultur e, food safety and environm ent 1.2.1.2.2 Put a yearly plan on broadcasti ng and posting the public communic ation material on AMR 1.2.1.2.2.1 Broadcasti ng is all year long, not only during the AMR awareness week (specific timing, place) 1.2.1.2.2.1 Broadcasti ng schedule (TV, Bill boards, advertise ment in malls, …) 1.2.1.2.2.1 1 1.2.1.2.2.1 6 months 1.2.1.2.2.1 MOH Media Office 1.2.1.2.2.1 MOH/ Media Office 1.2.1.2.2.1 To be determine d by the responsibl e authoritie s 1.2.1.2.2.1 MOH/ PAAF/ KEPA/ PAFN 1.2.1.2.2. 1 Schedule is put (Yes/No) 1.2.1.2.2.2 Prepare costing of the plan 1.2.1.2.2.2 Detailed costing of the plan 1.2.1.2.2.2 1 1.2.1.2.2.2 8 months 1.2.1.2.2.2 MOH/MO Informati on 1.2.1.2.2.2 MOH/ Media Office /MO Informati on 1.2.1.2.2.2 None 1.2.1.2.2.2 None 1.2.1.2.2. 2 Costing plan is finalized 1.2.1.2.3 Launch the broadcasti ng plan 1.2.1.2.3 Advertise ments launched according to a yearly schedule 1.2.1.2.3 1 plan/year 1.2.1.2.3 1 year 1.2.1.2.3 MOH/MO Informati on MOH/ Media Office /MO Informati on 1.2.1.2.3 The budget that was put while costing all the 1.2.1.2.3 MOH/PAA F/KEPA/P AFN 1.2.1.2.3 Proportio n of the plan that was put on schedule Kuwait national action plan on antimicrobial resistance 2022 36 advertise ments 1.2.1.2.4 Engage different types of media including social media in AMR awareness such as putting material/a ds periodicall y on ministry/g overnmen tal websites, social media accounts like Facebook, Twitter, Instagram , etc. 1.2.1.2.4 Media message 1.2.1.2.4 1 1.2.1.2.4 1 year 1.2.1.2.4 MOH/MO Informati on MOH/ Media Office /MO Informati on 1.2.1.2.4 To be determine d by the responsibl e authoritie s 1.2.1.2.4 MOH 1.2.1.2.4 Types of media or social media that mention AMR/mon th 1.2.1.2.5 Involve a public figure like Dr. Abdullah 1.2.1.2.5 Involveme nt of a public figure (Dr. 1.2.1.2.5 1 1.2.1.2.5 3 months 1.2.1.2.5 MOH/ TV/ Social Media Networks/ 1.2.1.2.5 MOH/Me dia Office/Aw areness 1.2.1.2.5 None 1.2.1.2.5 None 1.2.1.2.5 Public figure (Dr. Abdullah Al-Sanad) sending Kuwait national action plan on antimicrobial resistance 2022 37 Al-Sanad (spokespe rson MOH) in delivering AMR messages, like tweets on twitter or messages in Talk Shows or through TV ads/News bar Abdullah Al-Sanad) Platforms focal person message regarding AMR 1.2.1.2.6 Discuss AMR in TV talk shows 1.2.1.2.6.1 MOH sends a letter to Ministry of Informati on/ asking to host profession als in AMR to discuss this issue on TV and thus raise public awareness 1.2.1.2.6.1 Letter 1.2.1.2.6.1 1 1.2.1.2.6.1 2 months 1.2.1.2.6.1 MOH 1.2.1.2.6.1 Awarenes s focal person/ MOH undersecr etary general 1.2.1.2.6.1 None 1.2.1.2.6.1 None 1.2.1.2.6. 1 Proportio n of talk shows episodes that discuss AMR 1.2.1.2.7 1.2.1.2.7.1 1.2.1.2.7.1 1.2.1.2.7.1 2 1.2.1.2.7.1 2 months 1.2.1.2.7.1 PAAF 1.2.1.2.7.1 PAAF 1.2.1.2.7.1 None 1.2.1.2.7.1 None 1.2.1.2.7. 1 Kuwait national action plan on antimicrobial resistance 2022 38 Involve Non Governme ntal Organizati ons (NGOs) in AMR awareness campaign Contact FAO and OIE and ask about their communic ations program regarding AMR and communic ate with them the NAP on AMR Letter to FAO and OIE/Kuwai t offices KEPA PAFN KEPA PAFN None Strategic Objective 1.3 Include AMR education as per One health approach at an early age in schools 1.3.1 Include basic AMR education in school curricula 1.3.1.1 MOH sends a letter with key facts about AMR, antibiotics , hygiene and IPC basics through the School Health Administr ation asking to include material 1.3.1.1 Letter 1.3.1.1 1 1.3.1.1 2 months 1.3.1.1 MOH 1.3.1.1 MOH/Sch ool Health Administr ation 1.3.1.1 None 1.3.1.1 None 1.3.1.1 Letter sent Yes or No Kuwait national action plan on antimicrobial resistance 2022 39 related to these topics in school curricula 1.3.1.2 Prepare a module/A dd material related to basic AMR knowledg e, antibiotics , hygiene and IPC in the curricula 1.3.1.2.1 Create a committe e of comprisin g of AMR profession al and education profession als to create a module about basic AMR knowledg e, antibiotics , hygiene and IPC to be included in school curricula 1.3.1.2.1 Committe e 1.3.1.2.1 1 1.3.1.2.1 2 months 1.3.1.2.1 MOH/Min istry of Education 1.3.1.2.1 MOH/ Awarenes s Focal person/ awarenes s technical task force 1.3.1.2.1 Rewardin g of the committe e members 1.3.1.2.1 MOH/ MOE 1.3.1.2.1 Module prepared Yes/No 1.3.1.2.2 Include this module in secondary 1.3.1.2.2 Letter from MOH 1.3.1.2.2 1 1.3.1.2.2 8 months 1.3.1.2.2 MOH/ Ministry of Education 1.3.1.2.2 MOH/ School Health Administr ation/ 1.3.1.2.2 None 1.3.1.2.2 None 1.3.1.2.2 Percent of schools that teach the AMR module Kuwait national action plan on antimicrobial resistance 2022 40 school education Ministry of Education in their secondary school curricula 1.3.1.2.3 Yearly AMR module workshop s involving teachers 1.3.1.2.3 Workshop 1.3.1.2.3 1/year 1.3.1.2.3 1 year 1.3.1.2.3 MOH/ Ministry of Education 1.3.1.2.3 MOH/ School Health Administr ation /Health Promotio n Directorat e/ Ministry of Education 1.3.1.2.3 To be determine d by MOE 1.3.1.2.3 MOE 1.3.1.2.3 Proportio n of teachers who attend these workshop s Strategic Objective 1.4 Raise awareness of healthcare workers about AMR based on the One Health approach 1.4.1 Establish an evidence based communic ation program targeting the healthcare providers for human health, animal health, agricultur 1.4.1.1 Estimate knowledg e, attitudes and practices related to AMR among healthcar e workers 1.4.1.1.1 Prepare a survey to estimate this knowledg e among healthcar e workers and identify the gaps 1.4.1.1.1 Already done 2011 1.4.1.1.1 Done 1.4.1.1.1 Done Kuwait national action plan on antimicrobial resistance 2022 41 e and environm ent sector 1.4.1.2 Conduct awareness program within hospitals, primary Healthcar e, among physicians , nurses, pharmacis ts, dentists, physiothe rapists, and other HC providers 1.4.1.2.1 MOH mandates to all hospitals and primary Health care centers to provide mandator y sessions about AMR to all employee s who are subject to contract/li cense renewal 1.4.1.2.1 Letter from MOH to hospitals and to primary Health care centers 1.4.1.2.1 2 1.4.1.2.1 2 months 1.4.1.2.1 MOH 1.4.1.2.1 MOH/Awa reness Focal person 1.4.1.2.1 None 1.4.1.2.1 None 1.4.1.2.1 Proportio n of hospitals and primary Health care centers that provide and request yearly attendanc e of AMR conferenc es/session s 1.4.1.3 AMR mandator y courses for pharmacis ts in private practice who are subject to 1.4.1.3.1 Letter from MOH to Drug Inspection Control to request evidence of AMR course attendanc 1.4.1.3.1 Letter 1.4.1.3.1 1 1.4.1.3.1 6 months 1.4.1.3.1 MOH 1.4.1.3.1 MOH 1.4.1.3.1 None 1.4.1.3.1 None 1.4.1.3.1 Letter is issued Kuwait national action plan on antimicrobial resistance 2022 42 contract/ license renewal e about AMR upon license renewal 1.4.1.4 Link of AMR course attendanc e to hospital pharmacis ts’ and primary Healthcar e pharmacis ts’ promotio n. 1.4.1.4.1 MOH recomme nds yearly attendanc e for promotio n 1.4.1.4.1 Mandate 1.4.1.4.1 1 1.4.1.4.1 1 year 1.4.1.4.1 MOH 1.4.1.4.1 MOH Undersecr etary general/ AMR Focal person/ 1.4.1.4.1 None 1.4.1.4.1 None 1.4.1.4.1 Mandate is issued 1.4.1.5 Preparatio n of a bank of presentati ons, films, articles, etc. diffused to these syndicates and hospitals to be used as 1.4.1.5.1 Toolkit for AMR communic ation program to be used in hospital and syndicates 1.4.1.5.1 Toolkit (Slide sets, films, articles, etc...) 1.4.1.5.1 1 1.4.1.5.1 1 year 1.4.1.5.1 NMCG/A wareness Technical task force 1.4.1.5.1 NMCG/A wareness Technical task force 1.4.1.5.1 To be determine d by MOH 1.4.1.5.1 MOH 1.4.1.5.1 Toolkit available Kuwait national action plan on antimicrobial resistance 2022 43 material in their AMR communic ation programs. 1.4.1.6 Syndicates and hospitals send yearly report to MOH about this activity 1.4.1.6 Report to MOH from hospitals 1.4.1.6 Once/ year/ hospital 1.4.1.6 Yearly starting 1 year from starting the plan 1.4.1.6 Hospitals 1.4.1.6 AMR Focal person 1.4.1.6 None 1.4.1.6 None 1.4.1.6 Proportio n of hospitals that send report about AMR Awarenes s activities to MOH Strategic Objective 1.5 Raise awareness of veterinarians, agriculture professionals and environmental workers about AMR based on the One Health approach 1.5.1 Conduct an awareness program among veterinari ans, agricultur e profession als, environm ental workers, in addition 1.5.1.1 Prepare AMR awareness toolkit including slide sets, short films, lectures, posters for these profession als 1.5.1.1 AMR toolkit 1.5.1.1 1 1.5.1.1 6 months 1.5.1.1 PAAF KEPA PAFN 1.5.1.1 Awarenes s Technical Task force 1.5.1.1 To be determine d by the responsibl e authoritie s 1.5.1.1 PAAF KEPA PAFN 1.5.1.1 AMR toolkit is available Kuwait national action plan on antimicrobial resistance 2022 44 to profession als in PAAF, KEPA, and food safety. 1.5.1.2 Integrate AMR awareness in continuou s education programs of veterinari ans, agricultur e profession als, environm ental workers, in addition to profession als in PAAF, KEPA, and food safety 1.5.1.2.1 The focal person in each ministry/a uthority checks education al activities in their facilities and Includes AMR awareness as a topic of continuou s education 1.5.1.2.1 AMR education sessions in PAAF KEPA PAFN 1.5.1.2.1 2 per year in each specialty 1.5.1.2.1 1 year 1.5.1.2.1 PAAF KEPA PAFN 1.5.1.2.1 Focal person in each ministry/a uthority 1.5.1.2.1 None 1.5.1.2.1 None 1.5.1.2.1 Number of AMR Awarenes s sessions per year in each Ministry/a uthority 1.5.1.2.2 1.5.1.2.2 1.5.1.2.2 1.5.1.2.2 1.5.1.2.2 1.5.1.2.2 1.5.1.2.2 1.5.1.2.2 1.5.1.2.2 Kuwait national action plan on antimicrobial resistance 2022 45 Mandate that all drug companie s’ education al activities should include AMR awareness Mandate 1 6 months PAAF Awarenes s focal person in PAAF/Dire ctor General of PAAF None None Proportio n of promotio nal activities by drug companie s in these fields that include messages about AMR 1.5.2 Country participat es the regional/i nternation al AMR awareness campaign 1.5.2.1 Participat e actively in WHO regional AMR campaign and FAO and OIE activities related to AMR 1.5.2.1.1 Register Kuwait authoritie s (KEPA, PAAF, MOH) to participat e in the yearly schedule of AMR activities in WHO, FAO, OIE And encourage individual healthcar e profession als, 1.5.2.1.1 Participati on in Internatio nal activities organized by WHO FAO OIE 1.5.2.1.1 1 year 1.5.2.1.1 MOH PAAF KEPA 1.5.2.1.1 Focal persons in MOH PAAF KEPA/ Awarenes s Technical Task force 1.5.2.1.1 None 1.5.2.1.1 None 1.5.2.1.1 Proportio n of events related to AMR in which the country participat es Kuwait national action plan on antimicrobial resistance 2022 46 veterinari ans, agricultur e profession als, environm ental workers to participat e 1.5.2.2 Participat e in GCC activities related to AMR 1.5.2.2.1 Kuwait is part of GCC AMR Group 1.5.2.2.1 Done 1.5.2.2.1 Done 1.5.2.2.1 Done 1.5.2.2.2 Kuwait participat es in all the AMR activities GCC 1.5.2.2.2 Done 1.5.2.2.2 Done 1.5.2.2.2 Done Strategic Objective 1.6 Include AMR teaching in higher education/post-graduate studies in all human health specialties, agriculture, veterinary food safety, and environment related specialties. 1.6.1 Include AMR and related topics based on the One Health approach 1.6.1.1 Include AMR and related topics based on the One Health approach 1.6.1.1.1 preparatio n of modules for these specialties 1.6.1.1.1 Module for each specialty 1.6.1.1.1 1 per specialty 1.6.1.1.1 6 months 1.6.1.1.1 MOH KEPA PAFN 1.6.1.1.1 Awarenes s focal persons in all ministries /authoriti es /Awarene 1.6.1.1.1 None 1.6.1.1.1 None 1.6.1.1.1 Modules prepared yes/no Kuwait national action plan on antimicrobial resistance 2022 47 as a core compone nt of profession al education, training, certificati on in undergrad uate curricula for human health (medical, nursing, dental and pharmace utical), food safety, and environm ent related specialties . ss technical task force 1.6.1.1.2 Letter from MOH, PAFN KEPA to Ministry of Higher Education to impose on universitie s/authoriti es to include these 1.6.1.1.2 Letter 1.6.1.1.2 1 1.6.1.1.2 6 months 1.6.1.1.2 MOH KEPA PAFN 1.6.1.1.2 Awarenes s focal persons in all ministries /authoriti es / Awarenes s task force 1.6.1.1.2 None 1.6.1.1.2 None 1.6.1.1.2 Letter sent Yes/No Kuwait national action plan on antimicrobial resistance 2022 48 modules in the correspon ding education programs. 1.6.1.2 AMR and related topics based on the One Health approach included in the licensing procedure for nurses, dentists, physicians , pharmacis ts, veterinari ans and other profession als for which licensing is required. 1.6.1.2.1 Letter from MOH, PAAF, PAFN and KEPA to licensing bodies of these profession als to include AMR and its related topics in licensing exams and interviews or in the evaluation procedure for license renewal 1.6.1.2.1 Letter from, MOH, PAAF, PAFN and KEPA, to the licensing bodies of each of these profession s 1.6.1.2.1 1 per profession /per licensing body 1.6.1.2.1 3 months 1.6.1.2.1 MOH PAAF KEPA PAFN 1.6.1.2.1 MOH, PAAF, PAFN and KEPA /AMR focal persons in all authoritie s 1.6.1.2.1 None 1.6.1.2.1 None 1.6.1.2.1 Letters sent Yes/No Strategic Objective Include 1.7 AMR and related topics in quality assurance and accreditation programs in human health, animal health, agriculture, food chain and environment Kuwait national action plan on antimicrobial resistance 2022 49 1.7.1 IPC, AMR surveillanc e and AMS are included in the accreditati on standards of healthcare facilities 1.7.1.1 Letter from MOH to accreditati on bodies to include AMR surveillan ce and implemen tation of antimicro bial stewardsh ip programs as part of accreditati on standards in all healthcar e facilities as well as in the licensing renewal procedure s of private healthcar e facilities IPC is already 1.7.1.1 Letter 1.7.1.1 1 1.7.1.1 3 months 1.7.1.1 MOH on1.7.1.1 MOH/AM R awarenes s focal person/ General AMR focal person 1.7.1.1 None 1.7.1.1 None 1.7.1.1 AMR surveillan ce and AMS programs are included in the accreditat ion and license renewal standards for healthcar e facilities Kuwait national action plan on antimicrobial resistance 2022 50 part of these standards 1.7.2 IPC and rational use of antimicro bials is checked in the procedure of licensing farms, animal husbandry , agricultur e, aquatic and marine fields 1.7.2.1 Review of large animal/po ultry farms licensing policies and procedure s, to include IPC and proper ABX use and preventio n of ABX use as growth promoters 1.7.2.1.1 Mandate that ABX are not to be used as growth promoters 1.7.2.1.1 Mandate 1.7.2.1.1 1 1.7.2.1.1 3 months 1.7.2.1.1 PAAF 1.7.2.1.1 PAAF Director General /PAAF awarenes s focal person 1.7.2.1.1 None 1.7.2.1.1 None 1.7.2.1.1 Mandate issued 1.7.2.1.2 Letter from PAAF Director General to licensing office to include these points in 1.7.2.1.2 Letter 1.7.2.1.2 1 1.7.2.1.2 3 months 1.7.2.1.2 PAAF 1.7.2.1.2 PAAF Director General 1.7.2.1.2 None 1.7.2.1.2 None 1.7.2.1.2 AMR related topics are included in licensing conditions . Kuwait national action plan on antimicrobial resistance 2022 51 the standards N.B. Refer to Annex 2 for AMR Awareness Axis Strategic and Monitory plans Kuwait national action plan on antimicrobial resistance 2022 52 AMR Surveillance Operational and Budget Plan Global action plan strategic objective 2: Strengthen the knowledge and evidence base through surveillance and research. Strategic intervent ions Activity Sub activity Sub-sub activity Sub-sub sub activity Unit Quantity Date Location Responsi ble entity Cost Source Of funding Indicator Strategic Objective 2.1: Set up a national surveillance system for antimicrobial resistance based on One Health Approach 2.1.1 Establish a national coordina tion structure for AMR surveilla nce in humans, veterinar y agricultu re and environ ment 2.1.1.1 Write and approve terms of referenc e for a national coordina ting committ ee for AMR surveilla nce with the mandate to oversee the AMR surveilla nce program, including AMR surveilla nce in Humans, 2.1.1 Committ ee that includes focal for human, vets, agricultu re, environ ment and Food safety 2.1.1 1 2.1.1 6 months 2.1.1 MOH 2.1.1 MOH 2.1.1 None 2.1.1 None 2.1.1 Committ ee is formed yes/No Kuwait national action plan on antimicrobial resistance 2022 53 Veterinar y, agricultu re, environm ent and Food safety. 2.1.1.2. Write and approve terms of referenc e for a central office that executes the National surveilla nce in humans and receives data from other AMR offices in PAAF, KEPA and food safety 2.1.1.2.1 Write terms of referenc e of the AMR office at MOH 2.1.1.2.1 TOR of a central office at MOH 2.1.1.2.1 1 2.1.1.2.1 3 months 2.1.1.2.1 MOH 2.1.1.2.1 MOH 2.1.1.2.1 None 2.1.1.2.1 None 2.1.1.2.1 TOR written Kuwait national action plan on antimicrobial resistance 2022 54 2.1.1.2.2 Create the AMR coordina ting office at MOH. 2.1.1.2.2. 1 Include the already existing Glass team into the MOH National AMR office for Human sector at MOH. 2.1.1.2.2. 1.1 Add 2 employe es with a support from IT at MOH to be able to handle nationwi de data (to do the functions of the central office). 2.1.1.2.2. 1.1 Addition al employe es 2.1.1.2.2. 1.1 2 2.1.1.2.2. 1.1 6 months 2.1.1.2.2. 1.1 MOH 2.1.1.2.2. 1.1 MOH/Inf ormation system administr ation 2.1.1.2.2. 1.1 2 extra employe es 2.1.1.2.2. 1.1 MOH 2.1.1.2.2. 1.1 2 extra employe es are employe d. Yes/No 2.1.1.2.2. 2 Mandate that each MOH hospital has an AMR surveilla nce focal person that coordina tes with Central AMR surveilla 2.1.1.2.2. 2 Mandate 2.1.1.2.2. 2 1 2.1.1.2.2. 2 3 months 2.1.1.2.2. 2 MOH 2.1.1.2.2. 2 MOH 2.1.1.2.2. 2 None 2.1.1.2.2. 2 None 2.1.1.2.2. 2 Mandate issued Yes/No Kuwait national action plan on antimicrobial resistance 2022 55 nce office. 2.1.1.2.3 Inform PAAF,PA FN and KEPA about the need for AMR surveilla nce in their respectiv e fields. 2.1.1.2.3 Letter 2.1.1.2.3 2 2.1.1.2.3 1 month 2.1.1.2.3 MOH 2.1.1.2.3 MOH 2.1.1.2.3 None 2.1.1.2.3 None 2.1.1.2.3 Letter sent 2.1.1.2.4 Nominat e AMR focal persons in PAAF, KEPA, and Food safety 2.1.1.2.4 Nominati on of focal persons 2.1.1.2.4 3 2.1.1.2.4 3 months 2.1.1.2.4 PAAF and KEPA and PAFN 2.1.1.2.4 PAAF/ KEPA/ PAFN 2.1.1.2.4 None 2.1.1.2.4 None 2.1.1.2.4 AMR surveilla nce focal persons appointe d in all 3 authoriti es. 2.1.1.2.5 Write the job descripti on of these focal persons. The job descripti on would be to 2.1.1.2.5 TOR 2.1.1.2.5 3 2.1.1.2.5 3 months 2.1.1.2.5 PAAF and KEPA and PAFN 2.1.1.2.5 PAAF/ KEPA/ PAFN 2.1.1.2.5 None 2.1.1.2.5 None 2.1.1.2.5 TOR are set Kuwait national action plan on antimicrobial resistance 2022 56 collect AMR data and supply it to the Central AMR office and full coordina tion with the Central AMR office at MOH. 2.1.1.3 Identify priority organism s for the purpose of national AMR surveilla nce in human sector, animal sector, plants and Environm ent. 2.1.1.3 List of priority organism s for AMR surveilla nce in humans, animals, agricultu re and food safety 2.1.1.3 1 list 2.1.1.3 3 months 2.1.1.3 MOH 2.1.1.3 Central committ ee for AMR surveilla nce 2.1.1.3 None 2.1.1.3 None 2.1.1.3 List is available and includes all listed sectors. Kuwait national action plan on antimicrobial resistance 2022 57 2.1.1.4 Systemat ically collect, analyze and report data on AMR in humans in order to inform decision making at national and internati onal levels (Choose sentinel group of labs) 2.1.1.4.1 Choose a list of labs (dealing with specimen from humans) that can provide reliable AMR data will form a sentinel for starting AMR data collectio n that will be submitte d to AMR central office. 2.1.1.4.1 List of labs that potential ly will submit AMR data Already exist for 2021 GLASS Data 2.1.1.4.1 1 2.1.1.4.1 3 months 2.1.1.4.1 MOH / GLASS team 2.1.1.4.1 MOH 2.1.1.4.1 None 2.1.1.4.1 None 2.1.1.4.1 List is chosen (8 Labs submitte d GLASS data for 2021 Amiri Adan Mubarak Alkhabee r Jaber Farwania Jahra Chest Ibn Sina) 2.1.1.4.2 Increase the number of labs that are included in the list on yearly 2.1.1.4.2. 1 Establish close communi cation between central AMR 2.1.1.4.2. 1 New Labs in the list 2.1.1.4.2. 1 10 /year 2.1.1.4.2. 1 1 year 2.1.1.4.2. 1 MOH/ Central AMR Surveilla nce office 2.1.1.4.2. 1 MOH/ Central AMR Surveilla nce office 2.1.1.4.2. 1 None 2.1.1.4.2. 1 None 2.1.1.4.2. 1 Proportio n of labs in the country that are included in the list Kuwait national action plan on antimicrobial resistance 2022 58 basis until it becomes represen tative of the national data. OFFICE that also collects data for glass with the lab council to have a list of labs that are accredite d by the council, and to include them in the list of labs eligible to submit data to GLASS and National AMR surveilla nce 2.1.1.5 Establish an antimicr obial resistanc e 2.1.1.5.1 integrate all MOH laborator ies in network with the 2.1.1.5.1. 1 Training of hospital AMR Surveilla 2.1.1.5.1. 1 TOT Worksho ps 2.1.1.5.1. 1 1/year 2.1.1.5.1. 1 1 year 2.1.1.5.1. 1 MOH/ Central AMR Surveilla 2.1.1.5.1. 1 MOH/ Central AMR Surveilla 2.1.1.5.1. 1 30,000 KD/year 2.1.1.5.1. 1 MOH 2.1.1.5.1. 1 Yearly worksho p performe d Kuwait national action plan on antimicrobial resistance 2022 59 surveilla nce network for human health national referenc e Lab. nce focal persons for data cleaning and data entry into the MOH surveilla nce system nce office nce office Yes/No 2.1.1.5.2 Generate yearly report about AMR in humans in general and mainly priority organism s in humans by the MOH central office. 2.1.1.5.2 Report 2.1.1.5.2 1/year 2.1.1.5.2 2 years 2.1.1.5.2 MOH/ Central AMR Surveilla nce office 2.1.1.5.2 MOH/ Central AMR Surveilla nce office 2.1.1.5.2 None 2.1.1.5.2 None 2.1.1.5.2 Yearly human AMR report is issued 2.1.2 Participa te in Global Antimicr obial 2.1.2.1 Nominat e a hospital ad a team for 2.1.2.1 Team ad hospital nominat ed 2.1.2.1 Already done 2.1.2.1 Already done Kuwait national action plan on antimicrobial resistance 2022 60 Resistanc e Surveilla nce System (GLASS AMR) GLASS reporting with TOR 2.1.2.2 Give the GLASS team the authority to request and collect data from labs nationwi de 2.1.2.2 Letter from MOH 2.1.2.2 1 to each lab or hospital 2.1.2.2 Already done 2.1.2.2 Already done 2.1.2.2.1 The team initiates data collectio n from a sentinel of labs 2.1.2.2.1 Report submitte d to glass 2.1.2.2.1 1/year 2.1.2.2.1 Started 2021 2.1.2.2.1 Started 2021 2.1.2.3 Send yearly report to glass with increasin g 2.1.2.3.1 Central GLASS focal group (Part of AMR central 2.1.2.3.1 1 Yearly training of GLASS focal persons on GLASS 2.1.2.3.1. 1.1 Central worksho ps yearly 2.1.2.3.1. 1.1 Training worksho p 2.1.2.3.1. 1.1 1/year 2.1.2.3.1. 1.1 2 years 2.1.2.3.1. 1.1 MOH/ Central AMR Surveilla nce office 2.1.2.3.1. 1.1 MOH/ Central AMR Surveilla nce office 2.1.2.3.1. 1.1 20,000 KD 2.1.2.3.1. 1.1 MOH 2.1.2.3.1. 1.1 Worksho p done, yes/No have 10 20 % Kuwait national action plan on antimicrobial resistance 2022 61 number of contribut ing labs office), chooses from the list of eligible accredite d labs submitte d by central entity of medical labs to AMR office, data collectio n, manage ment and entry increase in number of participa ting labs in GLASS annually 2.1.2.3.2 Yearly lab report is sent to GLASS with increasin g number of contribut ing labs every year. 2.1.2.3.2 Report sent to GLASS 2.1.2.3.2 1/year 2.1.2.3.2 Started already 2.1.2.3.2 MOH/ Central AMR Surveilla nce office 2.1.2.3.2 MOH/ Central AMR Surveilla nce office 2.1.2.3.2 None 2.1.2.3.2 None 2.1.2.3.2 Data is available in the yearly GLASS report Strategic Objective 2.2: Build laboratory capacity to produce high-quality microbiological data for patient management and support surveillance activities in human, 2.2.1 Lab in Hospitals become 2.2.1.1 Pilot with 2 labs 2.2.1.1 Lab CAP affiliation 2.2.1.1 2 2.2.1.1 1 year 2.2.1.1 Labs 2.2.1.1 Medical Laborato 2.2.1.1 To be determin ed 2.2.1.1 MOH 2.2.1.1 Started already Kuwait national action plan on antimicrobial resistance 2022 62 CAP certified (College of American pathologi sts) ries Council 2.2.1.2 Increase the number of labs that are CAP members 2.2.1.2.1 Lab council puts a plan for sequenti al recruitm ent of labs into the CAP 2.2.1.2.1 Plan 2.2.1.2.1 1 2.2.1.2.1 1 year 2.2.1.2.1 Lab council 2.2.1.2.1 MOH 2.2.1.2.1 None 2.2.1.2.1 None 2.2.1.2.1 List is put already 2.2.1.2.2 Sequenti al recruitm ent of labs into CAP 2.2.1.2.2 Labs recruited 2.2.1.2.2 2 labs/year 2.2.1.2.2 5 years 2.2.1.2.2 Labs 2.2.1.2.2 Medical Laborato ries Council 2.2.1.2.2 To be determin ed 2.2.1.2.2 MOH 2.2.1.1 Proportio n of Labs that are CAP affiliated 2.2.2 Improve private labs capacity to be eligible for submitti ng data to GLASS 2.2.2.1 Reinforce the accredita tion activity of the lab council that audits labs 2.2.2.1.1 Mandate from MOH that each private lab should pass the accredita tion by 2.2.2.1.1 Mandate 2.2.2.1.1 1 2.2.2.1.1 12-24 months 2.2.2.1.1 MOH 2.2.2.1.1 MOH/Me dical lab. council/ Medical Licensing Dep. 2.2.2.1.1 None 2.2.2.1.1 None 2.2.2.1 Proportio n of labs that are functiona l and that have passed the accredita Kuwait national action plan on antimicrobial resistance 2022 63 and National AMR accordin g to availabilit y of qualified microbiol ogist, results of External QC and abidance to guideline s the Lab council tion testing 2.2.2.1.2 Accredita tion of the lab council includes the availabili ty of qualified microbiol ogist, results of External QC and abidance to guideline s s 2.2.2.1.2 Update of accredita tion standard s of labs 2.2.2.1.2 2.2.2.1.2 6 months 2.2.2.1.2 Labs 2.2.2.1.2 Medical Lab council 2.2.2.1.2 None 2.2.2.1.2 None Updated accredita tion standard s of Labs prepared Strategic objective 2.3: Collect data from Vet, Agriculture and Environment 2.3.1 2.3.1.1 2.3.1.1.1 2.3.1.1.1. 1 2.3.1.1.1. 1 2.3.1.1.1. 1 2.3.1.1.1. 1 2.3.1.1.1. 1 2.3.1.1.1. 1 2.3.1.1.1. 1 2.3.1.1.1. 1 2.3.1.1.1. 1 Kuwait national action plan on antimicrobial resistance 2022 64 Collect AMR data from Vets Map available data On AMR in vet and agricultu re in the country. Agricultu re and Environ ment focal persons collect available info about AMR in the country and issue a report Map PAAF labs and the type of AMR data that is generate d. Report about PAAF Labs 1 6 months PAAF Vet labs PAAF None None Report is Submitte d to central AMR surveilla nce office 2.3.1.1.1. 2 Collect available data about AMR in PAAF/PA FN 2.3.1.1.1. 2 Report from PAAF and food safety focal persons 2.3.1.1.1. 2 2 2.3.1.1.1. 2 6 months 2.3.1.1.1. 2 PAAF/PA FN 2.3.1.1.1. 2 PAAF/PA FN 2.3.1.1.1. 2 None 2.3.1.1.1. 2 None 2.3.1.1.1. 2 AMR Vets /food reports are submitte d to central AMR Surveilla nce office 2.3.1.2 Improve vet lab capacity in a way they generate 2.3.1.2.1 Establish quality control of Vet Microbio logy labs 2.3.1.2.1. 1 Assign expert to establish a system for 2.3.1.2.1. 1 1 professio nal assigned 2.3.1.2.1. 1 1 2.3.1.2.1. 1 1 year 2.3.1.2.1. 1 PAAF 2.3.1.2.1. 1 PAAF 2.3.1.2.1. 1 Salary 2.3.1.2.1. 1 PAAF 2.3.1.1.1. 1 Professio nal is assigned Kuwait national action plan on antimicrobial resistance 2022 65 data about AMR vets and agricultu re quality control and put a plan /employ ed 2.3.1.2.1. 2 Execute the plan of quality control in Vet labs 2.3.1.2.1. 2 qc of vet labs 2.3.1.2.1. 2 1 2.3.1.2.1. 2 2 year 2.3.1.2.1. 2 vet labs 2.3.1.2.1. 2 PAAF 2.3.1.2.1. 2 to be determin ed by PAAF 2.3.1.2.1. 2 PAAF 2.3.1.2.1. 2 Proportio n of VET Labs that Participat e in external quality control activities 2.3.1.2.2 Extend Vet Micro Labs to identify priority organism s antibiogr am 2.3.1.2.2. 1 Increase man power 2.3.1.2.2. 1 Employe es 2.3.1.2.2. 1 To be determin ed Per lab 2.3.1.2.2. 1 6 months 2.3.1.2.2. 1 Vet Labs 2.3.1.2.2. 1 PAAF 2.3.1.2.2. 1 to be determin ed by PAAF 2.3.1.2.2. 1 PAAF 2.3.1.2.2. 1 none 2.3.1.2.2. 2 Road map and full project 2.3.1.2.2. 2 Project 2.3.1.2.2. 2 1 2.3.1.2.2. 2 1 year 2.3.1.2.2. 2 PAAF/Ve t labs 2.3.1.2.2. 2 PAAF 2.3.1.2.2. 2 none 2.3.1.2.2. 2 none 2.3.1.2.2. 2 The project is put with specified budget Kuwait national action plan on antimicrobial resistance 2022 66 and ready for executio n 2.3.1.2.2. 3 Worksho ps for training about antibiogr am 2.3.1.2.2. 3 Worksho p 2.3.1.2.2. 3 1/year 2.3.1.2.2. 3 1 year 2.3.1.2.2. 3 PAAF Central Lab, or assigned lab 2.3.1.2.2. 3 PAAF 2.3.1.2.2. 3 Worksho p cost 2.3.1.2.2. 3 PAAF 2.3.1.2.2. 3 Worksho p is performe d. 2.3.1.2.3 Impleme nt national surveilla nce for antibiogr am priority animal pathogen s, zoonotic and commen sal bacterial isolates. 2.3.1.2.3. 1 Choose a number of Vet labs that could submit AMR data to PAAF for AMR surveilla nce 2.3.1.2.3. 1 List of labs 2.3.1.2.3. 1 1 list/year 2.3.1.2.3. 1 1 year 2.3.1.2.3. 1 PAAF 2.3.1.2.3. 1 PAAF AMR surveilla nce focal Person 2.3.1.2.3. 1 None 2.3.1.2.3. 1 None 2.3.1.2.3. 1 List of labs is available yearly 2.3.1.2.3. 2 Collect data from a Sentinel 2.3.1.2.3. 2 Yearly data collectio n 2.3.1.2.3. 2 1/year 2.3.1.2.3. 2 2 years 2.3.1.2.3. 2 PAAF 2.3.1.2.3. 2 PAAF/ AMR surveilla 2.3.1.2.3. 2 None 2.3.1.2.3. 2 None 2.3.1.2.3. 2 Data is yearly collected Kuwait national action plan on antimicrobial resistance 2022 67 of vet hospitals or labs that submit data to the departm ent of surveilla nce. (They belong to the list). nce focal person 2.3.1.2.4 The focal AMR entity at PAAF submits AMR data to the Central AMR surveilla nce lab. 2.3.1.2.4 Data Submitte d to Central AMR office at MOH 2.3.1.2.4 1/year 2.3.1.2.4 1 year 2.3.1.2.4 PAAF/ MOH 2.3.1.2.4 AMR Surveilla nce focal person at PAAF 2.3.1.2.4 None 2.3.1.2.4 None 2.3.1.2.4 Data submitte d to MOH Central Office. 2.3.2 Collect AMR data from Environ ment. 2.3.2.1 Map available data from KEPA 2.3.2.1 Check KEPA Labs and publicati ons about any AMR 2.3.2.1 Search 2.3.2.1 1 2.3.2.1 3 months 2.3.2.1 KEPA labs 2.3.2.1 KEPA focal person for AMR surveilla nce 2.3.2.1 None 2.3.2.1 None 2.3.2.1 Report is issued Kuwait national action plan on antimicrobial resistance 2022 68 data in environ ment 2.3.2.2 Initiate AMR data collectio n from Environm ent By research projects. 2.3.2.2.1 The director of the office of research and studies puts AMR surveilla nce as one of the priority subjects in research 2.3.2.2.1. 1 The plan of prioritizi ng AMR surveilla nce in Environm ent and marine environm ent re and is being discussed with universiti es/institu tes 2.3.2.2.1. 1 Minutes of discussio ns in meetings with universiti es//instit utes official letters 2.3.2.2.1. 1 4/5 2.3.2.2.1. 1 6 months 2.3.2.2.1. 1 KEPA Research office 2.3.2.2.1. 1 KEPA Research office 2.3.2.2.1. 1 None 2.3.2.2.1. 1 None 2.3.2.2.1. 1 % of research meetings with universiti es//instit utes where AMR is requeste d to be apriority in research projects. 2.3.2.2.1. 2 Call for proposal from universiti es//instit utes 2.3.2.2.1. 2 Letter to universiti es/institu tes from KEPA research director to send projects related to AMR 2.3.2.2.1. 2 1/univers ity 2.3.2.2.1. 2 1 year 2.3.2.2.1. 2 KEPA research office directora te 2.3.2.2.1. 2 KEPA research office directora te 2.3.2.2.1. 2 None 2.3.2.2.1. 2 None 2.3.2.2.1. 2 Proportio n of universiti es /institute s that send projects related to AMR in Kuwait national action plan on antimicrobial resistance 2022 69 in environ ment environm ent to KEPA research office 2.3.2.2.1. 3 The director of the office of research and studies applies for funds from KEPA for projects related to AMR surveilla nce in Vet, agricultu re, and Environm ent. 2.3.2.2.1. 3 Projects and funds 2.3.2.2.1. 3 Multiple 2.3.2.2.1. 3 6 months 2.3.2.2.1. 3 KEPA research office 2.3.2.2.1. 3 KEPA research office 2.3.2.2.1. 3 None 2.3.2.2.1. 3 None 2.3.2.2.1. 3 % of proposed projects related to AMR in environm ent that have been funded 2.3.2.2.2 Increase lab capacity of KEPA Lab that deals with the 2.3.2.2.2. 1 Letter from KEPA Director General to 2.3.2.2.2. 1 Letter from KEPA General director to 2.3.2.2.2. 1 1 2.3.2.2.2. 1 3 months 2.3.2.2.2. 1 KEPA 2.3.2.2.2. 1 KEPA 2.3.2.2.2. 1 None 2.3.2.2.2. 1 None 2.3.2.2.2. 1 KEPA Lab starts reporting AMR data Kuwait national action plan on antimicrobial resistance 2022 70 quality of coastal water to include AMR identifica tion and surveilla nce in water and sediment Technical affairs sector of micro labs asking to prepare a project with a budget that aims at expandin g their work from only identifica tion to antibiogr am testing technical affairs sector 2.3.2.2.2. 2 KEPA analytical central lab KEPA prepare road map for the labs to be able to do antibiogr 2.3.2.2.2. 2.1 Identify the needed machiner y and their budget 2.3.2.2.2. 2.1 List and budget 2.3.2.2.2. 2.1 1 2.3.2.2.2. 2.1 6 months 2.3.2.2.2. 2.1 KEPA Analytica l Lab center 2.3.2.2.2. 2.1 KEPA Analytica l Lab center 2.3.2.2.2. 2.1 None 2.3.2.2.2. 2.1 None 2.3.2.2.2. 2 Road map project with budget is put to extend KEPA microbiol ogy lab from Kuwait national action plan on antimicrobial resistance 2022 71 am testing bacterial identifica tion to include also antibiogr am testing 2.3.2.2.2. 2.2 Put a plan of needed extra staffing 2.3.2.2.2. 2.2 Plan 2.3.2.2.2. 2.2 1 2.3.2.2.2. 2.2 6 months 2.3.2.2.2. 2.2 KEPA Lab council 2.3.2.2.2. 2.2 KEPA Lab council 2.3.2.2.2. 2.2 None 2.3.2.2.2. 2.2 None See above 2.3.2.2.2. 3 KEPA provides the related budget 2.3.2.2.2. 3 Commun ication between KEPA and ministry of finance 2.3.2.2.2. 3 Letters 2.3.2.2.2. 3 2 2.3.2.2.2. 3 2 years 2.3.2.2.2. 3 KEPA MO finance 2.3.2.2.2. 3 KEPA MO finance 2.3.2.2.2. 3 None 2.3.2.2.2. 3 None 2.3.2.2.2. 3 None 2.3.2.2.2. 4 KEPA microbiol ogy labs start generati ng antibiogr am results for 2.3.2.2.2. 4 Antibiogr am KEPA LABS 2.3.2.2.2. 4 1/LAB 2.3.2.2.2. 4 3 years 2.3.2.2.2. 4 KEPA Micro lab 2.3.2.2.2. 4 KEPA 2.3.2.2.2. 4 Will be determin ed in the Road map project 2.3.2.2.2. 4 KEPA 2.3.2.2.2. 4 KEPA Marine lab actually generate s AMR data Kuwait national action plan on antimicrobial resistance 2022 72 priority organism s 2.3.2.2.3 Generate report about AMR surveilla nce in Environ ment 2.3.2.2.3 Report 2.3.2.2.3 1 2.3.2.2.3 4 years 2.3.2.2.3 KEPA 2.3.2.2.3 KEPA 2.3.2.2.3 None 2.3.2.2.3 None 2.3.2.2.3 Yes/No 2.3.3 The national AMR Surveilla nce Office at MOH gathers data from KEPA, PAAF and PAFN compiles it with Human AMR data and generate s yearly ONE Health AMR 2.3.3.1 KEPA, PAAF and PAFN submit available data to Central AMR surveilla nce office at MOH on yearly basis 2.3.3.1.1 Create a digital network for data sharing with MOH 2.3.3.1.1 Digital system 2.3.3.1.1 1 2.3.3.1.1 5 years 2.3.3.1.1 MOH, KEPA, PAAF PAFN 2.3.3.1.1 IT team at MOH, KEPA, PAAF PAFN 2.3.3.1.1 none 2.3.3.1.1 none 2.3.3.1.1 Digital System is put Kuwait national action plan on antimicrobial resistance 2022 73 surveilla nce report. 2.3.3.1.2 Add this function to the TOR of the focal person at PAAF and KEPA and food safety. 2.3.3.1.2 TOR 2.3.3.1.2 3 2.3.3.1.2 3 years 2.3.3.1.2 MOH/ KEPA/ PAAF/ PAFN 2.3.3.1.2 MOH/ KEPA/ PAAF/ PAFN 2.3.3.1.2 None 2.3.3.1.2 None 2.3.3.1.2 TOR includes surveilla nce function detail. Strategic objective 2.4: Create a National Reference Lab for AMR 2.4.1 To have A Kuwaiti Center of Disease Control that will be overseei ng bacterial viral and AMR referenc e labs 2.4.1.1 Project of referenc e lab with its budget and having it endorsed by MOH 2.4.1.1 Project endorsed by MOH 2.4.1.1 1 2.4.1.1 Already available 2.4.1.1 Kuwait CDC Lab 2.4.1.1 MOH 2.4.1.1 Included in the project, already approved by Minister of Health 2.4.1.1 MOH 2.4.1.1 Kuwait CDC will oversee the needs and functions of all referenc e laborator ial, including viral, bacterial and AMR. Kuwait national action plan on antimicrobial resistance 2022 74 2.4.1.2 Kuwait CDC becomes functiona l 2.4.1.2 Function al Kuwait CDC 2.4.1.2 1 2.4.1.2 5 years 2.4.1.2 Kuwait CDC 2.4.1.2 MOH/ Minister of Health 2.4.1.2 included in the approved project approved by minister of health 2.4.1.2 Council of Ministers /MOH and Ministry of Finance. 2.4.1.2 Kuwait CDC is establish ed . 2.4.1.3 Write and approve terms of referenc e for a national AMR referenc e laborator y with expertise in method s for confirmi ng and character izing specific pathogen s, putting guideline s, SOP for 2.4.1.3 TOR OF Referenc e Lab 2.4.1.3 1 2.4.1.3 3 months 2.4.1.3 Kuwait CDC lab 2.4.1.3 Kuwait CDC/Min ister of health/M edical Lab.coun cil 2.4.1.3 none 2.4.1.3 none 2.4.1.3 TOR of AMR referenc e Lab are put. They include: expertise in method s for confirmi ng and character izing specific pathogen s, putting guideline s, SOP for identifica tion and antibiogr am Kuwait national action plan on antimicrobial resistance 2022 75 identifica tion and antibiogr am testing of priority organism s for surveilla nce training accordin g to guideline s, and organizin g quality assuranc e schemes testing of priority organism s for surveilla nce training accordin g to guideline s, and organizin g quality assuranc e schemes 2.4.1.4 Prepare a full project and proposal for the referenc e lab 2.4.1.4 Referenc e Lab project as part of Kuwait CDC 2.4.1.4 1 2.4.1.4 5 years 2.4.1.4 Kuwait CDC 2.4.1.4 Kuwait CDC 2.4.1.4 project already approved 2.4.1.4 Kuwait CDC budget already approved 2.4.1.4 Yes/No 2.4.1.5 Prepare a budget for the building, equipme nt and 2.4.1.5 Budget 2.4.1.5 1 2.4.1.5 5 years 2.4.1.5 Kuwait CDC 2.4.1.5 Kuwait CDC 2.4.1.5 Budget within the budget of Kuwait CDC 2.4.1.5 MOH/ Council of ministers /Ministry 2.4.1.5 Budget for AMR lab is approved Kuwait national action plan on antimicrobial resistance 2022 76 man power of the referenc e Lab of Finance. 2.4.1.6 Executio n of the Referenc e Lab 2.4.1.6 Function al AMR referenc e lab 2.4.1.6 1 2.4.1.6 5 years 2.4.1.6 Kuwait CDC 2.4.1.6 Kuwait CDC 2.4.1.6 Budget within the budget of Kuwait CDC 2.4.1.6 MOH/ Council of ministers /Ministry of Finance. 2.4.1.6 Referenc e lab is set and functioni ng Kuwait national action plan on antimicrobial resistance 2022 77 Delegate the function of surveilla nce of the referenc e Lab pending its readiness 2.4.2.1 Identify institutio n affiliated to MOH that will host the manpow er and activities of the AMR Surveilla nce office for the actual work on the National and GLASS AMR reports pending the finalizati on of the 2.4.2.1.1 A letter from MOH to all labs that asks them to coordina te with the GLASS lab by deliverin g AMR data for the purpose of AMR Surveilla nce 2.4.2.1.1 Letter from MOH to hospitals through Medical lab council 2.4.2.1.1 1 2.4.2.1.1 Already available 2.4.2.1.1 MOH 2.4.2.1.1 MOH 2.4.2.1.1 None 2.4.2.1.1 None 2.4.2.1.1 Already available Kuwait national action plan on antimicrobial resistance 2022 78 referenc e lab. Strategic objective 2.5: Unify AMR identification in all Micro labs 2.5.1 Lab audit by lab accredita tion body accordin g to microbiol ogist consulta nt in charge, external quality control and use of CLSI guideline s 2.5.1.1 Accredita tion of the medical Laborato ries by Medical Laborato ries Council 2.5.1.1.1 Involve all laborator ies in external quality assuranc e programs 2.5.1.1.1. 1 Mandate that all labs including all private should be accredite d and all perform external QC. 2.5.1.1.1. 1.1 List of accredita tion bodies accepted in Kuwait, all labs should be accredite d by one of them 2.5.1.1.1. 1.1 List 2.5.1.1.1. 1.1 1 2.5.1.1.1. 1.1 6 months 2.5.1.1.1. 1.1 Central Labs/MO H/ Medical Lab.coun cil 2.5.1.1.1. 1.1 Central Labs/MO H/Medic al Lab.coun cil 2.5.1.1.1. 1.1 None 2.5.1.1.1. 1.1 None 2.5.1.1.1. 1.1 Number of internati onal accredita tion bodies that are recomme nded in Kuwait for the labs to get their accredita tion N.B. Refer to Annex 3 for AMR Surveillance Axis Strategic and Monitory plans Kuwait national action plan on antimicrobial resistance 2022 79 Infection Prevention and Control Operational and Budget Plan Global action plan strategic objective 3: Reduce the incidence of infection through effective sanitation, hygiene and prevention measures. Strategic intervent ions Activity Sub activity Sub-sub activity Sub-sub sub activity Unit Quantity Date Location Responsi ble entity Cost Source Of funding Indicator Strategic Objective 3.1 Emphasize the national infection prevention and control program in healthcare at the National and Health care facility levels. 3.1.1 Create a formal organizat ional structure to ensure proper develop ment and use of infection preventi on and control policies and strategie s 3.1.1.1 Infection Control Organiza tional structure is already establish ed and functioni ng. - 3.1.1.1 IPC Directora te in MOH that is a central, and fulfills the criteria of National IPC body that coordina tes and organizes IPC activities in HCF. 3.1.1.1 1 3.1.1.1 Done 1980 3.1.1.1 MOH 3.1.1.1 MOH /IPC Directora te 3.1.1.1 Done 3.1.1.1 none 3.1.1.1 Already available 3.1.1.2 To make official that IPC is part of the organogr 3.1.2.1 Decree from MOH about IPC departm 3.1.2.1 Decree from MOH 3.1.2.1 1 3.1.2.1 2 Months 3.1.2.1 MOH 3.1.2.1 MOH /IPC Directora te 3.1.2.1 None 3.1.2.1 None 3.1.2.1 The decree was issued. Kuwait national action plan on antimicrobial resistance 2022 80 am of each hospital with Terms of Referenc e and allocated staff ent in each hospital with TOR, and staffing organizat ion 3.1.1.3 IPC departm ents in hospitals and they work closely with the central IPC Directora te 3.1.1.3.1 To impose IPC program s in all hospitals 3.1.1.3.1. 1 IPC program availabilit y is checked by accredita tion standard s 3.1.1.3.1. 1 Recomm endation availabilit y in accredita tion standard s 3.1.1.3.1. 1 1 3.1.1.3.1. 1 Already available 3.1.1.3.1. 1 MOH/ Quality and Accredita tion Directora te 3.1.1.3.1. 1 MOH / Quality and Accredita tion Directora te 3.1.1.3.1. 1 None 3.1.1.3.1. 1 No need 3.1.1.3.1. 1 Exists already 3.1.1.3.2 IPC program s are available in all hospitals and they work under the umbrella of the 3.1.1.3.2 IPC Program/ Departm ent 3.1.1.3.2 One in each hospital 3.1.1.3.2 Already available 3.1.1.3.2 IPC directora te/Hospit als 3.1.1.3.2 MOH/IPC directora te/Hospit als 3.1.1.3.2 None 3.1.1.3.2 None 3.1.1.3.2 Number of Hospitals with IPC program s and Total number of hospital departm ents Kuwait national action plan on antimicrobial resistance 2022 81 Central IPC directora te. 3.1.2 Impleme nt laws for mandato ry complian ce of the facilities with IPC standard s 3.1.2.1 Decree from MOH 3.1.2.1.1 Decree that recomm ends that all HCF have to abide by IPC Recomm endation s. 3.1.2.1.1. 1 IPC Directora te puts the detailed IPC measures that should be required from each HCF, and sent to MOH to be included in ministry 3.1.2.1.1. 1 List of measure s 3.1.2.1.1. 1 1 3.1.2.1.1. 1 2 months 3.1.2.1.1. 1 MOH/IPC directora te 3.1.2.1.1. 1 MOH/IPC directora te 3.1.2.1.1. 1 No cost 3.1.2.1.1. 1 No cost 3.1.2.1.1. 1 List is sent from IPC Directora te to MOH undersec retary 3.1.2.1.1. 2 Decree is issued by MOH 3.1.2.1.1. 2 Decree 3.1.2.1.1. 2 1 3.1.2.1.1. 2 3 months 3.1.2.1.1. 2 MOH 3.1.2.1.1. 2 MOH 3.1.2.1.1. 2 None 3.1.2.1.1. 2 None 3.1.2.1.1. 2 Decree availabili ty and dissemin ation 3.1.2.1.2 Medical responsi bilities. 3.1.2.1.2. 1 Add complian ce to IPC 3.1.2.1.2. 1 Update of medical 3.1.2.1.2. 1 1 3.1.2.1.2. 1 3 months 3.1.2.1.2. 1 MOH 3.1.2.1.2. 1 IPC Directora te/MOH 3.1.2.1.2. 1 None 3.1.2.1.2. 1 None 3.1.2.1.2. 1 The Medical responsi Kuwait national action plan on antimicrobial resistance 2022 82 Add details IPC standard complian ce in hospitals measures and recomme ndations to the list of medical responsi bilities of hospitals as listed by MOH responsi bilities list issued by MOH bility list is updated and it includes the statemen t about IPC measure s. 3.1.3 WHO IPC Core compone nt based guideline s are establish ed in all HCF 3.1.3.1 Availabili ty of endorsed IPC based on WHO IPC core compone nts - 3.1.3.1 1 available guideline s 3.1.3.1 1 Central IPC Guideline 3.1.3.1 Done 3.1.3.1 MOH 3.1.3.1 MOH/ Directora te of IPC 3.1.3.1 MOH 3.1.3.1 Available 3.1.3.2 IPC policies and procedur es are included in hospital accredita tion standard s - 3.1.3.2 1 Available list 3.1.3.2 1 list 3.1.3.2 Done 3.1.3.2 MOH 3.1.3.2 MOH/ Directora te of IPC 3.1.3.2 MOH 3.1.3.2 Available Kuwait national action plan on antimicrobial resistance 2022 83 3.1.3.3 IPC policies and procedur es are being audited regularly by accredita tion bodies - 3.1.3.3 1 audit tool Available 3.1.3.3 1 audit tool 3.1.3.3 Done 3.1.3.3 MOH 3.1.3.3 MOH / Quality and Accredita tion Directora te 3.1.3.3 MOH 3.1.3.3 Available 3.1.3.4 National infection control policies and guideline s are distribut ed and periodica lly updated 3.1.3.4.1 Regular update of national IPC guideline s 3.1.3.4.1. 1 On going, but needs to be speeded up by increasin g manpow er in IPC nationwi de in central office and in hospitals 3.1.3.4.1. 1 Employin g new Inspector s, MDs and IPC professio nals with data entry personne l 3.1.3.4.1. 1 -10 MD 4 data entry personne l 15 inspector s 3.1.3.4.1. 1 2 years 3.1.3.4.1. 1 MOH 3.1.3.4.1. 1 IPC directora te/MOH 3.1.3.4.1. 1 MOH 3.1.3.4.1. 1 MOH 3.1.3.4.1. 1 Number employe d/Numb er needed 3.1.3.4.2 A direct channel with 3.1.3.4.2. 1 Communi cate this 3.1.3.4.2. 1.1 Letter from 3.1.3.4.2. 1.1 Letter 3.1.3.4.2. 1.1 1 3.1.3.4.2. 1.1 1 month 3.1.3.4.2. 1.1 3.1.3.4.2. 1.1 WCO 3.1.3.4.2. 1.1 3.1.3.4.2. 1.1 WHO 3.1.3.4.2. 1.1 Number of Kuwait national action plan on antimicrobial resistance 2022 84 WHO consulta nt regardin g few queries and new recomm endation s need to WHO office in Kuwait MOH/IPC directora te to WHO office in Kuwait asking for direct channel with a consulta nt for queries wheneve r they occur WHO office Kuwait Will be costed by WHO answere d queries /Number of needed consultat ions 3.1.3.4.2. 2 Communi cate this need to Regional WHO office 3.1.3.4.2. 2 Request from WCO to Regional office. 3.1.3.4.2. 2 Letter 3.1.3.4.2. 2 1 3.1.3.4.2. 2 2 months 3.1.3.4.2. 2 WHO office Kuwait 3.1.3.4.2. 2 WCO 3.1.3.4.2. 2 Will be costed by WHO 3.1.3.4.2. 2 WHO 3.1.3.4.3 Regular update of National IPC policies and procedur es 3.1.3.4.3. 1 Need updating + speeding up the process 3.1.3.4.3. 1 provide necessar y manpow er as in 3.1.3.4.1. 1 3.1.3.4.3. 1 As above Manpow er 3.1.3.4.1. 1 3.1.3.4.3. 1 ongoing 3.1.3.4.3. 1 MOH 3.1.3.4.3. 1 Plan of manpow er Above As in 3.1.3.4.1. 1 3.1.3.4.3. 1 Employe es salaries 3.1.3.4.3. 1 MOH 3.1.3.4.3. 1 Number of hospitals with updated policies/ Total number of hospitals Kuwait national action plan on antimicrobial resistance 2022 85 3.1.3.5 National IPC Guideline s and policies are being taught 3.1.3.5.1 TOT periodica lly performe d nationall y 3.1.3.5.1 Training sessions 3.1.3.5.1 Started years ago, and running 3.1.3.5.1 Already being performe d 3.1.3.5.1 MOH/IPC directora te/ Hospitals 3.1.3.5.1 IPC Directora te 3.1.3.5.1 Already budget is available and being performe d 3.1.3.5.1 MOH 3.1.3.5.1 Number of IPC professio nals trained annually /total number of IPC professio nals. 3.1.3.5.2 Continuo us training of HCW about IPC policies in hospitals is available 3.1.3.5.2. 1 Mandate from MOH that it is mandato ry to all HCW to attend at least 1 yearly and 1 upon employm ent 3.1.3.5.2. 1 Mandate 3.1.3.5.2. 1 1 3.1.3.5.2. 1 2 months 3.1.3.5.2. 1 MOH 3.1.3.5.2. 1 IPC Directora te/ MOH 3.1.3.5.2. 1 None 3.1.3.5.2. 1 None 3.1.3.5.2. 1 Decree is done and sent to hospitals . 3.1.3.5.2. 2 Improve attendan ce to these 3.1.3.5.2. 2.1 Attendan ce is reported to hospital 3.1.3.5.2. 2.1 Report presente d to hospital directors 3.1.3.5.2. 2.1 report/h ospital/y ear 3.1.3.5.2. 2.1 1 year 3.1.3.5.2. 2.1 MOH/ Hospitals 3.1.3.5.2. 2.1 Hospital IPC office 3.1.3.5.2. 2.1 None 3.1.3.5.2. 2.1 No 3.1.3.5.2. 2.1 Number of HCW attendee s /year Kuwait national action plan on antimicrobial resistance 2022 86 general HCW IPC training sessions administr ators and action taken to improve attendan ce 3.1.3.5.2. 2.2 Attendan ce evidence is available in yearly Hospital IPC report and monitore d by IPC Directora te 3.1.3.5.2. 2.2 Report presente d to IPC directora te 3.1.3.5.2. 2.2 1 Report/h ospital/y ear 3.1.3.5.2. 2.2 1 year 3.1.3.5.2. 2.2 IPC Directora te 3.1.3.5.2. 2.2 MOH/IPC directora te/Hospit al administr ators 3.1.3.5.2. 2.2 None 3.1.3.5.2. 2.2 No 3.1.3.5.2. 2.2 none 3.1.4 Monitor and evaluate complian ce with the IPC guideline s 3.1.4.1 Checklist s and audit tools are prepared and applied 3.1.4.1 documen ts (checklist s and audit tools) 3.1.4.1 1 3.1.4.1 Started years ago, and ongoing for new policies. 3.1.4.1 MOH/IPC Directora te 3.1.4.1 IPC Directora te 3.1.4.1 none 3.1.4.1 none 3.1.4.1 Number of policies with audit tools/Tot al number of policies Kuwait national action plan on antimicrobial resistance 2022 87 3.1.4.2 Regular updates of these audit tools 3.1.4.2.1 Check new policies if they have their audit tools prepared and dissemin ated and check old tools if they need update 3.1.4.2.1 Audit tool 3.1.4.2.1 One/new policy. Then total review once/yea r 3.1.4.2.1 Ongoing 3.1.4.2.1 IPC Directora te/ MOH 3.1.4.2.1 IPC Directora te/ MOH 3.1.4.2.1 None 3.1.4.2.1 None 3.1.4.2.1 Number of new policies with audit tool/Tota l number of new policies. 3.1.4.3 Audit plan available in hospitals 3.1.4.3.1 Audit plan is checked in standard s of the National Accredita tion Program applied by the Quality and Accredita tion 3.1.4.3.1 checking 3.1.4.3.1 1 3.1.4.3.1 done ongoing 3.1.4.3.1 IPC Directora te/ MOH 3.1.4.3.1 IPC Directora te/ MOH 3.1.4.3.1 None 3.1.4.3.1 None 3.1.4.3.1 Done and ongoing Kuwait national action plan on antimicrobial resistance 2022 88 Directora te 3.1.4.3.2 Central audit plan is being prepared annually and distribut ed to all hospitals 3.1.4.3.2 Audit plan 3.1.4.3.2 1 3.1.4.3.2 Done and ongoing yearly 3.1.4.3.2 IPC Directora te 3.1.4.3.2 IPC Directora te /MOH 3.1.4.3.2 none 3.1.4.3.2 none 3.1.4.3.2 Done and ongoing 3.1.4.3.3 Audit report is sent to central IPC directora te with correctiv e actions. 3.1.4.3.3 Report 3.1.4.3.3 one/ hospital 3.1.4.3.3 Done and ongoing 3.1.4.3.3 Hospitals /IPC directora te 3.1.4.3.3 Hospitals /IPC directora te/MOH 3.1.4.3.3 None 3.1.4.3.3 None 3.1.4.3.3 Done and ongoing 3.1.4.4 Establish national process indicator s 3.1.4.4.1 1st set of process indicator s: CLABSI CAUTI VAP 3.1.4.4.1. 1 Put the basic training material 3.1.4.4.1. 1 Process indicator s of the Bundles of care 3.1.4.4.1. 13 3.1.4.4.1. 1Already available 3.1.4.4.1. IPC directora te 3.1.4.4.1. 1 IPC directora te 3.1.4.4.1. 1No extra budget 3.1.4.4.1. 1 IPC directora te for both 3.1.4.4.1. 1 Each one of the 3 procedur es has its own bundle establish ed. 3.1.4.4.1. 2Update 3.1.4.4.1. 2 3.1.4.4.1. 2New 3.1.4.4.1. 2 3.1.4.4.1. 2 3.1.4.4.1. 2 IPC 3.1.4.4.1. 2MOH/ 3.1.4.4.1. 2None 3.1.4.4.1. 2None 3.1.4.4.1. 2Availabi Kuwait national action plan on antimicrobial resistance 2022 89 of the already available bundle of care in each of the mentione d bundles, by including new evidence based items to the bundle Prepare the updated bundles bundle definitio n and checklist 3 2 years directora te/MOH IPC directora te lity of 3 updated bundles 3.1.4.4.1. 3 Train the IPC professio nals nationwi de on the updated bundles 3.1.4.4.1. 3.1 TOT worksho ps 3.1.4.4.1. 3.1 TOT sessions 3.1.4.4.1. 3.1 2/year centrally Total=4 3.1.4.4.1. 3.1 2 years 3.1.4.4.1. 3.1 MOH/IPC directora te 3.1.4.4.1. 3.1 IPC Directora te /MOH 3.1.4.4.1. 3.1 No need for additiona l at MOH 3.1.4.4.1. 3.1 MOH 3.1.4.4.1. 3.1 % IPC professio nals trained about the new bundles 3.1.4.4.1. 4 Engage all HCW with the bundles by training, 3.1.4.4.1. 4.1 Prepare the ground in the hospitals: 3.1.4.4.1. 4.1 Letter for CLABSI bundle 3.1.4.4.1. 4.1 1 dissemin ated to all hospital directors 3.1.4.4.1. 4.1 CLABSI months Each bundle 1 y 3.1.4.4.1. 4.1 IPC Directora te/MOH 3.1.4.4.1. 4.1 IPC Directora te/MOH 3.1.4.4.1. 4.1 None 3.1.4.4.1. 4.1 None 3.1.4.4.1. 4.1 Letter sent or not Kuwait national action plan on antimicrobial resistance 2022 90 audit and feedback. Letter to hospital directors about the bundles project its importan ce and its processe s 3.1.4.4.1. 4.2 Update the material to be taught to HCW by IPC professio nals, accordin g to the updated bundles. 3.1.4.4.1. 4.2 Training package for each bundle 3.1.4.4.1. 4.2 3 (1/bundl e) 3.1.4.4.1. 4.2 2 years 3.1.4.4.1. 4.2 IPC Directora te/MOH 3.1.4.4.1. 4.2 IPC Directora te/MOH 3.1.4.4.1. 4.2 None 33.1.4.4. 1.4.2 None 3.1.4.4.1. 4.2 % of material directed to HCW that has been updated. 3.1.4.4.1. 4.3 In hospital training sessions by IPC professio nals to all 3.1.4.4.1. 4.3 Training sessions in hospitals to HCW performe d by each 3.1.4.4.1. 4.3 Multiple in each hospital 3.1.4.4.1. 4.3 4 years 3.1.4.4.1. 4.3 MOH/Ho spitals 3.1.4.4.1. 4.3 MOH/IPC directora te/Hospit als 3.1.4.4.1. 4.3 None 3.1.4.4.1. 4.3 None 3.1.4.4.1. 4.3 Complian ce with performa nce indicator for each bundle Kuwait national action plan on antimicrobial resistance 2022 91 concerne d HCW. Include Bundle training in the yearly IPC training and in peri employm ent training. hospital ‘s IPC team 3.1.4.4.1. 4.4 Auditing complian ce to these bundles on monthly basis and report to IPC directora te monthly 3.1.4.4.1. 4.4 Audit activity/A udit report. (about the updated bundles and updated checklists ) .1.4.4.1.4 .4 3/month s/hospita l 3.1.4.4.1. 4.4 5 years .1.4.4.1.4 .4 MOH/Ho spitals .1.4.4.1.4 .4 MOH/Ho spitals/IP C Directora te .1.4.4.1.4 .4 None .1.4.4.1.4 .4 None 3.1.4.4.1. 4.4 Process Indicator for each of the 3 bundles: For each bundle: % Complian ce by the specific bundle /opportu nities of audit for each bundle Kuwait national action plan on antimicrobial resistance 2022 92 3.1.4.4.2 Update outcome indicator s for the 3 bundles above (CLABSI, CAUTI, VAP) accordin g to new CDC/ guideline s 3.1.4.4.2. 1 Review updated CDC outcome indicator s and update already measure d bundles outcome indicator s according ly 3.1.4.4.2. 1 Reviewe d outcome indicator, calculatio n and benchma rking 3.1.4.4.2. 1 3 3.1.4.4.2. 1 6 months 3.1.4.4.2. 1 MOH/IPC directora te 3.1.4.4.2. 1 MOH/IPC directora te 3.1.4.4.2. 1 None 3.1.4.4.2. 1 MOH budget 3.1.4.4.2. 1 Number of outcome indicator measure ments and benchma rk is updated. 3.1.4.4.3 Integrate process and outcome indicator s for each bundle, and use in the analysis and correctiv e actions 3.1.4.4.3. 1 Put a road map for integrati ng analysis of outcome and process indicator s related to the bundles 3.1.4.4.3. 1 Protocol 3.1.4.4.3. 1 3 3.1.4.4.3. 1 1 year 3.1.4.4.3. 1 MOH/IPC directora te 3.1.4.4.3. 1 MOH/IPC directora te 3.1.4.4.3. 1 None 3.1.4.4.3. 1 MOH budget 3.1.4.4.3. 1 % of bundles whose analysis integrate s process and outcome data 3.1.4.4.4 3.1.4.4.4. 1 3.1.4.4.4. 1 3.1.4.4.4. 1 3.1.4.4.4. 1 3.1.4.4.4. 1 3.1.4.4.4. 1 3.1.4.4.4. 1 3.1.4.4.4. 1 3.1.4.4.4. 1 Kuwait national action plan on antimicrobial resistance 2022 93 Introduc e SSI bundle preparati on of material Protocol, Checklist, teaching material for IPC professio nals and HCW 1 Central 4 years MOH/IPC directora te MOH/IPC directora te None MOH budget % of material that is prepared 3.1.4.4.4. 2 Impleme ntation of SSI bundle 3.1.4.4.4. 2.1 Teaching of IPC professio nals by central IPC directora te 3.1.4.4.4. 2.1 Teaching sessions and worksho ps 3.1.4.4.4. 2.1 Central 3.1.4.4.4. 2.1 5 years 3.1.4.4.4. 2.1 IPC directora te/MOH 3.1.4.4.4. 2.1 MOH/IPC directora te /Hospital s 3.1.4.4.4. 2.1 None 3.1.4.4.4. 2.1 MOH 3.1.4.4.4. 2.1 % hospitals start submitti ng process and outcome indicator s for SSI. 3.1.4.4.4. 2.2 Teaching of healthcar e providers inside the hospitals by IPC professio nals 3.1.4.4.4. 2.2 Teaching sessions and worksho ps 3.1.4.4.4. 2.2 2/y in hospitals 3.1.4.4.4. 2.2 5 years 3.1.4.4.4. 2.2 MOH/Ho spitals 3.1.4.4.4. 2.2 MOH/IPC directora te /Hospital s 3.1.4.4.4. 2.2 None 3.1.4.4.4. 2.2 MOH 3.1.4.4.4. 2.2 % hospitals start submitti ng process and outcome indicator s for SSI. 3.1.4.4.4. 2.3 3.1.4.4.4. 2.3 3.1.4.4.4. 2.3 3.1.4.4.4. 2.3 5 years 3.1.4.4.4. 2.3 Hospitals 3.1.4.4.4. 2.3 3.1.4.4.4. 2.3 None 3.1.4.4.4. 2.3 MOH 3.1.4.4.4. 2.3 Kuwait national action plan on antimicrobial resistance 2022 94 Data collectio n Data collectio n 1 MOH/IPC directora te /Hospital s % hospitals start submitti ng process and outcome indicator s for SSI. 3.1.5 IPC programs /office in LTCF working in close cooperati on with IPC directora te in MOH 3.1.5.1 Mandate from MOH that IPC program/ with employe e with TOR and specified budget are available in LTCF the central and the “branche s”. 3.1.5.1.1 Commun ication between MOH and Public Authorit y of Disability Affairs regardin g IPC in LTCF and being overseen by the IPC directora te 3.1.5.1.1. 1 Letter from MOH to Public Authority of Disability Affairs asking to establish IPC in each LTCF and to have the personne l work closely with IPC directora te delegate to LTCF. 3.1.5.1.1. 1 Letter 3.1.5.1.1. 1 1 3.1.5.1.1. 1 2 months 3.1.5.1.1. 1 MOH/ Public Authority of Disability Affairs 3.1.5.1.1. 1 MOH/ Main LTCF 3.1.5.1.1. 1 No 3.1.5.1.1. 1 No 3.1.5.1.1. 1 Present Kuwait national action plan on antimicrobial resistance 2022 95 3.1.5.1.1. 2 Letter from Public Authority of Disability Affairs to LTCF that recomme nds IPC in each LTCF and organizes the communi cation with MOH 3.1.5.1.1. 2 Letter 3.1.5.1.1. 2 1 3.1.5.1.1. 2 2 months 3.1.5.1.1. 2 Public Authority of Disability Affairs 3.1.5.1.1. 2 Public Authority of Disability Affairs 3.1.5.1.1. 2 No 3.1.5.1.1. 2 No 3.1.5.1.1. 2 Letter sent 3.1.5.1.2 Establish ed Guidelin es for IPC in LTCF 3.1.5.1.2. 1 Preparati on of the LTCF guideline s and their endorse ment by Public Authority of Disability Affairs 3.1.5.1.2. 1 Guideline s Policies Procedur es 3.1.5.1.2. 1 1 3.1.5.1.2. 1 1 year 3.1.5.1.2. 1 IPC Directora te/ Public Authority of Disability Affairs 3.1.5.1.2. 1 MOH/IPC Directora te 3.1.5.1.2. 1 None 3.1.5.1.2. 1 None 3.1.5.1.2. 1 Availabili ty of the endorsed guideline s and set of policies and procedur es Kuwait national action plan on antimicrobial resistance 2022 96 3.1.5.1.2. 2 Dissemin ation of LTCF Policies and Procedur es 3.1.5.1.2. 2.1 TOT of LTCF IPC focal persons 3.1.5.1.2. 2 Worksho p once/y 3.1.5.1.2. 2 1/year 3.1.5.1.2. 2 1.5 years 3.1.5.1.2. 2 Public Authority of Disability Affairs 3.1.5.1.2. 2 MOH/ Public Authority of Disability Affairs 3.1.5.1.2. 2 20,000 KD 3.1.5.1.2. 2 MOH/ Public Authority of Disability Affairs 3.1.5.1.2. 2 % focal IPC persons in LTCF trained on the guideline s/total number of LTCF IPC focal persons. Strategic Objective 3.2 To have the HAI and AMR information digitalized and sent to IPC directorate as a digital report 3.2.1 Software for hospital data entry, analysis and generati ng both hospital and national reports 3.2.1.1 Subcom mittee from IPC directora te sends a letter to Informati on system departm ent at MOH explainin g what is required and asking 3.2.1.1 Letter 3.2.1.1 1 3.2.1.1 2 months 3.2.1.1 MOH 3.2.1.1 MOH/ IPC directora te 3.2.1.1 None 3.2.1.1 None 3.2.1 Software develope d and working Kuwait national action plan on antimicrobial resistance 2022 97 for the software 3.2.1.2 Informati on system dep. presents projects (either in-house, or ready to buy) with budget providing 3.2.1.2 Project 3.2.1.2 1 3.2.1.2 12 months 3.2.1.2 MOH 3.2.1.2 MOH/ Informati on system departm ent 3.2.1.2 To be determin ed 3.2.1.2 MOH See above 3.2.1.3 Agreeme nt between IPC directora te and informati on system dep. to choose one system 3.2.1.3 Agreeme nt letter 3.2.1.3 1 3.2.1.3 1 year 3 months 3.2.1.3 MOH 3.2.1.3 MOH/ IPC directora te/Healt h Informati on system departm ent 3.2.1.3 None 3.2.1.3 None See above 3.2.1.4 Apply the system in the hospitals 3.2.1.4 System applicati on 3.2.1.4 1 3.2.1.4 1 year 9 months 3.2.1.4 Hospitals 3.2.1.4 MOH/ IPC directora te/ Informati 3.2.1.4 To be determin ed by the MOH 3.2.1.4 MOH See above Kuwait national action plan on antimicrobial resistance 2022 98 on system departm ent/Hosp itals 3.2.1.5 Apply the Digital HAI/AMR System for National data collectio n from individua l hospitals to central IPC directora te 3.2.1.5 System applicati on 3.2.1.5 1 3.2.1.5 2 years 3.2.1.5 Hospitals 3.2.1.5 MOH/ IPC directora te/Infor mation system departm ent/Hosp itals 3.2.1.5 To be determin ed by the MOH 3.2.1.5 MOH See above 3.2.2 To Shift all hospital informati on system from paper to digital mode. 3.2.2.1 MOH recomme nds from hospitals to have an electroni c patient and data informati on system. 3.2.2.1.1 Letter from MOH to hospitals 3.2.2.1.1 Letter 3.2.2.1.1 1 to each hospital 3.2.2.1.1 2 months 3.2.2.1.1 MOH/Ho spitals 3.2.2.1.1 MOH/ Informati on system dep. 3.2.2.1.1 None 3.2.2.1.1 None 3.2.2.1.1 Letter is sent Kuwait national action plan on antimicrobial resistance 2022 99 3.2.2.2 Increase the number of hospitals that have digitalize d their medical informati on system - 3.2.2.2 Digital informati on system in each hospital 3.2.2.2 1/hospit al 3.2.2.2 5 years 3.2.2.2 Hospitals 3.2.2.2 Hospitals /MOH/ Informati on system dep. 3.2.2.2 to be determin ed by MOH 3.2.2.2 Private hospitals: the hospitals themselv es Public hospitals: MOH 3.2.2.2 % hospitals with digital informati on system 3.2.3 Connect Infection Control Departm ents to electroni c medical records 3.2.3.1 Connect Infection Control departm ents in all hospitals with the HIS and LIS at the hospital level 3.2.3.1.1 Letter from MOH to ask all hospitals to connect IC dep. with HIS and LIS at the hospital level 3.2.3.1.1 Letter 3.2.3.1.1 all private hospitals all governm ental hospitals 3.2.3.1.1 2 months 3.2.3.1.1 MOH 3.2.3.1.1 Hospitals MOH/Inf ormation system dep. 3.2.3.1.1 None 3.2.3.1.1 None 3.2.3.1.1 % IC dep connecte d with HIS/LIS in hospitals 3.2.3.1.2 Decree from MOH to all hospitals who have an electroni 3.2.3.1.2 Letter 3.2.3.1.2 all private hospitals / all governm ental hospitals 3.2.3.1.2 4 months 3.2.3.1.2 MOH 3.2.3.1.2 MOH 3.2.3.1.2 No 3.2.3.1.2 Hospitals 3.2.3.1.2 % IC dep connecte d with electroni c AMR data in hospitals Kuwait national action plan on antimicrobial resistance 2022 100 c Health informati on system to link their Lab AMR data to the Hospital system 3.2.3.2 Develop electroni c outbreak reporting system for data entry, analysis and generati ng reports. 3.2.3.2 electroni c outbreak reporting system 3.2.3.2 1 central 3.2.3.2 3 years 3.2.3.2 MOH 3.2.3.2 MOH /Informa tion system departm ent 3.2.3.2 to be determin ed by MOH 3.2.3.2 MOH 3.2.3.2 electroni c outbreak reporting system available 3.2.3.3 Develop electroni c reporting system for data entry, analysis and 3.2.3.3 Electroni c system for data collectio n analysis and generati ng 3.2.3.3 1 3.2.3.3 3 years 3.2.3.3 MOH/Ho spitals 3.2.3.3 MOH /Informa tion system departm ent 3.2.3.3 to be determin ed by MOH 3.2.3.3 MOH 3.2.3.3 Bundles data collectio n, analysis and generati on of hospital / Kuwait national action plan on antimicrobial resistance 2022 101 generati ng hospital/ national reports for bundles of care. hospitals /national reports for bundles process and outcome indicator s national reports is done through. an electroni c advance d system Yes/No 3.2.3.4 Develop electroni c infection preventi on and control system capable of self identifyin g HAI and detecting outbreak s 3.2.3.4.1 Electroni c system has a function for self diagnosis of HAIs and automati cally detects outbreak 3.2.3.4.1 Function in the electroni c system 3.2.3.4.1 1 3.2.3.4.1 5 years 3.2.3.4.1 MOH/Ho spitals 3.2.3.4.1 MOH/ Informati on system departm ent 3.2.3.4.1 to be determin ed by MOH 3.2.3.4.1 MOH 3.2.3.4.1 % of HAIs and outbreak s in hospitals are automati cally detected by the IT system Strategic Objective 3.3 Enhance IPC education in all health- related specialties and among HCW. 3.3.1 Include IPC as a core element in educatio n and 3.3.1.1 Include infection control in undergra duate curricula for 3.3.1.1.1 Prepare module about IPC and AMR to be included 3.3.1.1.1 Educatio nal IPC module 3.3.1.1.1 1 3.3.1.1.1 2 years 3.2.1.1.1 MOH 3.3.1.1.1 MOH/IPC directora te 3.3.1.1.1 None 3.3.1.1.1 MOH 3.3.1.1.1 Module is available Kuwait national action plan on antimicrobial resistance 2022 102 training of healthcar e professio nals health care students (medical, nursing, dental and pharmac eutical). in all health specialtie s in universiti es/PAAE T. 3.3.1.1.2 MOH letter to MOHE and PAAET to ask to include this modules into the undergra ds and graduate health students’ curricula 3.3.1.1.2 1 letter to MOHE and Letter to PAAET 3.3.1.1.2 2 3.3.1.1.2 2 years 3.2.1.1.2 MOH 3.3.1.1.2 MOH/IPC Directora te 3.3.1.1.2 None 3.3.1.1.2 No 3.3.1.1.2 Letters sent 3.3.1.1.3 Modules sent to Kuwait universit y/ PAAET to include it in curricula 3.3.1.1.3 Module sent to Kuwait Universit y and PAAET 3.3.1.1.3 1 3.3.1.1.3 2.5 years 3.3.1.1.3 MOHE / PAAET 3.3.1.1.3 MOHE / PAAET 3.3.1.1.3 None 3.3.1.1.3 No 3.3.1.1.3 % health specialtie s that include IPC module Kuwait national action plan on antimicrobial resistance 2022 103 3.3.2 Enhance IPC educatio n among undergra duates and higher educatio n health students 3.3.2.1 Include infection control in continuin g educatio n of healthcar e workers and mandato ry prerequis ite for promotio n 3.3.2.1.1 Provide IPC courses with CE credits in universiti es, hospitals , MOH, PAAET PAAF Include CME Credit 10% IPC 3.3.2.1.1 IPC courses 3.3.2.1.1 At least once/yea r in universiti es /IPC directora te and PAAF 3.3.2.1.1 2 years 3.3.2.1.1 Universiti es/ Hospitals / IPC Directora te/ PAAET PAAF 3.3.2.1.1 IPC directora te/MOHE / PAAET / PAAF 3.3.2.1.1 No extra 3.3.2.1.1 Universiti es/ Hospitals / PAAET / PAAF 3.3.2.1.1 Number of IPC courses/ year 3.3.2.1.2 Request that when CE credits for physician s, nurses, or pharmaci 3.3.2.1.2 Decree 3.3.2.1.2 1 for physician s 1 for Nurses 1 for pharmaci sts. 3.3.2.1.2 3 months 3.3.2.1.2 MOH 3.3.2.1.2 MOH/IPC Directora te 3.3.2.1.2 None 3.3.2.1.2 None 3.3.2.1.2 % professio nals have 10% of their CE credits are related to IPC Kuwait national action plan on antimicrobial resistance 2022 104 sts is needed, 10% of these credits should be about IPC. 3.3.2.1.3 In hospitals , yearly and upon employm ent, mandato ry attendan ce of IPC lectures 3.3.2.1.3 Letter from MOH to all hospitals 3.3.2.1.3 1 to each hospital 3.3.2.1.3 3 months 3.3.2.1.3 MOH/Ho spitals 3.3.2.1.3 MOH/Ho spitals 3.3.2.1.3 None 3.3.2.1.3 None 3.3.2.1.3 % hospitals that mandate d that all employe e get IPC training upon employm ent and yearly IPC lecture. 3.3.2.2 Hygiene and IPC educatio n provided outside formal teaching programs 3.3.2.2.1 Require IPC educatio n by drug compani es, hospitals , LTCFs, FAO, and medical/ veterinar y 3.3.2.2.1. 1 Request to include few topics about IPC in conferen ces agendas 3.3.2.2.1. 11 Letter to be sent 3.3.2.2.1. 11 letter 3.3.2.2.1. 1 1 letter /associati on or entity 3.3.2.2.1. 1 1 6 months 3.3.2.2.1. 1 1 MOH 3.3.2.2.1. 1 1 MOH/Dir ectorate IPC 3.3.2.2.1. 1 1 None 3.3.2.2.1. 1 1 None 3.3.2.2.1. 1 1 Yes/No Kuwait national action plan on antimicrobial resistance 2022 105 associati ons Strategic Objective 3.4 Prevent occupational infections in HCWs 3.4.1 Develop a compreh ensive program of vaccinati on to protect HCWs from vaccine preventa ble diseases - - 3.4.1 HCW vaccinati on program 3.4.1 1 all inclusive 3.4.1 Available And applied 3.4.1 MOH 3.4.1 MOH/Pu blic Health directora te 3.4.1 Price of vaccines 3.4.1 MOH 3.4.1 % of HCWs professio nals that are vaccinate d 3.4.2 Develop policies and procedur es to protect healthcar e workers from occupati onal exposure to - - 3.4.2 policies and procedur es to protect healthcar e workers from occupati onal exposure to infection s 3.4.2 1 3.4.2 Available And applied 3.4.2 MOH 3.4.2 MOH 3.4.2 None 3.4.2 None 3.4.2 Yes/No Kuwait national action plan on antimicrobial resistance 2022 106 infection s. 3.4.3 Availabili ty of Airborne Isolation Rooms in all hospitals 3.4.3.1 screenin g mapping and updating the recomme ndations accordin g to the expected need accordin g to need - 3.4.3.1 Mapping and Updated recomme ndations 3.4.3.1 1/1 3.4.3.1 5 years 3.4.3.1 MOH/Ho spitals 3.4.3.1 MOH/En gineering Directora te 3.4.3.1 None 3.4.3.1 MOH for Public hospitals private hospitals: the hospitals themselv es. 3.4.3.1 Yes/No 3.4.4 Mandate to hospitals to provide airborne isolation rooms (AII) available as per the updated recomme ndations - - 3.4.4 Mandate 3.4.4 1/hospit al 3.4.4 5 years 3.4.4 MOH 3.4.4 MOH 3.4.4 none 3.4.4 none 3.4.4 Percent hospitals have enough AII rooms as per MOH recomm endation Strategic Objective 3.5 Adequate waste management in hospitals 3.5.1 3.5.1.1 3.5.1.1.1 3.5.1.1.1. 1 3.5.1.1.1. 1 3.5.1.1.1. 1 3.5.1.1.1. 1 3.5.1.1.1. 1 3.5.1.1.1. 1 3.5.1.1.1. 1 3.5.1.1.1. 1 3.5.1.1.1. 1 Kuwait national action plan on antimicrobial resistance 2022 107 Put National Guideline s National policies, strategie s and plans for healthcar e waste manage ment is in place Unify recomm endation s between KEPA and MOH Create a committe e from MOH and KEPA that unifies the recomme ndation and the road map of all types of waste that are generate d in healthcar e Committ ee 1 6 months MOH/KE PA MOH None None Committ ee members are nominat ed 3.5.1.1.1. 2 The committe e reviews waste policies that are related to HCF and unifies recomme ndations and provides 3.5.1.1.1. 2 Revision 3.5.1.1.1. 2 1 3.5.1.1.1. 2 1 year 3.5.1.1.1. 2 KEPA 3.5.1.1.1. 2 KEPA 3.5.1.1.1. 2 None 3.5.1.1.1. 2 None 3.5.1.1.1. 2 Percent chapters that represen t conflict between recomm endation s of the 2 ministrie s that have been reviewed Kuwait national action plan on antimicrobial resistance 2022 108 the proper ways of supervisi on and unified 3.5.2 Supervisi on of waste disposal from public hospitals 3.5.2.1 Create a committ ee for the supervisi on of waste disposal from public hospitals - 3.5.2.1 Available and ongoing 3.5.2.1 Available and ongoing 3.5.3 Supervisi on of waste disposal in private hospitals 3.5.3.1 Create a committ ee for the supervisi on of waste disposal in private hospitals - 3.5.3.1 Committ ee 3.5.3.1 1 3.5.3.1 1 year 3.5.3.1 KEPA 3.5.3.1 MOH/KE PA 3.5.3.1 None 3.5.3.1 None 3.5.3.1 Yes/No 3.5.4 Waste policies are being audited by KEPA 3.5.4.1 Organiza tion of supervisi on of waste disposal - 3.5.4.1 Audit plan 3.5.4.1 1 3.5.4.1 1.5 years 3.5.4.1 KEPA 3.5.4.1 KEPA 3.5.4.1 1 employe e KEPA 3.5.4.1 KEPA 3.5.4.1 % Public hospitals are being audited for waste disposal. Kuwait national action plan on antimicrobial resistance 2022 109 inside and from private hospitals 3.5.4.2 Designat e 1 unit at KEPA to oversee the waste in hospitals 3.5.4.2 1 Unit At KEPA 3.5.4.2 1 3.5.4.2 1 year 3.5.4.2 KEPA 3.5.4.2 MOH/KE PA 3.5.4.2 to be determin ed 3.5.4.2 KEPA/Pri vate hospitals /MOH 3.5.4.2 % Private hospitals where waste manage ment is being supervise d Strategic Objective 3.6 To enhance infection prevention and control programs in veterinary and agriculture settings 3.6.1 Availabili ty of IPC guideline s in veterinar y practices 3.6.1.1 Impleme ntation of OIE guideline s regarding IPC in veterinar y field 3.6.1.1.1 Committ ee in PAAF that regularly checks updates in OIE guideline s regardin g IPC in veterinar y field, and updates the guideline s 3.6.1.1.1 IPC Committ ee in PAAF 3.6.1.1.1 1 3.6.1.1.1 6 months 3.6.1.1.1 PAAF 3.6.1.1.1 PAAF 3.6.1.1.1 None 3.6.1.1.1 None 3.6.1.1.1 Committ ee is formed Kuwait national action plan on antimicrobial resistance 2022 110 accordin gly 3.6.1.1.2 Overseei ng the impleme ntation of national IPC guideline s in Vet field and OIE good practices 3.6.1.1.2 Regular audits to farms 3.6.1.1.2 Put a yearly audit plan 3.6.1.1.2 Plan 3.6.1.1.2 1 3.6.1.1.2 1 year 3.6.1.1.2 PAAF 3.6.1.1.2 PAAF 3.6.1.1.2 none 3.6.1.1.2 none 3.6.1.1.2 % Farms that are being audited yearly for IPC measure s. 3.6.2 Include IPC in licensing of Vets 3.6.2.1 Include question s about OIE IPC guideline s and vaccinati ons in all vets licensing exams or interview s. 3.6.2.1.1 Prepare a set of question s related to IPC in Vets to be included in licensing exams and interview s. 3.6.2.1.1 Set of question s 3.6.2.1.1 1 3.6.2.1.1 6 months 3.6.2.1.1 PAAF 3.6.2.1.1 IPC Committ ee in PAAF 3.6.2.1.1 none 3.6.2.1.1 none 3.6.2.1.1 Availabili ty of IPC question s in licensing exams (Yes/No) 3.6.3 Include IPC in Continuo us educatio 3.6.3.1 Prepare a slide bank related to IPC in - 3.6.3.1 IPC slide bank 3.6.3.1 1 3.6.3.1 6 months 3.6.3.1 PAAF 3.6.3.1 PAAF 3.6.3.1 none 3.6.3.1 none 3.6.3.1 Yes/No Kuwait national action plan on antimicrobial resistance 2022 111 n of Vets and professio nals in Agricultu re vet and agricultu re, to be given to drug compani es that usually do the continuo us educatio n activities. 3.6.3.2 Mandate that all drug company events or seminars include a specific number of slides related to IPC and AMR. - 3.6.3.2 Mandate 3.6.3.2 1 3.6.3.2 9 months 3.6.3.2 PAAF 3.6.3.2 PAAF 3.6.3.2 None 3.6.3.2 None 3.6.3.2 Mandate available or not 3.6.4 Include hygiene and infection preventi on and 3.6.4.1 Close communi cation between. FAO and PAAF to - 3.6.4.1 Yearly educatio n plan that targets vaccinati 3.6.4.1 1 3.6.4.1 1 year 3.6.4.1 PAAF 3.6.4.1 PAAF/FA O 3.6.4.1 None 3.6.4.1 None 3.6.4.1 Joint educatio n plan between FAO and PAAF Kuwait national action plan on antimicrobial resistance 2022 112 control as core content in training of veterinar y professio nals. put a joint yearly plan of educatio n activities related to IPC. on and IPC that includes IPC related training 3.6.4.2 Include hygiene and infection preventi on and control as mandato ry prerequis ite for promotio n of for the veterinar y workers. 3.6.4.2.1 IPC credits mandato ry for promotio n in Vet. Associati ons 3.6.4.2.1 Mandate 3.6.4.2.1 1 3.6.4.2.1 6 months 3.6.4.2.1 Veterinar y associati on 3.6.4.2.1 PAAF/Ve terinary associati on 3.6.4.2.1 None 3.6.4.2.1 None 3.6.4.2.1 Mandate available or not N.B. Refer to Annex 4 for IPC Axis Strategic and Monitory plans Kuwait national action plan on antimicrobial resistance 2022 113 Antimicrobial Use Operational and Budget Plan Global action plan strategic objective 4: Optimize the use of antimicrobial medicines in human and animal health. Activity Sub activity Sub-sub activity Unit Quantity Date Location Responsibl e entity Cost Source Of funding Indicator Strategic Objective 4.1 Ensure governance of antibiotic axis pillar and follow up of the activities of this pillar 4.1.1 Identify who will be the ABX arm pillar focal point in each ministry /authority and assign the TOR 4.1.1 6 months MOH PAAF KEPA PAFN 4.1.1 Already available 4.1.1 None 4.1.1 available 4.1.2 Prepare clear TOR of the focal person for ABX in each ministry/au thority 4.1.2 TOR 4.1.2 1 4.1.2 2 months 4.1.2 MOH 4.1.2 AMR committee that reports to secretary 4.1.2 None 4.1.2 None 4.1.2 Yes/No 4.1.3 Assign the job to a defined person/pos ition in each ministry/au thority, 4.1.3 Letter of assignment of duties 4.1.3 1/each ministry 4.1.3 3 months 4.1.3 MOH PAAF KEPA PAFN 4.1.3 AMR Inter ministerial/ authorities executive committee 4.1.3 None 4.1.3 None 4.1.3 Proportion of ministries/ authorities where ABX arm focal person is assigned Kuwait national action plan on antimicrobial resistance 2022 114 and nomination by each ministry/au thority 4.1.4 Put TOR And reimburse ment plan for the different tasks. 4.1.4 TOT/ Reimburse ment plan 4.1.4 1 4.1.4 3 months 4.1.4 MOH 4.1.4 NMCG/ Focal person 4.1.4 None 4.1.4 None 4.1.4 Yes/No 4.1.5 Nominate the stakeholde rs for the task force of the pillar 4.1.5 Decree with names of stakeholde rs 4.1.5 1 4.1.5 4 months 4.1.5 MOH PAAF KEPA PAFN 4.1.5 MOH PAAF KEPA PAFN 4.1.5 None 4.1.5 None 4.1.5 ABX use task force group is formed Yes/No Strategic Objective 4.2 Ensure uninterrupted access to high-quality antimicrobial medicines 4.2 Already available 4.2 System is in place (Pharmace utical and Herbal Medicines Registratio n and Control Administrat ion/Drug Inspection Control 4.2 Already available 4.2.1 Put clear criteria for 4.2.1 System is in place 4.2.1 System is in place Kuwait national action plan on antimicrobial resistance 2022 115 standards of quality safety and efficiency of ABX 4.2.2 Put a system of controlling that all available ABX in the country should meet the internation al standards listed above otherwise they are not allowed to be in the market. 4.2.2 Already available, Only ABX that are licensed by WHO, EMEA or FDA, are allowed in the market 4.2.2 Already available 4.2.3 All ABX should be tested by a system that identifies counterfeit prior to licensing. 4.2.3 Available 4.2.3 System already in place 4.2.4 Put regulations 4.2.4 Available 4.2.4 System Kuwait national action plan on antimicrobial resistance 2022 116 that prohibit the sale of counterfeit products already in place 4.2.5 The system that controls quality assurance of ABX has the authority to stop counterfeit products from being licensed and marketed 4.2.5 available 4.2.5 System already In place Strategic Objective 4.3 Develop and enforce legislation and regulations on prescription and dispensing of medicine including antibiotics 4.3.1 Develop and implement national essential medicine list guided by the WHO Model List of Essential Medicines 4.3.1.1 Finalize the essential medicine list that is being prepared at MOH 4.3.1.1 National list issued and endorsed by MOH director general 4.3.1.1 1 4.3.1.1 6 months 4.3.1.1 MOH 4.3.1.1 Central Medical Stores Directorate 4.3.1.1 No need Then accordingly might need new need antibiotics that may need a budget 4.3.1.1 No need 4.3.1.1 List is issued Yes/No 4.3.2 Mandate 4.3.2 Mandate 4.3.2 1 4.3.2 6 months 4.3.2 MOH 4.3.2 MOH Undersecre 4.3.2 None 4.3.2 None 4.3.2 Yes/No Kuwait national action plan on antimicrobial resistance 2022 117 that every institution has an essential medicine list tary general/ ABX focal person 4.3.3 Each institution has an essential medicine list and this is checked in accreditati on standards include checking the availability of the essential medicine list 4.3.3.1 Mandate from MOH that once the national essential medicine list is available, all hospitals including public and private hospitals should formulate their own list 4.3.3.1 Mandate 4.3.3.1 1 4.3.3.1 8 months 4.3.3.1 MOH 4.3.3.1 MOH Undersecre tary general / Abx focal person 4.3.3.1 None 4.3.3.1 None 4.3.3.1 Yes/No 4.3.3.2 Include the availability of essential medicine list into the license renewal 4.3.3.2.1 Private hospital renewal license checklist should include the availability of essential 4.3.3.2.1 Checklist 4.3.3.2.1 1 4.3.3.2.1 8 months 4.3.3.2.1 MOH 4.3.3.2.1 Medical Licensing Dep/ MOH 4.3.3.2.1 None 4.3.3.2.1 None 4.3.3.2.1 Licensing checklist includes the item of essential medicine list or not Kuwait national action plan on antimicrobial resistance 2022 118 conditions of private hospitals medicine list 4.3.4 Re imburseme nt plan is based on essential medicine list in public and private hospitals 4.3.4 After issuing the essential medicine list, Mandate from Undersecre tary General 4.3.4 1 4.3.4 8 months 4.3.4 MOH 4.3.4 MOH/ Undersecre tary General / NMCG 4.3.4 None 4.3.4 None 4.3.4 % of reimbursed ABX that are listed in the essential medicine list Strategic Objective 4.4 Start AMS program in primary Healthcare 4.4.1 Create a technical group that puts national ABX use guidelines for outpatient care based on Internation al guidelines and National AMR profiles: 4.4.1.1 Put TOR and renewal conditions of the focal group of stakeholde rs 4.4.1.1 TOR 4.4.1.1 1 4.4.1.1 3 months 4.4.1.1 MOH 4.4.1.1 MOH/ National Committee of proper ABX use. 4.4.1.1 None 4.4.1.1 None 4.4.1.1 TOR put Yes or no Kuwait national action plan on antimicrobial resistance 2022 119 can be a subcommit tee from the national task force for the ABX pillar for proper use of ABX 4.4.1.2 Assign the members of this committee 4.4.1.2 Committee members 4.4.1.2 1 committee 4.4.1.2 3 months 4.4.1.2 MOH 4.4.1.2 MOH/ National Committee of proper ABX use. 4.4.1.2 None 4.4.1.2 None 4.4.1.2 TOR put Yes or no 4.4.1.3 Put TOR and official renewal time for the guidelines committee 4.4.1.3 TOR 4.4.1.3 1 4.4.1.3 3 months 4.4.1.3 MOH 4.4.1.3 MOH/ National Committee of proper ABX use. 4.4.1.3 None 4.4.1.3 None 4.4.1.3 TOR put Yes or no 4.4.2 Guidelines in primary healthcare are available and are regularly updated 4.4.2 Guidelines 4.4.2 1 4.4.2 6 months 4.4.2 MOH 4.4.2 Primary Healthcare Directorate / technical committee / National Committee for ABX use 4.4.2 None 4.4.2 MOH 4.4.2 Guidelines available Yes or no Kuwait national action plan on antimicrobial resistance 2022 120 4.4.2.1 Training workshop about ABX guidelines in primary healthcare 4.4.2.1 Workshop 4.4.2.1 Once/year 4.4.2.1 5 years 4.4.2.1 MOH 4.4.2.1 Primary Health care Directorate / technical committee 4.4.2.1 None 4.4.2.1 MOH 4.4.2.1 Proportion of primary healthcare physician who attend every year /4.4.3 Apply AMS in primary healthcare: Monitoring ABX consumpti on and Link prescriptio n to diagnoses 4.4.3.1 Project ABX consumpti on documenta tion and surveillanc e in primary care 4.4.3.1.1 Put a proposal for this project 4.4.3.1.1 Proposal 4.4.3.1.1 1 4.4.3.1.1 8 months 4.4.3.1.1 Primary Health care 4.4.3.1.1 AMR committee /Primary Health care Directorate 4.4.3.1.1 COST: No need for extra manpower 4.4.3.1.1 None 4.4.3.1.1 Project is put 4.4.3.2 Start collecting data and link it to diagnosis 4.4.3.2 Data collection 4.4.3.2 Same number as primary healthcare centers 4.4.3.2 10 months 4.4.3.2 Primary healthcare centers 4.4.3.2 Primary Healthcare Directorate /Informatio n system dep. 4.4.3.2 No 4.4.3.2 No 4.4.3.2 Proportion of primary Healthcare centers that are feeding data into the project 4.4.3.3 Data analysis and feedback to prescribers 4.4.3.3 Report of analyzed data 4.4.3.3 Once/year 4.4.3.3 1 year 4.4.3.3 Central primary Heath care Directorate 4.4.3.3 Clinical Pharmacist in primary Healthcare. 4.4.3.3 Employ 1 Clinical pharmacist in charge of the project 4.4.3.3 MOH 4.4.3.3 Proportion of primary Healthcare centers Kuwait national action plan on antimicrobial resistance 2022 121 in primary healthcare that receive annual report with feedback about ABX prescriptio n 4.4.3.4 Employ more pharmacist s in primary healthcare 4.4.3.4 New employed Pharmacist s 4.4.3.4 According to the needed clinical pharmacist s 4.4.3.4 1 year 4.4.3.4 Primary Health care/ MOH 4.4.3.4 Pharmaceu tical Services Directorate 4.4.3.4 Salaries for new pharmacist s 4.4.3.4 MOH 4.4.3.4 Number of pharmacist s that are employed 4.4.3.5 Improve manpower with professiona ls for the AMS project in primary healthcare 4.4.3.5.1 Train available pharmacist s on AMS and clinical pharmacy principles 4.4.3.5.1 Workshops /Courses 4.4.3.5.1 To be assessed 4.4.3.5.1 18 months 4.4.3.5.1 Primary Health care directorate 4.4.3.5.1 ABX use taskforce group 4.4.3.5.1 30,000 KD/ workshop 4.4.3.5.1 MOH 4.4.3.5.1 Number of pharmacist s in primary Health care who have a certificate in AMS training 4.4.3.5.2 Employ new clinical pharmacist specialized in AMS and 1 full time clinical microbiolo gist in 4.4.3.5.2 Clinical pharmacist specialized in AMS 4.4.3.5.2 2 4.4.3.5.2 1 8 months 4.4.3.5.2 Primary Healthcare directorate 4.4.3.5.2 Pharmaceu tical Services Directorate 4.4.3.5.2 Salary x2 4.4.3.5.2 MOH 4.4.3.5.2 Clinical pharmacist s are employed, Yes/No Kuwait national action plan on antimicrobial resistance 2022 122 primary healthcare directorate 4.4.4 Update the digital system that is available in primary healthcare to integrate the ABX guidelines into the electronic system in the form of pop-ups 4.4.4 ABX guidelines integrated in primary Heath care digital system 4.4.4 1 4.4.4 2 years 4.4.4 Primary Healthcare directorate 4.4.4 MOH/Prim ary Healthcare / technical committee /Informatio n System Dep. 4.4.4 To be determined 4.4.4 MO 4.4.4 updated electronic system available Strategic Objective 4.5 Apply AMS In Public and Private hospitals 4.5.1 Improve and measure appropriat e use of antimicrobi al agents in healthcare 4.5.1.1 Nominate who will be the AMS focal person (Could be the ABX pillar focal person) 4.5.1.1 Decree 4.5.1.1 1 4.5.1.1 3 months 4.5.1.1 MOH 4.5.1.1 MOH Undersecre tary r general /NMCG 4.5.1.1 Already employed in MOH No cost (The Abx focal person) 4.5.1.1 None 4.5.1.1 AMS focal person is nominated 4.5.2 Identify the National 4.5.2.1 AMS technical 4.5.2.1 Group of specialists 4.5.2.1 1 4.5.2.1 3 months 4.5.2.1 MOH 4.5.2.1 MOH/ 4.5.2.1 Cost/Activit y / 4.5.2.1 MOH 4.5.2.1 AMS Kuwait national action plan on antimicrobial resistance 2022 123 AMS Task force (Could be a subcommit tee of the ABX pillar Task force) the National AMS Technical team group is assigned (subgroup from the ABX technical committee. +other specialists like IT, etc) ABX taskforce group / AMS Focal person professiona l Technical Task force members are nominated Yes/No 4.5.2.2 TOR of the technical groups are well defined They include: guidelines for inpatient and outpatient care. put or endorse diagnostic pathways, treatment and national AMS targets 4.5.2.2 TOR 4.5.2.2 1 4.5.2.2 3 months 4.5.2.2 MOH 4.5.2.2 ABX Pillar Task force / ABX focal person/ MOH Undersecre tary general. 4.5.2.2 None 4.5.2.2 None 4.5.2.2 TOR put Kuwait national action plan on antimicrobial resistance 2022 124 4.5.3 Put national guidelines either de novo or Endorse existing internation al guidelines with regular updates 4.5.3.1 MOH puts national guidelines for common community acquired infections (CAI) 4.5.3.1 National guidelines for common CAI 4.5.3.1 1 4.5.3.1 6 months 4.5.3.1 MOH 4.5.3.1 AMS Task force Group 4.5.3.1 none 4.5.3.1 MOH 4.5.3.1 CAI guidelines developed Yes/No 4.5.3.2 Hospitals put institutiona l guidelines for treatment of Healthcare associated infections (HAI) according to their local epidemiolo gy, with the help of taskforce members 4.5.3.2.1 Mandate for hospitals to issue HAI treatment guidelines based on local epidemiolo gy and with the help of taskforce members 4.5.3.2.1 Mandate 4.5.3.2.1 1 4.5.3.2.1 6 months 4.5.3.2.1 MOH 4.5.3.2.1 MOH Undersecre tary General/Ta sk Force 4.5.3.2.1 None 4.5.3.2.1 None 4.5.3.2.1 Mandate Yes/No 4.5.3.2.2 4.5.3.2.2 4.5.3.2.2 1 4.5.3.2.2 8 months 4.5.3.2.2 4.5.3.2.2 Task force 4.5.3.2.2 4.5.3.2.2 Hospitals 4.5.3.2.2 Kuwait national action plan on antimicrobial resistance 2022 125 Organize the work of taskforce members with the different hospitals to assist in putting their own HAI guidelines Organizatio nal plan and distribution of the hospitals to the different taskforce members MOH/ Hospitals To be determined Proportion of hospitals that have HAI guidelines based on their own epidemiolo gy. 4.5.3.2.3 HAI treatment guidelines should be reviewed every year 4.5.3.2.3 Revision 4.5.3.2.3 1 4.5.3.2.3 once / year 4.5.3.2.3 Hospitals/ MOH 4.5.3.2.3 Hospitals/ MOH/ Taskforce 4.5.3.2.3 None 4.5.3.2.3 None 4.5.3.2.3 Proportion of hospitals that have guidelines updated 4.5.3.3 Disseminati on and implement ation of these treatment guidelines in hospital practice. 4.5.3.3.1 Workshops for discussion and endorseme nt of these guidelines with practicing physicians all over the country 4.5.3.3.1 Workshops 4.5.3.3.1 Number of hospitals 4.5.3.3.1 1 year 4.5.3.3.1 MOH/Hosp itals 4.5.3.3.1 MOH/ Taskforce/ ABX Focal person 4.5.3.3.1 Number of workshops X 5000 KD 4.5.3.3.1 MOH 4.5.3.3.1 Number of hospitals where guidelines workshops have been performed 4.5.3.3.2 Distributio n of 4.5.3.3.2 Material 4.5.3.3.2 4.5.3.3.2 1 year 4.5.3.3.2 MOH/Hosp itals 4.5.3.3.2 MOH/Hosp itals 4.5.3.3.2 To be determined 4.5.3.3.2 MOH/ Hospitals 4.5.3.3.2 Proportion of hospitals Kuwait national action plan on antimicrobial resistance 2022 126 educational material in the form of booklets, brochures, posters, &pocket cards, or equivalent softcopies available on mobile phones 1 for national CAI guidelines 1 for HAI guidelines in each hospital that have the softcopies available on the mobile phones of staff 4.5.3.3.3 Post the guidelines on the MOH website and integrate them into the intranet of each hospital 4.5.3.3.3 IT project 4.5.3.3.3 1/Hospital 4.5.3.3.3 1yr, 3 months 4.5.3.3.3 Hospitals 4.5.3.3.3 Hospitals/I nformation System Dep./Hospi tal IT 4.5.3.3.3 To be determined 4.5.3.3.3 Hospitals 4.5.3.3.3 Proportion of hospitals that have the guidelines posted on their intranet 4.5.3.3.4 Integrate the guidelines into the electronic medical record, in the form of pop-ups 4.5.3.3.4 IT Project 4.5.3.3.4 1/hospital 4.5.3.3.4 2 years 4.5.3.3.4 Hospitals 4.5.3.3.4 Hospitals/I nformation System Dep/ Hospital IT 4.5.3.3.4 To be determined 4.5.3.3.4 Hospitals 4.5.3.3.4 Proportion of hospitals that have guidelines recommen dations integrated in the electronic Kuwait national action plan on antimicrobial resistance 2022 127 medical records system 4.5.4 Make AMS programs mandatory in each hospital (presence of AMS team/ committee) 4.5.4.1 Mandate by MOH for this issue 4.5.4.1 Mandate 4.5.4.1 1 4.5.4.1 1 y 6 months 4.5.4.1 MOH 4.5.4.1 MOH Undersecre tary General/ AMS Task force. 4.5.4.1 None 4.5.4.1 None 4.5.4.1 Mandate issued Yes/No 4.5.4.2 Build AMS manpower 4.5.4.2.1 Train microbiolo gists, clinical pharmacist s and Infectious Disease specialists on AMS through national workshops 4.5.4.2.1 Workshops 4.5.4.2.1 Depends on the REGIONS 4.5.4.2.1 1 y 6 months 4.5.4.2.1 Hospitals/ Universities / MOH 4.5.4.2.1 Task force 4.5.4.2.1 30,000 KD x number of workshops 4.5.4.2.1 MOH 4.5.4.2.1 Percent microbiolog ists and clinical pharmacist s that have attended at least 1 AMS workshop Strategic Objective 4.6 Quality control of antimicrobials used in animals and plants 4.6 ABX used in the agriculture/ veterinary are under the same control as 4.6 Already available 4.6 Already available Kuwait national action plan on antimicrobial resistance 2022 128 those used in humans Pharmaceu tical and Herbal Medicines Registratio n and Control Administrat ion/The Dug Inspection Control Strategic Objective 4.7 Restrict the use of critically important ABX to human health in the veterinary field 4.7.1 Establish the list of critically important antibiotics for humans in the animal sector. 4.7.1 List 4.7.1 1 4.7.1 3 months 4.7.1 MOH 4.7.1 ABX Task force 4.7.1 None 4.7.1 None 4.7.1 List put Yes/No 4.7.2 Determine from this list which antibiotics should be restricted for use to humans 4.7.2 List 4.7.2 1 4.7.2 3 months 4.7.2 PAAF/MOH 4.7.2 ABX Task force 4.7.2 None 4.7.2 None 4.7.2 List put Yes/No 4.7.3 4.7.3 Decree 4.7.3 1 4.7.3 6 months 4.7.3 PAAF 4.7.3 4.7.3 None 4.7.3 None 4.7.3 Kuwait national action plan on antimicrobial resistance 2022 129 Issue a decree that the critically important ABX to human health are not to be used in animals whether in individual treatment or in herd therapy ABX Task force/ ABX Focal person/ PAAF Decree issued Yes /No 4.7.4 Prohibit the importatio n of these critically important ABX for vet use 4.7.4.1 Decree that prohibits the importatio n and sale of these ABX in the vet field 4.7.4.1 Decree 4.7.4.1 1 4.7.4.1 6 months 4.7.4.1 PAAF 4.7.4.1 PAAF 4.7.4.1 None 4.7.4.1 None 4.7.4.1 Decree is issued Yes/No Strategic Objective 4.8 Organize the use of antimicrobial agents in terrestrial and aquatic animals and agriculture. 4.8.1 Put (or endorse) guidelines regarding the use of ABX in animals 4.8.1 Guidelines 4.8.1 1 4.8.1 8 months 4.8.1 PAAF/MOH 4.8.1 ABX Task force /PAAF Focal person 4.8.1 Bonus for the members 4.8.1 PAAF/ MOH 4.8.1 Guidelines are established Yes/No Kuwait national action plan on antimicrobial resistance 2022 130 and agriculture 4.8.2 Disseminat e these guidelines among veterinaria ns 4.8.2.1 Booklets/ Brochures/ app that summarize the key points in these guidelines. 4.8.1.1 Booklets Brochures Application 4.8.1.1 3 4.8.1.1 18 months 4.8.1.1 PAAF 4.8.1.1 PAAF focal person/PA AF 4.8.1.1 To be determined 4.8.1.1 PAAF 4.8.1.1 Proportion of Vet clinics that have easy access to these updated guidelines 4.8.2.1 Regular workshops for veterinary specialists regarding the application of these guidelines 4.8.2.1 Workshop 4.8.2.1 2*/year 4.8.2.1 1 year 4.8.2.1 PAAF 4.8.2.1 PAAF 4.8.2.1 7000 to 10000 KD per workshop 4.8.2.1 PAAF 4.8.2.1 proportion of veterinary specialists attending these workshops 4.8.3 Restrict selling ABX for animal and agriculture health to exclusively prescriptio ns by vets 4.8.3.1 Decree that vet pharmacies should dispense ABX only according to vet prescriptio ns, and should submit these 4.8.3.1 Decree 4.8.3.1 1 4.8.3.1 2 years 4.8.3.1 PAAF 4.8.3.1 ABX focal person / PAAF/ MOH 4.8.3.1 None 4.8.3.1 None 4.8.3.1 Decree is issued Yes/No Kuwait national action plan on antimicrobial resistance 2022 131 prescriptio ns with the evidence of selling to PAAF. 4.8.4 Control the use of ABX in animals 4.8.4.1. Detection of the ABX residues in milk, meat, poultry and eggs 4.8.4.1. Already available 4.8.4.1. system in place PAAF/MOH public Health Lab 4.8.4.1. Already available Strategic Objective 4.9 Capacity building among vets in antimicrobial use and AMR 4.9.1 Provide training courses for vets for ABX use according to guidelines and provide certificate. 4.9.1 Workshop 4.9.1 2/year 4.9.1 2 years 4.9.1 PAAF 4.9.1 PAAF 4.9.1 5,000 KD X 2 /YR 4.9.1 PAAF 4.9.1 Proportion of vets that have a yearly certificate 4.9.2 Study baseline consumpti on imported antibiotics in this field 4.9.2.1 Pharmaceu tical Dep in PAAF Committee that will study and document this consumpti on and 4.9.2.1 Report 4.9.2.1 1/year 4.9.2.1 2 years 4.9.2.1 PAAF 4.9.2.1 PAAF 4.9.2.1 None 4.9.2.1 PAAF 4.9.2.1 Report issued Yes/No Kuwait national action plan on antimicrobial resistance 2022 132 compare it to internation al benchmark N.B. Refer to Annex 5 for Antimicrobial Use Axis Strategic and Monitory plans Kuwait national action plan on antimicrobial resistance 2022 133 References 1. No time to wait: securing the future from drug-resistant infections. report to the secretary general of the united nations April 2019. 2. WHO Global Strategy for Containment of Antimicrobial Resistance.2001. 3. Global action plan on antimicrobial resistance. WHO 2015. 4. Taqi M, Jamal W, Rotimi VO .Proportion of positive blood cultures that yielded extended spectrum β-lactamase (ESBL) and carbapenem-resistant Enterobacteriaceae (CRE) isolates in a Teaching Hospital in Kuwait over a 2-year period.. ID week 2017, 4-8 October, 2017, San Diego, USA. 5. Al Sweih N, Moghnia O, Rotimi VO. Explosive Emergence of Colistin-resistant and Carbapenem resistant Enterobacteriaceae (CRE) Among Community Food- handlers in Kuwait. ID week 2017, 4-8 October, 2017, San Diego, USA 6. Jamal W, Salama M, Shahin M, Rotimi. The Burden of Acinetobacter baumannii in the Intensive Care Unit of a Teaching Hospital in Kuwait Over a 3-Year Period. ID week 2017, 4-8 October, 2017, San Diego, USA. 7. Kuwait National Healthcare- associated Infection Surveillance System (KNHSS) 2019 data report. 8. Kuwait National Healthcare- associated Infection Surveillance System (KNHSS) 2020 data report. 9. Mokaddas, E., Ahmad S, ,Samir I. Secular trends in susceptibility patterns of Mycobacterium tuberculosis isolates in Kuwait,1996–2005. Int. J. Tuberc. Lung Dis. 12, 319–325 (2008). 10. Ahmad S, Mokaddas, E, Al-Mutairi, NM. Epidemiology of tuberculosis and multidrug-resistant tuberculosis in the Middle East Region. Expert Rev. Anti Infect. Ther. 16, 709–721 (2018). 11. Abal AT, Ahmad S, Mokaddas E. Variations in the occurrence of the S315T mutation within the katG gene in isoniazid-resistant clinical Mycobacterium tuberculosis isolates from Kuwait. Microb Drug Resist. 2002;8:99–105. 12. Ahmad S, Mokaddas E, Fares E. Characterization of rpoB mutations in rifampin resistant Mycobacterium tuberculosis isolates from Kuwait and Dubai. Diagn Microbiol Infect Dis. 2002;44:245–52. 13. Ahmad S, Mokaddas E. The occurrence of rare rpoB mutations in rifampicin-resistant Mycobacterium tuberculosis isolates from Kuwait. Int J Antimicrob Agents. 2005;26:205–12. Kuwait national action plan on antimicrobial resistance 2022 134 14. Ahmad S, Al-Mutairi NM, Mokaddas E. Variations in the occurrence of specific rpoB mutations in rifampicin-resistant Mycobacterium tuberculosis strains isolated from patients of different ethnic groups in Kuwait. Indian J Med Res. 2012; 135:756–62. 15. Al-Mutairi N, Ahmad S , Mokaddas E. Molecular characterization of multidrug‑resistant Mycobacterium tuberculosis (MDR‑TB) isolates identifies local transmission of infection in Kuwait, a country with a low incidence of TB and MDR‑TB. Eur J Med Res (2019) 24:38. 16. Chehadeh W, Albaksami O, John SE, et al. Drug resistance-associated mutations in antiretroviral treatment-naive and -experienced patients in Kuwait. Acta Virol 2018; 62: 259–65. 17. .Aly N, Omar A , Badawy D, Al-Mousa H, Sadek A. Audit of Physicians’ Adherence to the Antibiotic Policy Guidelines in Kuwait. Med Princ Pract 2012; 21:310–17. 18. Ramchurrena K, Balakrishnab Y, Mahomedc S. Patients’ knowledge, attitudes and practices regarding antibiotic use at a regional hospital in KwaZulu-Natal, South Africa 2017. 19. Schechner V, Temkin E, Harbarth S, et al. Epidemiological interpretation of studies examining the effect of antibiotic usage on resistance. Clin Microbiol Rev 2013; 26:289–307. 20. Van de Sande-Bruinsma N, Grundmann H, Verloo D, et al. Antimicrobial drug use and resistance in Europe. Emerg Infect Dis 2008;14: 1722–30. 21. Awad AS, Aboud EA. Knowledge, attitude and practice towards antibiotic use among the public in Kuwait. PLoS ONE 2015; 10(2): e0117910 22. Assessment of the the level of knowledge, attitudes and practices towards antibiotic use among public attending Kuwait MOH Healthcare facilities 2019. 23. United Nations Environment Programme 2022. Environmental Dimensions of Antimicrobial Resistance. Summary for Policymakers. 24. Al-Bahry, S N, Mahmoud IY, Al-Belushi K I, et al. Coastal sewage discharge and its impact on fish with reference to antibiotic resistant enteric bacteria and enteric pathogens as bio-indicators of pollution. Chemosphere 2009; 77(11): 1534-9. 25. Al-Bahry S N, Mahmoud I Y, Al-Zadjali M, et al. Antibiotic resistant bacteria as bio-indicator of polluted effluent in the green turtles, Chelonia mydas in Oman. Marine Environmental Research 2011;71(2): 139-44. 26. Al-Bahry, S N, Al-Zadjali, M A, Mahmoud I Y et al. Biomonitoring marine habitats in reference to antibiotic resistant bacteria and ampicillin resistance determinants from oviductal fluid of the nesting green sea turtle, Chelonia mydas. Chemosphere 2012; 87(11): 1308-15. Kuwait national action plan on antimicrobial resistance 2022 135 27. Light E, Baker-Austin C, Card M.R et al. Establishing a marine monitoring programme to assess antibiotic resistance: a case study from the Gulf Cooperation Council (GCC) region 2022.medRxiv2022.02.04.22270466.Available at: https://doi.org/10.1101/2022.02.04.22270466 (accessed March 10, 2022). 28. Al-Sarawi, HA, Jha AN, Baker-Austin C, et al. Baseline screening for the presence of antimicrobial resistance in E. coli isolated from Kuwait's marine environment. Marine Pollution Bulletin 2018;129 (2): 893-8. Kuwait national action plan on antimicrobial resistance 2022 136 Annexes Kuwait national action plan on antimicrobial resistance 2022 137 Annex 1 A. Governance Strategic Plan Activity Sub-activity Sub-sub- activity Sub-sub-sub-activity Milestone Strategic Objective G1. National coordination between focal points in the different sectors and different pillars G1.1 Identify the needed AMR focal points in human health, animal health, welfare, and production, food safety and security, Plants and agriculture, and environment. The TOR should include coordination among the different ministries and authorities along with a yearly meeting of the different focal persons. G1.1.1 Define the TOR of focal points in each of these sectors G1. 6 months G1.1.2 Employ and assign the functions of a focal person for each pillar and for AMR in general G1.1.2.1 Assign AMR focal points for each pillar in human health G1.1.2.1.1 one focal point for each of the following pillars: IPC, Surveillance, ABX, Awareness G1.1.2.2 Assign the general focal Person in MOH G1.1.2.2.1 Dr. Abeer Aly pending assignment/ New employee G1.1.2.3 Assign 1 focal person in animal health and agriculture fields for all pillars including IPC, Surveillance, ABX, Awareness G1.1.2.3.1 Representative in NMCG is the focal person or authorities appoint a person G1.1.2.4 G1.1.2.4.1 Kuwait national action plan on antimicrobial resistance 2022 138 Assign 1 focal person in KEPA for all pillars including IPC, Surveillance, ABX, Awareness Representative in NMCG is the focal person or authorities appoint a person G1.1.2.5 Assign 1 Focal person in food safety regarding IPC, Surveillance, ABX, Awareness G1.1.2.5.1 leave the decision to ministries/authorities G1.1.2 Include inter-ministerial communication and coordination with the general AMR focal person in the TOR of the focal points Strategic Objective G2. Provide legal and ministerial support for the realization of the activities listed in the plan G2.1 Form inter-ministerial NMCG committee G2.1.1 Nominate the members and have a ministerial decree about their appointment G2. 3 months G2.1.2 Write the TOR of the NMCG that include: to facilitate and oversee implementation, monitoring and evaluation of the AMR action plan G2.1.3 The NMCG has dedicated funds for administrative costs. G2.1.3.1 NMCG puts a budget for administrative costs Strategic Objective G3. The plan is based on evidence-based medicine and put by professionals G3.1 Technical groups for specific activities are created G3.1.1 G3. 3 months Kuwait national action plan on antimicrobial resistance 2022 139 when needed from all sectors Mapping of professionals throughout the country from public and private sectors that could be part of technical groups when needed. Strategic Objective G4. Provide guidance and tools to form a basis for preparation of a national action plan on AMR G4.1 Formulate or endorse guidelines for the different topics, along with tools G4.1.1 Each technical group for each pillar will agree on existing guidelines or producing new guidelines or endorsing international guidelines and make them national G4. 1 year Kuwait national action plan on antimicrobial resistance 2022 140 B. Governance Monitoring Plan Activity Sub activity Sub-sub activity Sub-sub sub activity Indicator Purpose Calculation Frequency Data source Method Baseline Strategic Objective G1. National coordination between focal points in the different sectors and different pillars G1.1 Identify the needed AMR focal points in human health, animal health, welfare, and production, food safety and security, Plants and agriculture, and environme nt. The TOR should include coordinatio n among the different ministries G1.1.1 Define the TOR of focal points in each of these sectors G1.1.1 TOR are put Kuwait national action plan on antimicrobial resistance 2022 141 and authorities along with a yearly meeting of the different focal persons. G1.1.2 Employ and assign the functions of a focal person for each pillar and for AMR in general Assign AMR focal points for each pillar in human health G1.1.2.1.1 one focal point for each of the following pillars: IPC, Surveillanc e, ABX, Awareness G1.1.2 Focal persons for each pillar at MOH are assigned. Focal points in PAAF, and KEPA, and food safety are assigned G1.1.2 Oversee the implement ation of different activities in the NAP and ensure communica tion between different authorities G1.1.2 Yes/No G1.1.2 Once G1.1.2 MOH G1.1.2 Checking G1.1.2 Partially available G1.1.2.2 Assign the general focal person in MOH G1.1.2.2.1 Dr. Abeer Aly pending assignment / New employee G1.1.2.3 Assign 1 focal person in animal G1.1.2.3.1 Representa tive in NMCG Kuwait national action plan on antimicrobial resistance 2022 142 health and agriculture fields for all pillars including IPC, Surveillanc e, ABX, Awareness is the focal person or authorities appoint a person G1.1.2.4 Assign 1 focal person in KEPA for all pillars including IPC, Surveillanc e, ABX, Awareness G1.1.2.4.1 Representa tive in NMCG is the focal person or authorities appoint a person G1.1.2.5 Assign 1 Focal person in food safety IPC: Surveillanc e: ABX Awareness G1.1.2.5.1 leave the decision to ministries/ authorities G1.1.2 Include inter ministerial G1.1.2 None Kuwait national action plan on antimicrobial resistance 2022 143 communica tion and coordinatio n with the general AMR focal person in the TOR of the focal points Strategic Objective G2. Provide legal and ministerial support for the realization of the activities listed in the plan G2.1 Form inter ministerial NMCG committee G2.1.1 Nominate the members and have a ministerial decree about their appointme nt G2.1.1 Already available G2.1.2 Write the TOR of the NMCG that include: to facilitate and oversee implement ation, monitoring and evaluation of the AMR action plan G2.1.2 Already available Kuwait national action plan on antimicrobial resistance 2022 144 G2.1.3 The NMCG has dedicated funds for administrat ive costs. G2.1.3.1 NMCG puts a budget for administrat ive costs G2.1.3.1 A budget is put and provided G2.1.3.1 Yes/No G2.1.3.1 Once G2.1.3.1 NMCG G2.1.3.1 Checking G2.1.3.1 Partially available Strategic Objective G3. The plan is based on evidence-based medicine and put by professionals G3.1 Technical groups for specific activities are created when needed from all sectors G3.1.1 Mapping of professiona ls throughout the country from public and private sectors that could be part of technical groups when needed. G3.1.1 Technical groups are formed for each pillar, including representat ive of One Health approach G3.1.1 Ensure proper implement ation and monitoring of the activities of the NAP G3.1.1 Yes/No G3.1.1 Once G3.1.1 NMCG/ MOH Undersecre tary general /Director General in PAAF/KEPA /PAFN G3.1.1 Checking G3.1.1 Partially available in MOH Strategic Objective G4. Provide guidance and tools to form a basis for preparation of a national action plan on AMR G4.1 Formulate or endorse guidelines for the different topics, along with tools G4.1.1 Each technical group for each pillar will agree on existing guidelines or producing new guidelines G4.1.1 Guidelines are available when needed G4.1.1 Standardize practice related to AMR in different sectors G4.1.1 Yes/No G4.1.1 Once/year G4.1.1 Technical groups/ Focal persons of each pillar G4.1.1 Checking G4.1.1 Partially available Kuwait national action plan on antimicrobial resistance 2022 145 or endorsing internation al guidelines and make them national Kuwait national action plan on antimicrobial resistance 2022 146 Annex 2 A. Awareness Strategic Plan Activity Sub-activity Sub-sub- activity Sub-sub-sub-activity Date Milestone Strategic Objective 1.1 Organize the activities of this axis and ensure a proper follow up 1.1.1 To designate a specific employee or post that is responsible of realizing the plan, do the proper communications and follow up on the progress of the plan 1.1.1 Assign one employee/post to overlook these activities in MOH, KEPA, PAAF, food safety 1.1.1 3 months 1.1 8 months 1.1.2 Put TOR of employment 1.1.2 2 months 1.1.3 Letter of employment or assignment of Responsibilities of focal persons in the 4 ministries/authorities 1.1.3 3 months Strategic Objective 1.2 Increase national public awareness of AMR as per One health approach through communication programs 1.2.1 Establish an evidence-based public communications program targeting the general public in the community 1.2.1.1 Estimate the knowledge, attitude and practice of general public regarding AMR in humans, animals, agriculture and environment 1.2.1.1 Done 1.2 5 years 1.2.1.2 Conduct national public awareness campaigns based on the One health approach 1.2.1.2.1 Preparation of material regarding the awareness campaign based on the One health approach 1.2.1.2.1.1 Assign a team to formulate and design the public communication 1.2.1.2.1.1 Done Kuwait national action plan on antimicrobial resistance 2022 147 material regarding AMR 1.2.1.2.1.2 Produce the public communication material regarding AMR 1.2.1.2.1.1 Done 1.2.1.2.1.3 Update the communication material to cover all aspects of the One health approach: Animal Health, Agriculture, food safety and environment 1.2.1.2.1.3 6 months 1.2.1.2.2 Put a yearly plan on broadcasting and posting the public communication material on AMR 1.2.1.2.2.1 Broadcasting is all year long, not only during the AMR awareness week (specific timing, place) 1.2.1.2.2.1 6 months 1.2.1.2.2.2 Prepare costing of the plan 1.2.1.2.2.2 8 months 1.2.1.2.3 Launch the broadcasting plan 1.2.1.2.3 1 year 1.2.1.2.4 Engage different types of media including social media in AMR awareness such as putting material/ads periodically on ministry/governmental websites, social media 1.2.1.2.4 1 year Kuwait national action plan on antimicrobial resistance 2022 148 accounts like Facebook, Twitter, Instagram, etc. 1.2.1.2.5 Involve a public figure like Dr. Abdallah Al-Sanad (spokesperson MOH) in delivering AMR messages, like tweets on twitter or messages in Talk Shows or through TV ads/News bar 1.2.1.2.5 3 months 1.2.1.2.6 Discuss AMR in TV talk shows 1.2.1.2.6.1 MOH sends a letter to Ministry of Information asking to host professionals in AMR to discuss this issue on TV and thus raise public awareness 1.2.1.2.6.1 2 months 1.2.1.2.7 Involve Non Governmental Organizations (NGOs) in AMR awareness campaign 1.2.1.2.7.1 Contact FAO and OIE and ask about their communications program regarding AMR and communicate with them the NAP on AMR 1.2.1.2.7.1 2 months Strategic Objective 1.3 Include AMR education as per One health approach at an early age in schools 1.3.1 Include basic AMR education in school curricula 1.3.1.1 MOH sends a letter with key facts about AMR, antibiotics, hygiene and IPC basics 1.3.1.1 2 months 1.3 2 years Kuwait national action plan on antimicrobial resistance 2022 149 through the School Health Administration asking to include material related to these topics in school curricula 1.3.1.2 Prepare a module/Add material related to basic AMR knowledge, antibiotics, hygiene and IPC in the curricula 1.3.1.2.1 Create a committee of comprising of AMR professional and education professionals to create a module about basic AMR knowledge, antibiotics, hygiene and IPC to be included in school curricula 1.3.1.2.1 2 months 1.3.1.2.2 Include this module in secondary school education 1.3.1.2.2 8 months 1.3.1.2.3 Yearly AMR module workshops involving teachers 1.3.1.2.3 1 year Strategic Objective 1.4 Raise awareness of healthcare workers about AMR based on the One Health approach 1.4.1 Establish an evidence-based communication program targeting the healthcare providers for human health, animal health, agriculture and environment sector 1.4.1.1 Estimate knowledge, attitudes and practices related to AMR among healthcare workers 1.4.1.1.1 Prepare a survey to estimate this knowledge among healthcare workers and identify the gaps 1.4.1.1.1 Done 1.4 3 years 1.4.1.2 Conduct awareness program 1.4.1.2.1 MOH mandates to all 1.4.1.2.1 2 months Kuwait national action plan on antimicrobial resistance 2022 150 within hospitals, primary healthcare, among physicians, nurses, pharmacists, dentists, physiotherapists, and other HC providers hospitals and primary health care centers to provide mandatory sessions about AMR to all employees who are subject to contract/license renewal 1.4.1.3 AMR mandatory courses for pharmacists in private practice who are subject to contract/ license renewal 1.4.1.3.1 Letter from MOH to Drug Inspection Control to request evidence of AMR course attendance about AMR upon license renewal 1.4.1.3.1 6 months 1.4.1.4 Link of AMR course attendance to hospital pharmacists’ and primary Health care pharmacists’ promotion. 1.4.1.4.1 MOH recommends yearly attendance for promotion 1.4.1.4.1 1 year 1.4.1.5 Preparation of a bank of presentations, films, articles, etc. diffused to these syndicates and hospitals to be used as material in their AMR communication programs. 1.4.1.5.1 Toolkit for AMR communication program to be used in hospital and syndicates 1.4.1.5.1 1 year Kuwait national action plan on antimicrobial resistance 2022 151 1.4.1.6 Syndicates and hospitals send yearly report to MOH about this activity 1.4.1.6 Yearly starting 1 year from starting the plan Strategic Objective 1.5 Raise awareness of veterinarians, agriculture professionals and environmental workers about AMR based on the One Health approach 1.5.1 Conduct an awareness program among veterinarians, agriculture professionals, environmental workers, in addition to professionals in PAAF, KEPA, and food safety. 1.5.1.1 Prepare AMR awareness toolkit including slide sets, short films, lectures, posters for these professionals 1.5.1.1 6 months 1.5 3 years 1.5.1.2 Integrate AMR awareness in continuous education programs of veterinarians, agriculture professionals, environmental workers, in addition to professionals in PAAF, KEPA, and food safety 1.5.1.2.1 The focal person in each ministry/authority checks educational activities in their facilities and Includes AMR awareness as a topic of continuous education 1.5.1.2.1 1 year 1.5.1.2.2 Mandate that all drug companies’ educational activities should include AMR awareness 1.5.1.2.2 6 months Kuwait national action plan on antimicrobial resistance 2022 152 1.5.2 Country participates the regional/international AMR awareness campaign 1.5.2.1 Participate actively in WHO regional AMR campaign and FAO and OIE activities related to AMR 1.5.2.1.1 Register Kuwait ministries/authorities (KEPA, PAAF, MOH) to participate in the yearly schedule of AMR activities in WHO, FAO, OIE And encourage individual healthcare professionals, veterinarians, agriculture professionals, environmental workers to participate 1.5.2.1.1 1 year 1.5.2.2 Participate in GCC activities related to AMR 1.5.2.2.1 Kuwait is part of GCC AMR Group 1.5.2.2.1 Done 1.5.2.2.2 Kuwait participates in all the AMR activities GCC 1.5.2.2.2 Done Strategic Objective 1.6 Include AMR teaching in higher education/post-graduate studies in all human health specialties, agriculture, veterinary food safety, and environment related specialties. 1.6.1 Include AMR and related topics based on the One Health approach as a core component of professional education, training, certification 1.6.1.1 Include AMR and related topics based on the One Health approach in undergraduate curricula for human health (medical, nursing, dental and pharmaceutical), agriculture, veterinary food safety, and 1.6.1.1.1 preparation of modules for these specialties 1.6.1.1.1 6 months 1.6 1.5 years Kuwait national action plan on antimicrobial resistance 2022 153 environment related specialties. 1.6.1.1.2 Letter from MOH, PAAF, PAFN and KEPA to Ministry of Higher Education to impose on universities/authorities to include these modules in the corresponding education programs. 1.6.1.1.2 6 months 1.6.1.2 AMR and related topics based on the One Health approach included in the licensing procedure for nurses, dentists, physicians, pharmacists, veterinarians and other professionals for which licensing is required. 1.6.1.2.1 Letter from MOH, PAAF, PAFN and KEPA to licensing bodies of these professionals to include AMR and its related topics in licensing exams and interviews or in the evaluation procedure for license renewal 1.6.1.2.1 3 months Strategic Objective Include 1.7 AMR and related topics in quality assurance and accreditation programs in human health, animal health, agriculture, food chain and environment 1.7.1 IPC, AMR surveillance and AMS are included in the accreditation standards of healthcare facilities 1.7.1.1 Letter from MOH to accreditation bodies to include AMR surveillance and implementation of antimicrobial stewardship programs as part of accreditation standards in all 1.7.1.1 3 months 1.7 9 months Kuwait national action plan on antimicrobial resistance 2022 154 healthcare facilities as well as in the licensing renewal procedures of private healthcare facilities IPC is already part of these standards 1.7.2 IPC and rational use of antimicrobials is checked in the procedure of licensing farms, animal husbandry, agriculture, aquatic and marine fields 1.7.2.1 Review of large animal/poultry farms licensing policies and procedures, to include IPC and proper ABX use and prevention of ABX use as growth promoters 1.7.2.1.1 Mandate that ABX are not to be used as growth promoters 1.7.2.1.1 3 months 1.7.2.1.2 Letter from PAAF Director General to licensing office to include these points in the standards 1.7.2.1.2 3 months Kuwait national action plan on antimicrobial resistance 2022 155 B. Awareness Monitoring Plan Activity Sub activity Sub-sub activity Sub-sub sub activity Indicator Purpose Calculation Frequency Data source Method Baseline Strategic Objective 1.1 Organize the activities of this axis and ensure a proper follow up 1.1.1 To designate a specific employee or post that is responsible of realizing the plan, do the proper communica tions and follow up on the progress of the plan 1.1.1 Assign one employee/ post to overlook these activities in MOH, KEPA, PAAF, food safety 1.1.1 Awareness Focal person assigned 1.1.1 Oversee activities of this pillar 1.1.1 Yes/No 1.1.1 Once 1.1.1 MOH KEPA, PAAF, PAFN 1.1.1 Checking 1.1.1 Not available 1.1.2 Put TOR of employme nt 1.1.2 TOR is put for all 4 focal persons. 1.1.2 Organize work in this pillar 1.1.2 Yes/No 1.1.2 Once 1.1.2 MOH 1.1.2 Checking 1.1.2 Not available 1.1.3 Letter of employme nt or assignment of Responsibil ities of 1.1.3 Letter of employme nt or assignment of duties to specific focal 1.1.3 Oversee activities in this pillar 1.1.3 Yes/No 1.1.3 Once 1.1.3 MOH, KEPA, PAAF, PAFN 1.1.3 Checking 1.1.3 Not available Kuwait national action plan on antimicrobial resistance 2022 156 focal persons in the 4 ministries/ authorities persons in the 4 ministries/ authorities is done Strategic Objective 1.2 Increase national public awareness of AMR as per One health approach through communication programs 1.2.1 Establish an evidence based public communica tions program targeting the general public in the community 1.2.1.1 Estimate the knowledge, attitude and practice of general public regarding AMR in humans, animals, agriculture and environme nt 1.2.1.1 Done 1.2.1.1 Done 1.2.1.2 Conduct national public awareness campaigns based on the One health approach 1.2.1.2.1 Preparation of material regarding the awareness campaign based on the One health approach 1.2.1.2.1.1 Assign a team to formulate and design the public communica tion material regarding AMR 1.2.1.2.1.1 Done 1.2.1.2.1.1 Done Kuwait national action plan on antimicrobial resistance 2022 157 1.2.1.2.1.2 Produce the public communica tion material regarding AMR 1.2.1.2.1.1 Done 1.2.1.2.1.1 Done 1.2.1.2.1.3 Update the communica tion material to cover all aspects of the One health approach: Animal Health, Agriculture, food safety and environme nt 1.2.1.2.1.3 The communica tion material covers all fields of One Health approach (Yes/No) 1.2.1.2.1.3 Highlight the effect of AMR on all fields not just the human health 1.2.1.2.1.3 Yes/No 1.2.1.2.1.3 Once 1.2.1.2.1.3 The awareness technical task force from MOH/PAAF /KEPA/PAF N 1.2.1.2.1.3 Checking 1.2.1.2.1.3 Partially available 1.2.1.2.2 Put a yearly plan on broadcastin g and posting the public communica tion 1.2.1.2.2.1 Broadcastin g is all year long, not only during the AMR awareness week (specific 1.2.1.2.2.1 Schedule is put (Yes/No) 1.2.1.2.2.1 Organize the diffusion of AMR related messages all yearlong 1.2.1.2.2.1 Yes/No 1.2.1.2.2.1 Once 1.2.1.2.2.1 MOH/ Media Office 1.2.1.2.2.1 Checking 1.2.1.2.2.1 Partially available Kuwait national action plan on antimicrobial resistance 2022 158 material on AMR timing, place) 1.2.1.2.2.2 Prepare costing of the plan 1.2.1.2.2.2 Costing plan is finalized 1.2.1.2.2.2 Organize the diffusion of AMR related messages all yearlong 1.2.1.2.2.2 Yes/No 1.2.1.2.2.2 Once 1.2.1.2.2.2 MOH/ Media Office 1.2.1.2.2.2 Checking 1.2.1.2.2.2 Not available 1.2.1.2.3 Launch the broadcastin g plan 1.2.1.2.3 Proportion of the plan that was put on schedule 1.2.1.2.3 Diffusion of AMR messages all year long 1.2.1.2.3 Number of broadcasts related to AMR per month 1.2.1.2.3 Once per year 1.2.1.2.3 MOH 1.2.1.2.3 Counting 1.2.1.2.3 Partially available 1.2.1.2.4 Engage different types of media including social media in AMR awareness such as putting material/ad s periodically on ministry/go vernmental websites, social 1.2.1.2.4 Types of media or social media that mention AMR/mont h 1.2.1.2.4 Relevant informatio n on AMR and related topics reaches to the public as much as possible 1.2.1.2.4 Yes/No 1.2.1.2.4 Once 1.2.1.2.4 MOH/ Media Office 1.2.1.2.4 Checking 1.2.1.2.4 Not available Kuwait national action plan on antimicrobial resistance 2022 159 media accounts like Facebook, Twitter, Instagram, etc. 1.2.1.2.5 Involve a public figure like Dr. Abdallah Al Sanad (spokesper son MOH) in delivering AMR messages, like tweets on twitter or messages in Talk Shows or through TV ads/News bar 1.2.1.2.5 Public figure (Dr. Abdulla Al Sanad) sending message regarding AMR 1.2.1.2.5 The public figure influences the public awareness on AMR 1.2.1.2.5 Yes/No 1.2.1.2.5 Once 1.2.1.2.5 MOH/Medi a Office/ Awareness focal person 1.2.1.2.5 Checking 1.2.1.2.5 Partially available 1.2.1.2.6 Discuss AMR in TV talk shows 1.2.1.2.6.1 MOH sends a letter to Ministry of Informatio n asking to host 1.2.1.2.6.1 Proportion of talk shows episodes that discuss AMR 1.2.1.2.6.1 enhance public knowledge about the dangers of AMR 1.2.1.2.6.1 Number of talk show episodes that target AMR/total number of 1.2.1.2.6.1 Once/year 1.2.1.2.6.1 MOH 1.2.1.2.6.1 Data collection 1.2.1.2.6.1 Not available Kuwait national action plan on antimicrobial resistance 2022 160 professiona ls in AMR to discuss this issue on TV and thus raise public awareness episodes*1 00 1.2.1.2.7 Involve Non Governmen tal Organizatio ns (NGOs) in AMR awareness campaign 1.2.1.2.7.1 Contact FAO and OIE and ask about their communica tions program regarding AMR and communica te with them the NAP on AMR 1.2.1.2.7.1 None Strategic Objective 1.3 Include AMR education as per One health approach at an early age in schools 1.3.1 Include basic AMR education in school curricula 1.3.1.1 MOH sends a letter with key facts about AMR, antibiotics, hygiene and IPC basics and to School 1.3.1.1 Letter sent Yes or No 1.3.1.1 Improve AMR awareness starting in young age 1.3.1.1 Yes/No 1.3.1.1 Once 1.3.1.1 MOH 1.3.1.1 Checking 1.3.1.1 Not available Kuwait national action plan on antimicrobial resistance 2022 161 Health Administrat ion asking to include material related to these topics in school curricula 1.3.1.2 Prepare a module/Ad d material related to basic AMR knowledge, antibiotics, hygiene and IPC in the curricula 1.3.1.2.1 Create a committee of comprising of AMR professiona l and education professiona ls to create a module about basic AMR knowledge, antibiotics, hygiene and IPC to be included in school curricula 1.3.1.2.1 Module prepared Yes/No 1.3.1.2.1 Standardize AMR education at the school level 1.3.1.2.1 Yes/No 1.3.1.2.1 Once 1.3.1.2.1 MOH/ Awareness Focal person/ awareness technical task force 1.3.1.2.1 Checking 1.3.1.2.1 Not available 1.3.1.2.2 Include this module in 1.3.1.2.2 Percent of schools 1.3.1.2.2 Enhance the 1.3.1.2.2 Number of schools 1.3.1.2.2 Once/year 1.3.1.2.2 MOH/ School 1.3.1.2.2 Data collection 1.3.1.2.2 Not available Kuwait national action plan on antimicrobial resistance 2022 162 secondary school education that teach the AMR module in their secondary school curricula education and knowledge about the dangers of AMR starting from a young age that teach AMR module/To tal number of schools*10 0 Health Administrat ion/ Ministry of Education 1.3.1.2.3 Yearly AMR module workshops involving teachers 1.3.1.2.3 Proportion of teachers who attend these workshops 1.3.1.2.3 Standardize AMR teaching in schools 1.3.1.2.3 Number of teachers who attend these modules/T otal number of teachers*1 00 1.3.1.2.3 Once/year 1.3.1.2.3 MOH/ School Health Administrat ion/Health promotion Departmen t/ Ministry of Education 1.3.1.2.3 Data collection 1.3.1.2.3 ` Not available Strategic Objective 1.4 Raise awareness of healthcare workers about AMR based on the One Health approach 1.4.1 Establish an evidence based communica tion program targeting the healthcare providers for human health, animal 1.4.1.1 Estimate knowledge, attitudes and practices related to AMR among healthcare workers 1.4.1.1.1 Prepare a survey to estimate this knowledge among healthcare workers and identify the gaps 1.4.1.1.1 Done 1.4.1.1.1 Done Kuwait national action plan on antimicrobial resistance 2022 163 health, agriculture and environme nt sector 1.4.1.2 Conduct awareness program within hospitals, primary Health care, among physicians, nurses, pharmacist s dentists, physiother apists, and other HC providers 1.4.1.2.1 MOH mandates to all hospitals and primary Healthcare centers to provide mandatory sessions about AMR to all employees who are subject to contract/lic ense renewal 1.4.1.2.1 Proportion of hospitals and primary Health care centers that provide and request yearly attendance of AMR conference s /sessions 1.4.1.2.1 AMR and related topics are an important elements education and practice 1.4.1.2.1 Number of healthcare facilities that provide and request yearly attendance of AMR conference s/Total number of healthcare facilities*1 00 1.4.1.2.1 Once/year 1.4.1.2.1 MOH 1.4.1.2.1 Data collection 1.4.1.2.1 Not available 1.4.1.3 AMR mandatory courses for pharmacist s in private practice who are subject to contract/ 1.4.1.3.1 Letter from MOH to Drug Inspection Control to request evidence of AMR 1.4.1.3.1 Letter is issued 1.4.1.3.1 Make sure that AMR education/ CE is mandatory for license renewal in the human health sector 1.4.1.3.1 Yes/No 1.4.1.3.1 Once 1.4.1.3.1 MOH 1.4.1.3.1 Checking 1.4.1.3.1 Not available Kuwait national action plan on antimicrobial resistance 2022 164 license renewal course attendance about AMR upon license renewal 1.4.1.4 Link of AMR course attendance to hospital pharmacist s’ and primary care pharmacist s’ promotion. 1.4.1.4.1 MOH recommen ds yearly attendance for promotion 1.4.1.4.1 Mandate is issued 1.4.1.4.1 Emphasize the importance of AMR education and practice in the human health sector 1.4.1.4.1 Yes/No 1.4.1.4.1 Once 1.4.1.4.1 MOH Undersecre tary general / AMR Focal person 1.4.1.4.1 Checking 1.4.1.4.1 Not available 1.4.1.5 Preparation of a bank of presentatio ns, films, articles, etc. diffused to these syndicates and hospitals to be used as material in their AMR communica 1.4.1.5.1 Toolkit for AMR communica tion program to be used in hospital and syndicates 1.4.1.5.1 Toolkit available 1.4.1.5.1 Standardize AMR CE and knowledge in the human health sector 1.4.1.5.1 Yes/No 1.4.1.5.1 Once 1.4.1.5.1 NMCG/ Awareness Technical task force 1.4.1.5.1 Checking 1.4.1.5.1 Not available Kuwait national action plan on antimicrobial resistance 2022 165 tion programs. 1.4.1.6 Syndicates and hospitals send yearly report to MOH about this activity 1.4.1.6 Proportion of hospitals that send report about AMR Awareness activities to MOH 1.4.1.6 Keep track of AMR activities in hospitals 1.4.1.6 Number of hospitals that send report about AMR Awareness activities to MOH/Total number of hospitals*1 00 1.4.1.6 Once/year 1.4.1.6 MOH 1.4.1.6 Data collection 1.4.1.6 Not available Strategic Objective 1.5 Raise awareness of veterinarians, agriculture professionals and environmental workers about AMR based on the One Health approach 1.5.1 Conduct an awareness program among veterinaria ns, agriculture professiona ls, environme ntal workers, in addition to professiona ls in PAAF, KEPA, and food safety. 1.5.1.1 Prepare AMR awareness toolkit including slide sets, short films, lectures, posters for these professiona ls 1.5.1.1 AMR toolkit is available 1.5.1.1 Standardize AMR CE and knowledge in the non human health sector 1.5.1.1 Yes/No 1.5.1.1 Once 1.5.1.1 Awareness Technical Task force PAAF KEPA PAFN 1.5.1.1 Checking 1.5.1.1 Not available Kuwait national action plan on antimicrobial resistance 2022 166 1.5.1.2 Integrate AMR awareness in continuous education programs of veterinaria ns, agriculture professiona ls, environme ntal workers, in addition to professiona ls in PAAF, KEPA, and food safety 1.5.1.2.1 The focal person in each ministry/au thority checks educational activities in their facilities and Includes AMR awareness as a topic of continuous education 1.5.1.2.1 Number of AMR Awareness sessions per year in each Ministry/au thority 1.5.1.2.1 Enhance AMR knowledge and facing its dangers on the official/gov ernmental level 1.5.1.2.1 Number of sessions 1.5.1.2.1 Once/year 1.5.1.2.1 PAAF KEPA-PAFN 1.5.1.2.1 Counting 1.5.1.2.1 Not available 1.5.1.2.2 Mandate that all drug companies’ educational activities should include AMR awareness 1.5.1.2.2 Proportion of promotion al activities by drug companies in these fields that include messages about AMR 1.5.1.2.2 Engage drug companies in improving AMR awareness among veterinaria ns, agriculture professiona ls 1.5.1.2.2 Number of activities held by drug companies that include messages on AMR/Total number of activities held by 1.5.1.2.2 Once/year 1.5.1.2.2 PAAF Awareness focal person / Director General of PAAF 1.5.1.2.2 Data collection 1.5.1.2.2 Not available Kuwait national action plan on antimicrobial resistance 2022 167 these companies *100 1.5.2 Country participates the regional/int ernational AMR awareness campaign 1.5.2.1 Participate actively in WHO regional AMR campaign and FAO and OIE activities related to AMR 1.5.2.1.1 Register Kuwait ministries /authorities (KEPA, PAAF, MOH) to participate in the yearly schedule of AMR activities in WHO, FAO, OIE And encourage individual healthcare professiona ls, veterinaria ns, agriculture professiona ls, environme ntal workers to participate 1.5.2.1.1 Proportion of events related to AMR in which the country participates 1.5.2.1.1 Engage the country as a whole in the regional and internation al fighting of AMR 1.5.2.1.1 Number of events related to AMR attended by the country/To tal number of events attended by the country*10 0 1.5.2.1.1 Once/year 1.5.2.1.1 MOH PAAF KEPA Awareness Technical Task force 1.5.2.1.1 Data collection 1.5.2.1.1 Not available 1.5.2.2 Participate 1.5.2.2.1 Kuwait is 1.5.2.2.1 Done 1.5.2.2.1 Done Kuwait national action plan on antimicrobial resistance 2022 168 in GCC activities related to AMR part of GCC AMR Group 1.5.2.2.2 Kuwait participates in all the AMR activities GCC 1.5.2.2.2 Done 1.5.2.2.2 Done Strategic Objective 1.6 Include AMR teaching in higher education/post-graduate studies in all human health specialties, agriculture, veterinary food safety, and environment related specialties. 1.6.1 Include AMR and related topics based on the One Health approach as a core component of professiona l education, training, certificatio n 1.6.1.1 Include AMR and related topics based on the One Health approach in undergradu ate curricula for human health (medical, nursing, dental and pharmaceu tical), food safety, and environme nt related specialties. 1.6.1.1.1 preparatio n of modules for these specialties 1.6.1.1.1 Modules prepared yes/no 1.6.1.1.1 Standardize AMR education and knowledge based on the One Health Approach 1.6.1.1.1 Yes/No 1.6.1.1.1 Once 1.6.1.1.1 Awareness focal persons in all ministries/ authorities /Awarenes s technical task force 1.6.1.1.1 Checking 1.6.1.1.1 Not available Kuwait national action plan on antimicrobial resistance 2022 169 1.6.1.1.2 Letter from MOH, PAFN and KEPA to Ministry of Higher Education to impose on universities /authorities to include these modules in the correspond ing education programs. 1.6.1.1.2 Letter sent Yes/No 1.6.1.1.2 Standardize AMR knowledge based on the One Health Approach 1.6.1.1.2 Yes/No 1.6.1.1.2 Once 1.6.1.1.2 Awareness focal persons in all ministries/ authorities /awareness technical Task force 1.6.1.1.2 Checking 1.6.1.1.2 Not available 1.6.1.2 AMR and related topics based on the One Health approach included in the licensing procedure for nurses, dentists, physicians, pharmacist 1.6.1.2.1 Letter from MOH, PAAF, PAFN and KEPA to licensing bodies of these professiona ls to include AMR and its related topics in licensing exams and 1.6.1.2.1 Letters sent Yes/No 1.6.1.2.1 Standardize AMR knowledge based on the One Health Approach 1.6.1.2.1 Yes/No 1.6.1.2.1 Once 1.6.1.2.1 MOH, PAAF,PAFN and KEPA /AMR focal persons in all authorities 1.6.1.2.1 Checking 1.6.1.2.1 Not available Kuwait national action plan on antimicrobial resistance 2022 170 s, veterinaria ns and other professiona ls for which licensing is required. interviews or in the evaluation procedure for license renewal Strategic Objective 1.7 Include AMR and related topics in quality assurance and accreditation programs in human health, animal health, agriculture, food chain and environment 1.7.1 IPC, AMR surveillanc e and AMS are included in the accreditati on standards of healthcare facilities 1.7.1.1 Letter from MOH to accreditati on bodies to include AMR surveillanc e and implement ation of antimicrobi al stewardshi p programs as part of accreditati on standards in all healthcare facilities as well as in the licensing renewal 1.7.1.1 AMR surveillanc e and AMS programs are included in the accreditati on and license renewal standards for healthcare facilities 1.7.1.1 Standardize quality assurance practices related to AMR including surveillanc e and stewardshi p in healthcare facilities 1.7.1.1 Yes/No 1.7.1.1 Once 1.7.1.1 MOH 1.7.1.1 Checking 1.7.1.1 Not available Kuwait national action plan on antimicrobial resistance 2022 171 procedures of private healthcare facilities IPC is already part of these standards 1.7.2 IPC and rational use of antimicrobi als is checked in the procedure of licensing farms, animal husbandry, agriculture, aquatic and marine fields 1.7.2.1 Review of large animal/pou ltry farms licensing policies and procedures , to include IPC and proper ABX use and prevention of ABX use as growth promoters 1.7.2.1.1 Mandate that ABX are not to be used as growth promoters 1.7.2.1.1 Mandate issued 1.7.2.1.1 Put a legal frame for the control of ABX use in the non human sector 1.7.2.1.1 Yes/No 1.7.2.1.1 Once 1.7.2.1.1 PAAF/ PAAF Director General /PAAF awareness focal person 1.7.2.1.1 Checking 1.7.2.1.1 Not available 1.7.2.1.2 Letter from PAAF Director General to licensing office to include 1.7.2.1.2 AMR related topics are included in licensing conditions. 1.7.2.1.2 Emphasize on the importance of AMR and related topics in the non 1.7.2.1.2 Yes/No 1.7.2.1.2 Once 1.7.2.1.2 PAAF/ Director General of PAAF 1.7.2.1.2 Checking 1.7.2.1.2 Not available Kuwait national action plan on antimicrobial resistance 2022 172 these points in the standards human sector Kuwait national action plan on antimicrobial resistance 2022 173 Annex 3 A. Surveillance Strategic Plan Strategic interventions Activity Sub-activity Sub-sub- activity Sub-sub-sub activity Date Milestone for strategic objective Strategic Objective 2.1: Set up a national surveillance system for antimicrobial resistance based on One Health Approach 2.1.1 Establish a national coordination structure for AMR surveillance in humans, veterinary agriculture and environment 2.1.1.1 Write and approve terms of reference for a national coordinating committee for AMR surveillance with the mandate to oversee the AMR surveillance program, including AMR surveillance in Humans, Veterinary, agriculture, environment and Food safety. 2.1.1 6 months 2.1 3 years 2.1.1.2. Write and approve terms of reference for a central office that executes the National surveillance in humans and receives data from other AMR offices in PAAF, KEPA and food safety 2.1.1.2.1 Write terms of reference of the AMR office at MOH 2.1.1.2.1 3 months Kuwait national action plan on antimicrobial resistance 2022 174 2.1.1.2.2 Create the AMR coordinating office at MOH. 2.1.1.2.2.1 Include the already existing Glass team into the MOH National AMR office for Human sector at MOH. 2.1.1.2.2.1.1 Add 2 employees with a support from IT at MOH to be able to handle nationwide data (to do the functions of the central office). 2.1.1.2.2.1.1 6 months 2.1.1.2.2.2 Mandate that each MOH hospital has an AMR surveillance focal person that coordinates with Central AMR surveillance office. 2.1.1.2.2.2 3 months 2.1.1.2.3 Inform PAAF, PAFN and KEPA about the need for AMR surveillance in their respective fields. 2.1.1.2.3 1 month 2.1.1.2.4 Nominate AMR focal persons in PAAF, KEPA, and Food safety 2.1.1.2.4 3 months 2.1.1.2.5 Write the job description of these focal persons. The job description would be to collect AMR data and supply it 2.1.1.2.5 3 months Kuwait national action plan on antimicrobial resistance 2022 175 to the Central AMR office and full coordination with the Central AMR office at MOH. 2.1.1.3 Identify priority organisms for the purpose of national AMR surveillance in human sector, animal sector, plants and Environment. 2.1.1.3 3 months 2.1.1.4 Systematically collect, analyze and report data on AMR in humans in order to inform decision-making at national and international levels (Choose sentinel group of labs) 2.1.1.4.1 Choose a list of labs (dealing with specimen from humans) that can provide reliable AMR data will form a sentinel for starting AMR data collection that will be submitted to AMR central office. 2.1.1.4.1 3 months 2.1.1.4.2 Increase the number of labs that are included in the list on yearly basis until it becomes representative of the national data. 2.1.1.4.2.1 Establish close communication between central AMR OFFICE that also collects data for glass with the lab council to have a list of labs that are accredited by the council, and to 2.1.1.4.2.1 1 year Kuwait national action plan on antimicrobial resistance 2022 176 include them in the list of labs eligible to submit data to GLASS and National AMR surveillance 2.1.1.5 Establish an antimicrobial resistance surveillance network for human health 2.1.1.5.1 integrate all MOH laboratories in network with the national reference Lab. 2.1.1.5.1.1 Training of hospital AMR Surveillance focal persons for data cleaning and data entry into the MOH surveillance system 2.1.1.5.1.1 1 year 2.1.1.5.2 Generate yearly report about AMR in humans in general and mainly priority organisms in humans by the MOH central office. 2.1.1.5.2 2 years 2.1.2 Participate in Global Antimicrobial Resistance Surveillance System (GLASS AMR) 2.1.2.1 Nominate a hospital ad a team for GLASS reporting with TOR 2.1.2.1 Already done 2.1.2.2 Give the GLASS team the authority to request and collect data from labs nationwide 2.1.2.2 Already done 2.1.2.2.1 The team initiates data 2.1.2.2.1 Started 2021 Kuwait national action plan on antimicrobial resistance 2022 177 collection from a sentinel of labs 2.1.2.3 Send yearly report to glass with increasing number of contributing labs 2.1.2.3.1 Central GLASS focal group (Part of AMR central office), chooses from the list of eligible accredited labs submitted by central entity of medical labs to AMR office, 2.1.2.3.1 1 Yearly training of GLASS focal persons on GLASS data collection, management and entry 2.1.2.3.1.1.1 Central workshops yearly 2.1.2.3.1.1.1 2 years 2.1.2.3.2 Yearly lab report is sent to GLASS with increasing number of contributing labs every year. 2.1.2.3.2 Started already Strategic Objective 2.2: Build laboratory capacity to produce high-quality microbiological data for patient management and support surveillance activities in human, 2.2.1 Lab in Hospitals become CAP certified (College of American pathologists) 2.2.1.1 Pilot with 2 labs 2.2.1.1 1 year 2.2 5 years 2.2.1.2 Increase the number of labs that are CAP members 2.2.1.2.1 Lab council puts a plan for sequential recruitment of labs into the CAP 2.2.1.2.1 1 year 2.2.1.2.2 Sequential recruitment of labs into CAP 2.2.1.2.2 5 years Kuwait national action plan on antimicrobial resistance 2022 178 2.2.2 Improve private labs capacity to be eligible for submitting data to GLASS and National AMR 2.2.2.1 Reinforce the accreditation activity of the lab council that audits labs according to availability of qualified microbiologist, results of External QC and abidance to guidelines 2.2.2.1.1 Mandate from MOH that each private lab should pass the accreditation by the Lab council 2.2.2.1.1 12-24 months 2.2.2.1.2 Accreditation of the lab council includes the availability of qualified microbiologist, results of External QC and abidance to guidelines 2.2.2.1.2 6 months Strategic objective 2.3: Collect data from Vet, Agriculture and Environment 2.3.1 Collect AMR data from Vets 2.3.1.1 Map available data On AMR in vet and agriculture in the country. 2.3.1.1.1 Agriculture and Environment focal persons collect available info about AMR in the country and issue a report 2.3.1.1.1.1 Map PAAF labs and the type of AMR data that is generated. 2.3.1.1.1.1 6 months 2.3 5 years 2.3.1.1.1.2 Collect available data about AMR in PAAF/PAFN 2.3.1.1.1.2 6 months 2.3.1.2 2.3.1.2.1 2.3.1.2.1.1 2.3.1.2.1.1 Kuwait national action plan on antimicrobial resistance 2022 179 Improve vet lab capacity in a way they generate data about AMR vets and agriculture Establish quality control of Vet Microbiology labs Assign expert to establish a system for quality control and put a plan 1 year 2.3.1.2.1.2 Execute the plan of quality control in Vet labs 2.3.1.2.1.2 2 year 2.3.1.2.2 Extend Vet Micro Labs to identify priority organisms antibiogram 2.3.1.2.2 1 Increase man power 2.3.1.2.2 1 6 months 2.3.1.2.2.2 Road map and full project 2.3.1.2.2.2 1 year 2.3.1.2.2.3 Workshops for training about antibiogram 2.3.1.2.2.3 1 year 2.3.1.2.3 Implement national surveillance for antibiogram priority animal pathogens, zoonotic and commensal bacterial isolates. 2.3.1.2.3.1 Choose a number of Vet labs that could submit AMR data to PAAF for AMR surveillance 2.3.1.2.3.1 1 year 2.3.1.2.3.2 Collect data from a Sentinel of vet hospitals or labs that submit data to the 2.3.1.2.3.2 2 years Kuwait national action plan on antimicrobial resistance 2022 180 department of surveillance. (They belong to the list). 2.3.1.2.4 The focal AMR entity at PAAF submits AMR data to the Central AMR surveillance lab. 2.3.1.2.4 1 year 2.3.2 Collect AMR data from Environment. 2.3.2.1 Map available data from KEPA 2.3.2.1 Check KEPA Labs and publications about any AMR data in environment 2.3.2.1 3 months 2.3.2.2 Initiate AMR data collection from Environment By research projects. 2.3.2.2.1 The director of the office of research and studies puts AMR surveillance as one of the priority subjects in research 2.3.2.2.1.1 The plan of prioritizing AMR surveillance in Environment and marine environment re and is being discussed with universities/institutes. 2.3.2.2.1.1 6 months 2.3.2.2.1.2 Call for proposal from universities/institutes 2.3.2.2.1.2 1 year 2.3.2.2.1.3 The director of the office of research and studies applies for funds from KEPA for projects related to AMR surveillance in Vet, agriculture, and Environment. 2.3.2.2.1.3 6 months Kuwait national action plan on antimicrobial resistance 2022 181 2.3.2.2.2 Increase lab capacity of KEPA Lab that deals with the quality of coastal water to include AMR identification and surveillance in water and sediment 2.3.2.2.2.1 Letter from KEPA Director General to Technical affairs sector of micro labs asking to prepare a project with a budget that aims at expanding their work from only identification to antibiogram testing 2.3.2.2.2.1 3 months 2.3.2.2.2.2 KEPA analytical central lab KEPA prepare road map for the labs to be able to do antibiogram testing 2.3.2.2.2.2.1 Identify the needed machinery and their budget 2.3.2.2.2.2.1 6 months 2.3.2.2.2.2.2 Put a plan of needed extra staffing 2.3.2.2.2.2.2 6 months 2.3.2.2.2.3 KEPA provides the related budget 2.3.2.2.2.3 Communication between KEPA and ministry of finance 2.3.2.2.2.3 2 years 2.3.2.2.2.4 KEPA microbiology labs start generating antibiogram results for priority organisms 2.3.2.2.2.4 3 years 2.3.2.2.3 Generate report about AMR 2.3.2.2.3 4 years Kuwait national action plan on antimicrobial resistance 2022 182 surveillance in Environment 2.3.3 The national AMR Surveillance Office at MOH gathers data from KEPA, PAAF and PAFN compiles it with Human AMR data and generates yearly ONE Health AMR surveillance report. 2.3.3.1 KEPA, PAAF and PAFN submit available data to Central AMR surveillance office at MOH on yearly basis 2.3.3.1.1 Create a digital network for data sharing with MOH 2.3.3.1.1 5 years 2.3.3.1.2 Add this function to the TOR of the focal person at PAAF and KEPA and food safety. 2.3.3.1.2 3 years Strategic objective 2.4: Create a National Reference Lab for AMR 2.4.1 To have A Kuwaiti Center of Disease Control that will be overseeing bacterial ,viral and AMR reference labs 2.4.1.1 Project of reference lab with its budget and having it endorsed by MOH 2.4.1.1 Already available 2.4 5 years 2.4.1.2 Kuwait CDC becomes functional 2.4.1.2 5 years . 2.4.1.3 Write and approve terms of reference for a national 2.4.1.3 3 months Kuwait national action plan on antimicrobial resistance 2022 183 AMR reference laboratory with expertise in method s for confirming and characterizing specific pathogens, putting guidelines, SOP for identification and antibiogram testing of priority organisms for surveillance training according to guidelines, and organizing quality assurance schemes 2.4.1.4 Prepare a full project and proposal for the reference lab 2.4.1.4 5 years 2.4.1.5 Prepare a budget for the building, equipment and man power of the reference Lab 2.4.1.5 5 years 2.4.1.6 Execution of the Reference Lab 2.4.1.6 5 years 2.4.2 Delegate the function of surveillance of the 2.4.2.1 Identify institution affiliated to MOH that will host the 2.4.2.1.1 A letter from MOH to all labs that asks them to coordinate 2.4.2.1.1 Already available Kuwait national action plan on antimicrobial resistance 2022 184 Reference Lab pending its readiness manpower and activities of the AMR Surveillance office for the actual work on the National and GLASS AMR reports pending the finalization of the reference lab. with the GLASS lab by delivering AMR data for the purpose of AMR Surveillance Strategic objective 2.5: Unify AMR identification in all Micro labs 2.5.1 Lab audit by lab accreditation body according to microbiologist consultant in charge, external quality control and use of CLSI guidelines 2.5.1.1 Accreditation of the medical Laboratories by Medical Laboratories Council 2.5.1.1.1 Involve all laboratories in external quality assurance programs 2.5.1.1.1.1 Mandate that all labs including all private should be accredited and all perform external QC. 2.5.1.1.1.1.1 List of accreditation bodies accepted in Kuwait, all labs should be accredited by one of them 2.5.1.1.1.1.1 6 months 2.5 5 years Kuwait national action plan on antimicrobial resistance 2022 185 B. Surveillance Monitoring Plan Strategic interventi ons Activity Sub activity Sub-sub activity Sub-sub sub activity Indicator Purpose Calculatio n Frequenc y Data source Method Baseline Strategic Objective 2.1: Set up a national surveillance system for antimicrobial resistance based on One Health Approach 2.1.1 Establish a national coordinati on structure for AMR surveillan ce in humans, veterinary agricultur e and environm ent 2.1.1.1 Write and approve terms of reference for a national coordinati ng committe e for AMR surveillan ce with the mandate to oversee the AMR surveillan ce program, including AMR surveillan ce in Humans, Veterinary , agricultur e, environm 2.1.1 Committe e is formed yes/No 2.1.1 To oversee and coordinat e surveillan ce activities in Humans, Vets, Agricultur e and Environm ent. 2.1.1 Yes/No 2.1.1 Once 2.1.1 MOH 2.1.1 Checking 2.1.1 Not formed Kuwait national action plan on antimicrobial resistance 2022 186 ent and Food safety. 2.1.1.2. Write and approve terms of reference for a central office that executes the National surveillan ce in humans and receives data from other AMR offices in PAAF, KEPA and food safety 2.1.1.2.1 Write terms of reference of the AMR office at MOH 2.1.1.2.1 TOR written 2.1.1.2.1 To organize and frame the work of this committe e 2.1.1.2.1 Yes/No 2.1.1.2.1 Once 2.1.1.2.1 MOH 2.1.1.2.1 Checking 2.1.1.2.1 Not written yet 2.1.1.2.2 Create the AMR coordinati ng office at MOH. 2.1.1.2.2.1 Include the already existing Glass team into the MOH National 2.1.1.2.2.1 .1 Add 2 employee s with a support from IT at MOH to be able to 2.1.1.2.2.1 .1 2 extra employee s are employed. Yes/No 2.1.1.2.2.1 .1 To execute all the Human AMR surveillan ce and to 2.1.1.2.2.1 .1 Office with employed personnel is formed. 2.1.1.2.2.1 .1 Once 2.1.1.2.2.1 .1 MOH/ Informati on system administr ation 2.1.1.2.2.1 .1 Checking 2.1.1.2.2. 1.1 Not available Kuwait national action plan on antimicrobial resistance 2022 187 AMR office for Human sector at MOH. handle nationwid e data (to do the functions of the central office). collect data from the Vet and Agricultur e and KEPA Surveillan ce. 2.1.1.2.2.2 Mandate that each MOH hospital has an AMR surveillan ce focal person that coordinat es with Central AMR surveillan ce office. 2.1.1.2.2.2 Mandate issued Yes/No 2.1.1.2.2.2 Mandate is issued 2.1.1.2.2.2 Yes/No 2.1.1.2.2.2 Once 2.1.1.2.2.2 MOH 2.1.1.2.2.2 Checking 2.1.1.2.2. 2 Not available 2.1.1.2.3 Inform PAAF,PAF N and KEPA about the need for AMR surveillan ce in their 2.1.1.2.3 Letter sent Kuwait national action plan on antimicrobial resistance 2022 188 respective fields. 2.1.1.2.4 Nominate AMR focal persons in PAAF, KEPA, and Food safety 2.1.1.2.4 AMR surveillan ce focal persons appointed in all 3 authoritie s 2.1.1.2.4 To start the activities that lead to data collection and ultimately do the surveillan ce data collection in their respective authoritie s 2.1.1.2.4 Yes/No 2.1.1.2.4 ONCE in each authority 2.1.1.2.4 MOH PAAF KEPA PAFN 2.1.1.2.4 Checking 2.1.1.2.4 Only GLASS focal person is employed at MOH. No national surveillan ce job descriptio n. None in PAAF, KEPA, PAFN 2.1.1.2.5 Write the job descriptio n of these focal persons. The job descriptio n would be to collect AMR data and supply it to the Central 2.1.1.2.5 TOR are set 2.1.1.2.5 To organize the job and reach the goal of surveillan ce 2.1.1.2.5 Yes/No 2.1.1.2.5 Once in each authority 2.1.1.2.5 MOH PAAF KEPA PAFN 2.1.1.2.5 Checking 2.1.1.2.5 Not available Kuwait national action plan on antimicrobial resistance 2022 189 AMR office and full coordinati on with the Central AMR office at MOH. 2.1.1.3 Identify priority organisms for the purpose of national AMR surveillan ce in human sector, animal sector, plants and Environm ent. 2.1.1.3 List is available and includes all listed sectors. 2.1.1.3 To focus surveillan ce on the most important AMR trends that are of interest in all sectors 2.1.1.3 List is put Yes/No 2.1.1.3 Once 2.1.1.3 MOH 2.1.1.3 Checking Not available. 2.1.1.4 Systemati cally collect, analyze and report data on 2.1.1.4.1 Choose a list of labs (dealing with specimen from humans) 2.1.1.4.1 List is chosen(8 Labs submitted GLASS data for 2021 2.1.1.4.1 To include only data that is microbiol ogically brought according 2.1.1.4.1 Yes/No 2.1.1.4.1 Once/year 2.1.1.4.1 MOH 2.1.1.4.1 Checking 2.1.1.4.1 List for GLASS data has been put for 2022 Kuwait national action plan on antimicrobial resistance 2022 190 AMR in humans in order to inform decision making at national and internatio nal levels (Choose sentinel group of labs) that can provide reliable AMR data will form a sentinel for starting AMR data collection that will be submitted to AMR central office. Amiri Adan Mubarak Alkhabeer Jaber Farwania Jahra Chest Ibn Sina) to recogniza ble microbiol ogy guidelines like CLSI or EUCAST 2.1.1.4.2 Increase the number of labs that are included in the list on yearly basis until it becomes represent ative of the national data. 2.1.1.4.2.1 Establish close communic ation between central AMR OFFICE that also collects data for glass with the lab council to have a list of labs that are accredited by the 2.1.1.4.2.1 Proportio n of labs in the country that are included in the list 2.1.1.4.2.1 To have surveillan ce data that is represent ative of all the country 2.1.1.4.2.1 Number of labs in the list/total number of labs 2.1.1.4.2.1 Once/year 2.1.1.4.2.1 MOH/ Surveillan ce office 2.1.1.4.2.1 Checking 2.1.1.4.2. 1 10 labs will be included in 2022 in GLASS data Kuwait national action plan on antimicrobial resistance 2022 191 council, and to include them in the list of labs eligible to submit data to GLASS and National AMR surveillan ce 2.1.1.5 Establish an antimicro bial resistance surveillan ce network for human health 2.1.1.5.1 integrate all MOH laboratori es in network with the national reference Lab. 2.1.1.5.1.1 Training of hospital AMR Surveillan ce focal persons for data cleaning and data entry into the MOH surveillan ce system 2.1.1.5.1.1 Yearly workshop performe d Yes/No 2.1.1.5.1.1 To provide adequate training about data managem ent in a unanimou s way throughou t all the included labs 2.1.1.5.1.1 Workshop done Yes /No 2.1.1.5.1.1 Once/year 2.1.1.5.1.1 MOH 2.1.1.5.1.1 Checking 2.1.1.5.1. 1 Only GLASS focal is being trained 2.1.1.5.2 Generate yearly report about AMR in humans in 2.1.1.5.2 Yearly human AMR report is issued 2.1.1.5.2 To direct empiric therapy and strategic plan in 2.1.1.5.2 Yes/No 2.1.1.5.2 Once/Year 2.1.1.5.2 MOH Surveillan ce office 2.1.1.5.2 Checking 2.1.1.5.2 GLASS report started 2021 Kuwait national action plan on antimicrobial resistance 2022 192 general and mainly priority organisms in humans by the MOH central office. treatment and preventio n and antibiotic use in humans. 2.1.2 Participat e in Global Antimicro bial Resistance Surveillan ce System (GLASS AMR) 2.1.2.1 Nominate a hospital ad a team for GLASS reporting with TOR 2.1.2.1 Already done Already available. 2.1.2.2 Give the GLASS team the authority to request and collect data from labs nationwid e 2.1.2.2 Already done 2.1.2.2 Already done 2.1.2.2.1 The team initiates 2.1.2.2.1 Started 2021 2.1.2.2.1 Started 2021 Kuwait national action plan on antimicrobial resistance 2022 193 data collection from a sentinel of labs 2.1.2.3 Send yearly report to glass with increasing number of contributi ng labs 2.1.2.3.1 Central GLASS focal group (Part of AMR central office), chooses from the list of eligible accredited labs submitted by central entity of medical labs to AMR office, 2.1.2.3.1 1 Yearly training of GLASS focal persons on GLASS data collection, managem ent and entry 2.1.2.3.1.1 .1 Central workshop s yearly 2.1.2.3.1.1 .1 Workshop done, yes/No have 10 20 % increase in number of participati ng labs in GLASS annually 2.1.2.3.1.1 .1 To do proper data entry into GLASS 2.1.2.3.1.1 .1 Yes/No 2.1.2.3.1.1 .1 Once/Year (and for new employee ) 2.1.2.3.1.1 .1 Surveillan ce/GLASS office at MOH 2.1.2.3.1.1 .1 Checking 2.1.2.3.1. 1.1 Not being done on yearly basis systemati cally 2.1.2.3.2 Yearly lab report is sent to GLASS with increasing number of contributi 2.1.2.3.2 Data is available in the yearly GLASS report 2.1.2.3.2 To be included in the global AMR map and to evaluate benchmar 2.1.2.3.2 Yes/No 2.1.2.3.2 Once/Year 2.1.2.3.2 GLASS Report 2.1.2.3.2 Checking 2.1.2.3.2 Started 2021 Kuwait national action plan on antimicrobial resistance 2022 194 ng labs every year. k with other countries Strategic Objective 2.2: Build laboratory capacity to produce high-quality microbiological data for patient management and support surveillance activities in human, 2.2.1 Lab in Hospitals become CAP certified (College of American pathologis ts) 2.2.1.1 Pilot with 2 labs 2.2.1.1 Started already 2.2.1.1 To check feasibility 2.2.1.1 Started already 2.2.1.2 Increase the number of labs that are CAP members 2.2.1.2.1 Lab council puts a plan for sequential recruitme nt of labs into the CAP 2.2.1.2.1 List is put already 2.2.1.2.1 List is put already 2.2.1.2.2 Sequential recruitme nt of labs into CAP 2.2.1.1 Proportio n of Labs that are CAP affiliated 2.2.1.1 To ensure high standard lab work and 2.2.1.1 Number of labs that are CAP Members/ Total labs 2.2.1.1 Once/Year 2.2.1.1 MOH Central laboratori es 2.2.1.1 Checking 2.2.1.1 2 started already as pilot Kuwait national action plan on antimicrobial resistance 2022 195 get internatio nal scientific support 2.2.2 Improve private labs capacity to be eligible for submittin g data to GLASS and National AMR 2.2.2.1 Reinforce the accreditati on activity of the lab council that audits labs according to availabilit y of qualified microbiol ogist, results of External QC and abidance to guidelines 2.2.2.1.1 Mandate from MOH that each private lab should pass the accreditati on by the Lab council 2.2.2.1 Proportio n of labs that are functional and that have passed the accreditati on testing 2.2.2.1 To have quality AMR data from all the labs 2.2.2.1 Number of of labs that are functional and that have passed the accreditati on testing/to tal number of labs 2.2.2.1 Once/Year 2.2.2.1 Central Medical laboratory council/ Medical Licensing Dep. 2.2.2.1 Checking 2.2.2.1 All governme ntal labs are accredite d Not all private labs are accredite d and many do not pass the accreditat ion check yearly. 2.2.2.1.2 Accreditat ion of the lab includes the availabilit y of 2.2.2.1.2 Updated accreditati on standards of Labs prepared or not To improve private lab capacity for detecting AMR Update done yes/No once Central Medical laboratory council checking available in MOH Labs Kuwait national action plan on antimicrobial resistance 2022 196 qualified microbiol ogist, results of External QC and abidance to guidelines Strategic objective 2.3: Collect data from Vet, Agriculture and Environment 2.3.1 Collect AMR data from Vets 2.3.1.1 Map available data On AMR in vet and agricultur e in the country. 2.3.1.1.1 Agricultur e and Environm ent focal persons collect available info about AMR in the country and issue a report 2.3.1.1.1.1 Map PAAF labs and the type of AMR data that is generated . 2.3.1.1.1.1 Report is Submitted to central AMR surveillan ce office 2.3.1.1.1.1 To check the available Situation regarding AMR identificat ion and reporting in Vet labs. 2.3.1.1.1.1 Report done Yes/No 2.3.1.1.1.1 Once 2.3.1.1.1.1 Vet Labs PAAF 2.3.1.1.1.1 Data collection according to a checklist 2.3.1.1.1. 1 Unknown 2.3.1.1.1.2 Collect available data about AMR in PAAF/PAF N 2.3.1.1.1.2 AMR Vets/food reports are submitted to central AMR Surveillan ce office 2.3.1.1.1.2 To collect available AMR data 2.3.1.1.1.2 AMR report from PAAF/PAF N 2.3.1.1.1.2 Once/year 2.3.1.1.1.2 Vet Labs/PAF N 2.3.1.1.1.2 Data collection 2.3.1.1.1. 2 Not available 2.3.1.2 2.3.1.2.1 2.3.1.2.1.1 2.3.1.1.1.1 2.3.1.1.1.1 2.3.1.1.1.1 Yes/No 2.3.1.1.1.1 Once 2.3.1.1.1.1 PAAF 2.3.1.1.1.1 Checking 2.3.1.1.1. 1 Kuwait national action plan on antimicrobial resistance 2022 197 Improve vet lab capacity in a way they generate data about AMR vets and agricultur e Establish quality control of Vet Microbiol ogy labs Assign expert to establish a system for quality control and put a plan Profession al is assigned To put a plan with a defined budget for Vet labs to start generatin g adequate AMR data The Vet labs generate only microorga nism identificat ion data, no AMR data is generated 2.3.1.2.1.2 Execute the plan of quality control in Vet labs 2.3.1.2.1.2 Proportio n of VET Labs that Participat e in external quality control activities 2.3.1.2.1.2 To provide periodic check up on the accuracy of AMR detection in vet labs. 2.3.1.2.1.2 Number of of VET Labs that participat e in external quality control activities/ Total number of vet labs. 2.3.1.2.1.2 once/year 2.3.1.2.1.2 Vet labs/PAAF 2.3.1.2.1.2 Checking 2.3.1.2.1. 2 Not available 2.3.1.2.2 Extend Vet Micro Labs to identify priority organisms antibiogra m 2.3.1.2.2 1 Increase man power 2.3.1.2.2 1 None Kuwait national action plan on antimicrobial resistance 2022 198 2.3.1.2.2.2 Road map and full project 2.3.1.2.2.2 The project is put with specified budget and ready for execution 2.3.1.2.2.2 To upgrade Vet labs to become able to generate AMR data 2.3.1.2.2.2 Yes/No 2.3.1.2.2.2 Once 2.3.1.2.2.2 PAAF 2.3.1.2.2.2 Checking 2.3.1.2.2. 2 Not available 2.3.1.2.2.3 Workshop s for training about antibiogra m 2.3.1.2.2.3 Workshop is performe d. 2.3.1.2.2.3 To train microbiol ogists and technician in Vet labs about AMR IDENTIFIC ATION 2.3.1.2.2.3 Proportio n of vet labs that are represent ed in these workshop s 2.3.1.2.2.3 Once/year 2.3.1.2.2.3 PAAF 2.3.1.2.2.3 Checking 2.3.1.2.2. 3 Not available 2.3.1.2.3 Implemen t national surveillan ce for antibiogra m priority animal pathogens , zoonotic and commens al bacterial isolates. 2.3.1.2.3.1 Choose a number of Vet labs that could submit AMR data to PAAF for AMR surveillan ce 2.3.1.2.3.1 List of labs is available yearly 2.3.1.2.3.1 To collect Microbiol ogically sound AMR data from Vet Labs. 2.3.1.2.3.1 Yes/No 2.3.1.2.3.1 Once/Year 2.3.1.2.3.1 PAAF 2.3.1.2.3.1 Checking 2.3.1.2.3. 1 Not available Kuwait national action plan on antimicrobial resistance 2022 199 2.3.1.2.3.2 Collect data from a Sentinel of vet hospitals or labs that submit data to the departme nt of surveillan ce. (They belong to the list). 2.3.1.2.3.2 Data is yearly collected 2.3.1.2.3.2 To generate AMR data from Vets and Agricultur e and correlate it with Human AMR and decide upon ABX use in agricultur e and vets. 2.3.1.2.3.2 Yes/No 2.3.1.2.3.2 Once/Year 2.3.1.2.3.2 PAAF Vets Lab 2.3.1.2.3.2 Checking 2.3.1.2.3. 2 Not available. 2.3.1.2.4 The focal AMR entity at PAAF submits AMR data to the Central AMR surveillan ce lab 2.3.1.2.4 Data submitted to MOH Central Office. 2.3.1.2.4 To pool data into the central national One Health AMR office, to generate decisions related to ABX in all sectors of One Health. 2.3.1.2.4 Yes/No 2.3.1.2.4 Once/Year 2.3.1.2.4 MOH Central AMR One Health office 2.3.1.2.4 Checking 2.3.1.2.4 Not available 2.3.2 2.3.2.1 2.3.2.1 2.3.2.1 2.3.2.1 2.3.2.1 2.3.2.1 2.3.2.1 2.3.2.1 2.3.2.1 Kuwait national action plan on antimicrobial resistance 2022 200 Collect AMR data from Environm ent. Map available data from KEPA Check KEPA Labs and publicatio ns about any AMR data in environm ent Report is issued To collect available baseline informatio n about AMR in the environm ent. Yes/No Once Publicatio ns from Kuwait Checking Not available. 2.3.2.2 Initiate AMR data collection from Environm ent By research projects. 2.3.2.2.1 The director of the office of research and studies puts AMR surveillan ce as one of the priority subjects in research 2.3.2.2.1.1 The plan of prioritizin g AMR surveillan ce in Environm ent and marine environm ent re and is being discussed with universitie s/institute s. 2.3.2.2.1.1 % of research meetings with universitie s/institute s where AMR is requested to be apriority in research projects. 2.3.2.2.1.1 To prioritize AMR in environm ent as research target, and attract related projects and funds 2.3.2.2.1.1 Number of research meetings with universitie s where AMR is requested to be a priority in research projects/ total number of research meetings. 2.3.2.2.1.1 Twice /year 2.3.2.2.1.1 KEPA/ Universiti es/KISR 2.3.2.2.1.1 Checking 2.3.2.2.1. 1 Not available 2.3.2.2.1.2 Call for proposal from universitie s/institute s 2.3.2.2.1.2 Proportio n of universitie s that send projects related to AMR in 2.3.2.2.1.2 To increase the number of research projects about 2.3.2.2.1.2 Number of universitie s that send projects related to AMR in 2.3.2.2.1.2 Twice/yea r 2.3.2.2.1.2 KEPA Research office 2.3.2.2.1.2 Checking 2.3.2.2.1. 2 Not available Kuwait national action plan on antimicrobial resistance 2022 201 environm ent to KEPA research office AMR in the environm ent. environm ent to KEPA research office/Tot al number of universitie s. 2.3.2.2.1.3 The director of the office of research and studies applies for funds from KEPA for projects related to AMR surveillan ce in Vet, agricultur e, and Environm ent. 2.3.2.2.1.3 % of proposed projects related to AMR in environm ent that have been funded 2.3.2.2.1.3 To secure funds for the projects in order for them to be realized 2.3.2.2.1.3 Number of proposed projects related to AMR in environm ent that have been funded/to tal number of projects related to AMR that were proposed. 2.3.2.2.1.3 Once/6 months 2.3.2.2.1.3 KEPA Research office 2.3.2.2.1.3 Checking 2.3.2.2.1. 3 Almost none 2.3.2.2.2 Increase lab capacity of KEPA Lab that 2.3.2.2.2.1 Letter from KEPA Director General to Technical 2.3.2.2.2.1 KEPA Lab starts reporting AMR data 2.3.2.2.2.1 To expand the capacity of the lab from 2.3.2.2.2.1 Yes/No 2.3.2.2.2.1 Once/year 2.3.2.2.2.1 KEPA lab 2.3.2.2.2.1 Checking 2.3.2.2.2. 1 Not available Kuwait national action plan on antimicrobial resistance 2022 202 deals with the quality of coastal water to include AMR identificat ion and surveillan ce in water and sediment affairs sector of micro labs asking to prepare a project with a budget that aims at expanding their work from only identificat ion to antibiogra m testing microorga nism identificat ion to AMR detection 2.3.2.2.2.2 KEPA analytical central lab KEPA prepare road map for the labs to be able to do antibiogra m testing 2.3.2.2.2.2 .1 Identify the needed machinery and their budget 2.3.2.2.2.2 Road map project with budget is put to extend KEPA microbiol ogy lab from bacterial identificat ion to include also antibiogra m testing 2.3.2.2.2.2 To put a plan for how to reach the target of making KEPA lab (marine…) detect AMR. 2.3.2.2.2.2 Yes /No 2.3.2.2.2.2 Once/6 months 2.3.2.2.2.2 KEPA Analytical Lab center 2.3.2.2.2.2 Checking 2.3.2.2.2. 2 KEPA marine lab identifies microorga nisms, does not detect AMR. Kuwait national action plan on antimicrobial resistance 2022 203 2.3.2.2.2.2 .2 Put a plan of needed extra staffing See above 2.3.2.2.2.3 KEPA provides the related budget 2.3.2.2.2.3 Communi cation between KEPA and ministry of finance 2.3.2.2.2.3 None 2.3.2.2.2.4 KEPA microbiol ogy labs start generatin g antibiogra m results for priority organisms 2.3.2.2.2.4 KEPA Marine lab actually generates AMR data 2.3.2.2.2.4 To have AMR data from marine environm ent 2.3.2.2.2.4 Yes/No 2.3.2.2.2.4 Once/Year 2.3.2.2.2.4 KEPA marine lab 2.3.2.2.2.4 Checking 2.3.2.2.2. 4 Not available 2.3.2.2.3 Generate report about AMR surveillan ce in Environm ent 2.3.2.2.3 Yes/No 2.3.3 2.3.3.1 2.3.3.1.1 2.3.3.1.1 2.3.3.1.1 2.3.3.1.1 Yes/No 2.3.3.1.1 2.3.3.1.1 MOH 2.3.3.1.1 Checking 2.3.3.1.1 Kuwait national action plan on antimicrobial resistance 2022 204 The national AMR Surveillan ce Office at MOH gathers data from KEPA, PAAF, and PAFN compiles it with Human AMR data and generates yearly ONE Health AMR surveillan ce report. KEPA, PAAF , and PAFN submit available data to Central AMR surveillan ce office at MOH on yearly basis Create a digital network for data sharing with MOH Digital System is put To facilitate AMR data collection in health approach by making it digital Once/6 months Not available 2.3.3.1.2 Add this function to the TOR of the focal person at PAAF and KEPA and food safety. 2.3.3.1.2 TOR includes surveillan ce function detail. Strategic objective 2.4: Create a National Reference Lab for AMR 2.4.1 2.4.1.1 2.4.1.1 2.4.1.1 2.4.1.1 2.4.1.1 2.4.1.1 2.4.1.1 2.4.1.1 Kuwait national action plan on antimicrobial resistance 2022 205 To have A Kuwaiti Center of Disease Control that will be overseein g bacterial, viral and AMR reference labs Project of reference lab with its budget and having it endorsed by MOH CDC will oversee the needs and functions of all reference laboratori al, including viral, bacterial and AMR. To centralize all the reference labs Yes/No Once/year MOH Checking Project is already under the umbrella of Minister of Health and under serious considera tion. 2.4.1.2 Kuwait CDC becomes functional 2.4.1.2 Kuwait CDC is establishe d 2.4.1.2 To put the project of Kuwait CDC into action 2.4.1.2 Yes/No 2.4.1.2 Once/Year 2.4.1.2 MOH 2.4.1.2 Checking 2.4.1.2 The Minister of Health has put the project among his priorities and has provided the budget for it. . 2.4.1.3 Write and approve terms of reference for a national 2.4.1.3 TOR of AMR reference Lab are put. 2.4.1.3 To define the functions and fulfill them 2.4.1.3 Yes/No 2.4.1.3 Once 2.4.1.3 MOH/ Kuwait CDC/Medi cal Lab.Counc il 2.4.1.3 Checking 2.4.1.3 Not done yet Kuwait national action plan on antimicrobial resistance 2022 206 AMR reference laboratory with expertise in method s for confirmin g and characteri zing specific pathogens , putting guidelines , SOP for identificat ion and antibiogra m testing of priority organisms for surveillan ce training according to guidelines , and organizing quality assurance schemes They include: expertise in method s for confirmin g and characteri zing specific pathogens , putting guidelines , SOP for identificat ion and antibiogra m testing of priority organisms for surveillan ce training according to guidelines , and organizing quality assurance schemes 2.4.1.4 Prepare a full 2.4.1.4 Yes/No 2.4.1.4 2.4.1.4 Yes/No 2.4.1.4 Once 2.4.1.4 Kuwait CDC/MOH 2.4.1.4 checking 2.4.1.4 Not yet Kuwait national action plan on antimicrobial resistance 2022 207 project and proposal for the reference lab To put the full road map and define the budget and submit it for funding 2.4.1.5 Prepare a budget for the building, equipmen t and man power of the reference Lab 2.4.1.5 Budget for AMR lab is approved within the budget of Kuwait CDC 2.4.1.5 To provide the needed budget for Manpowe r and equipmen t 2.4.1.5 Yes/No 2.4.1.5 Once/year 2.4.1.5 Kuwait CDC/ MOH Checking Not yet 2.4.1.6 Execution of the Reference Lab 2.4.1.6 Reference lab is set and functionin g 2.4.1.6 To fulfill the functions listed in the TOR 2.4.1.6 Yes/no 2.4.1.6 Once/year 2.4.1.6 Kuwait CDC 2.4.1.6 Checking 2.4.1.6 Not yet 2.4.2 Delegate the function of surveillan ce of the reference Lab pending 2.4.2.1 Identify institution affiliated to MOH that will host the manpowe r and activities 2.4.2.1.1 A letter from MOH to all labs that asks them to coordinat e with the GLASS lab 2.4.2.1.1 Already available 2.4.2.1.1 To start surveillan ce while waiting for the reference lab, which might 2.4.2.1.1 AMR surveillan ce is being submitted to GLASS National AMR not Kuwait national action plan on antimicrobial resistance 2022 208 its readiness of the AMR Surveillan ce office for the actual work on the National and GLASS AMR reports pending the finalizatio n of the reference lab. by delivering AMR data for the purpose of AMR Surveillan ce take few years finalized yet A plan is put above Strategic objective 2.5: Unify AMR identification in all Micro labs 2.5.1 Lab audit by lab accreditati on body according to microbiol ogist consultant in charge, external quality control and use of CLSI guidelines 2.5.1.1 Accreditat ion of the medical Laboratori es by Medical Laboratori es Council 2.5.1.1.1 Involve all laboratori es in external quality assurance programs 2.5.1.1.1.1 Mandate that all labs including all private should be accredited and all perform external QC. 2.5.1.1.1.1 .1 List of accreditati on bodies accepted in Kuwait, all labs should be accredited by one of them 2.5.1.1.1.1 .1 Number of internatio nal accreditati on bodies that are recomme nded in Kuwait for the labs to get their accreditati on 2.5.1.1.1.1 .1 To identify internatio nal accreditati on bodies to perform accreditati on of the labs in Kuwait and not to be limited 2.5.1.1.1.1 .1 Number 2.5.1.1.1.1 .1 Once/Year 2.5.1.1.1.1 .1 MOH/ Reference lab/ Medical Lab.counc il 2.5.1.1.1.1 .1 Checking 2.5.1.1.1. 1.1 CAP Kuwait national action plan on antimicrobial resistance 2022 209 to the local accreditati on activity Kuwait national action plan on antimicrobial resistance 2022 210 Annex 4 A. IPC Strategic Plan Strategic interventions Activity Sub-activity Sub-sub- activity Sub-sub-sub activity Date Milestone Strategic objective 3.1 Emphasize the national infection prevention and control program in healthcare at the National and Health care facility levels. 3.1.1 Create a formal organizational structure to ensure proper development and use of infection prevention and control policies and strategies 3.1.1.1 Infection Control Organizational structure is already established and functioning. - 3.1.1.1 Done 1980 3.1 5 years 3.1.1.2 To make official that IPC is part of the organogram of each hospital with Terms of Reference and allocated staff 3.1.2.1 Decree from MOH about IPC department in each hospital with TOR, and staffing organization 3.1.2.1 2 Months 3.1.1.3 IPC departments in hospitals and they work closely with the central IPC Directorate 3.1.1.3.1 To impose IPC programs in all hospitals 3.1.1.3.1.1 IPC program availability is checked by accreditation standards 3.1.1.3.1.1 Already available 3.1.1.3.2 IPC programs are available in all hospitals and they work under the 3.1.1.3.2 Already available Kuwait national action plan on antimicrobial resistance 2022 211 umbrella of the Central IPC directorate. 3.1.2 Implement laws for mandatory compliance of the facilities with IPC standards 3.1.2.1 Decree from MOH 3.1.2.1.1 Decree that recommends that all HCF have to abide by IPC Recommendations. 3.1.2.1.1.1 IPC Directorate puts the detailed IPC measures that should be required from each HCF, and sent to MOH to be included in ministry 3.1.2.1.1.1 2 months 3.1.2.1.1.2 Decree is issued by MOH 3.1.2.1.1.2 3 months 3.1.2.1.2 Medical responsibilities. Add details IPC standard compliance in hospitals 3.1.2.1.2.1 Add compliance to IPC measures and recommendations to the list of medical responsibilities of hospitals as listed by MOH 3.1.2.1.2.1 3 months 3.1.3 WHO IPC Core component based guidelines are established in all HCF 3.1.3.1 Availability of endorsed IPC based on WHO IPC core components - - 3.1.3.1 Done 3.1.3.2 IPC policies and procedures are included in hospital accreditation standards - - 3.1.3.2 Done 3.1.3.3 IPC policies and procedures are being audited - - 3.1.3.3 Done Kuwait national action plan on antimicrobial resistance 2022 212 regularly by accreditation bodies 3.1.3.4 National infection control policies and guidelines are distributed and periodically updated 3.1.3.4.1 Regular update of national IPC guidelines 3.1.3.4.1.1 On going, but needs to be speeded up by increasing manpower in IPC nationwide in central office and in hospitals 3.1.3.4.1.1 2 years 3.1.3.4.2 A direct channel with WHO consultant regarding few queries and new recommendations 3.1.3.4.2.1 Communicate this need to WHO office in Kuwait 3.1.3.4.2.1.1 Letter from MOH/IPC directorate to WHO office in Kuwait asking for direct channel with a consultant for queries whenever they occur 3.1.3.4.2.1.1 1 month 3.1.3.4.2.2 Communicate this need to Regional WHO office 3.1.3.4.2.2 Request from WCO to Regional office. 3.1.3.4.2.2 2 months 3.1.3.4.3 Regular update of National IPC policies and procedures 3.1.3.4.3.1 Need updating + speeding up the process 3.1.3.4.3.1 ongoing 3.1.3.5 National IPC Guidelines and policies are being taught 3.1.3.5.1 TOT periodically performed nationally 3.1.3.5.1 Already being performed Kuwait national action plan on antimicrobial resistance 2022 213 3.1.3.5.2 Continuous training of HCW about IPC policies in hospitals is available 3.1.3.5.2.1 Mandate from MOH that it is mandatory to all HCW to attend at least 1 yearly and 1 upon employment 3.1.3.5.2.1 2 months 3.1.3.5.2.2 Improve attendance to these general HCW IPC training sessions 3.1.3.5.2.2.1 Attendance is reported to hospital administrators and action taken to improve attendance 3.1.3.5.2.2.1 1 year 3.1.3.5.2.2.2 Attendance evidence is available in yearly Hospital IPC report and monitored by IPC Directorate 3.1.3.5.2.2.2 1 year 3.1.4 Monitor and evaluate compliance with the IPC guidelines 3.1.4.1 Checklists and audit tools are prepared and applied 3.1.4.1 Started years ago, and ongoing for new policies. 3.1.4.2 Regular updates of these audit tools 3.1.4.2.1 Check new policies if they have their audit tools prepared and disseminated and check old tools if they need update - 3.1.4.2.1 Ongoing 3.1.4.3 Audit plan available in hospitals 3.1.4.3.1 Audit plan is checked in standards of the 3.1.4.3.1 done ongoing Kuwait national action plan on antimicrobial resistance 2022 214 National Accreditation Program applied by the Quality and Accreditation Directorate 3.1.4.3.2 Central audit plan is being prepared annually and distributed to all hospitals 3.1.4.3.2 Done and ongoing yearly 3.1.4.3.3 Audit report is sent to central IPC directorate with corrective actions. 3.1.4.3.3 Done and ongoing 3.1.4.4 Establish national process indicators 3.1.4.4.1 1st set of process indicators: CLABSI CAUTI VAP 3.1.4.4.1.1Put the basic training material 3.1.4.4.1.1Already available 3.1.4.4.1.2Update of the already available bundle of care in each of the mentioned bundles, by including new evidence- based items to the bundle 3.1.4.4.1.2 Prepare the updated bundles 3.1.4.4.1.2 2 years 3.1.4.4.1.3Train the IPC professionals nationwide on the updated bundles 3.1.4.4.1.3.1 TOT workshops 3.1.4.4.1.3.1 2 years 3.1.4.4.1.4 Engage all HCW with the 3.1.4.4.1.4.1 3.1.4.4.1.4.1 CLABSI months Kuwait national action plan on antimicrobial resistance 2022 215 bundles by training, audit and feedback. Prepare the ground in the hospitals: Letter to hospital directors about the bundles project its importance and its processes Each bundle 1 y 3.1.4.4.1.4.2 Update the material to be taught to HCW by IPC professionals, according to the updated bundles. 3.1.4.4.1.4.2 2 years 3.1.4.4.1.4.3 In-hospital training sessions by IPC professionals to all concerned HCW. Include Bundle training in the yearly IPC training and in peri employment training. 3.1.4.4.1.4.3 4 years 3.1.4.4.1.4.4 Auditing compliance to these bundles on monthly basis and report to IPC directorate monthly 3.1.4.4.1.4.4 5 years 3.1.4.4.2 Update outcome indicators for the 3 3.1.4.4.2.1 Review updated CDC outcome 3.1.4.4.2.1 6 months Kuwait national action plan on antimicrobial resistance 2022 216 bundles above (CLABSI, CAUTI, VAP) according to new CDC/ guidelines indicators and update already measured bundles outcome indicators accordingly 3.1.4.4.3 Integrate process and outcome indicators for each bundle, and use in the analysis and corrective actions 3.1.4.4.3.1 Put a road map for integrating analysis of outcome and process indicators related to the bundles 3.1.4.4.3.1 1 year 3.1.4.4.4 Introduce SSI bundle 3.1.4.4.4.1 preparation of material 3.1.4.4.4.1 4 years 3.1.4.4.4.2 Implementation of SSI bundle 3.1.4.4.4.2.1 Teaching of IPC professionals by central IPC directorate 3.1.4.4.4.2.1 5 years 3.1.4.4.4.2.2 Teaching of healthcare providers inside the hospitals by IPC professionals 3.1.4.4.4.2.2 5 years 3.1.4.4.4.2.3 Data collection 3.1.4.4.4.2.3 5 years 3.1.5 IPC programs/office in LTCF working in close cooperation with IPC directorate in MOH 3.1.5.1 Mandate from MOH that IPC program/with employee with TOR and specified 3.1.5.1.1 Communication between MOH and Public Authority of Disability Affairs regarding IPC in 3.1.5.1.1.1 Letter from MOH to Public Authority of Disability Affairs asking to establish IPC in each LTCF 3.1.5.1.1.1 2 months Kuwait national action plan on antimicrobial resistance 2022 217 budget are available in LTCF the central and the “branches”. LTCF and being overseen by the IPC directorate and to have the personnel work closely with IPC directorate delegate to LTCF. 3.1.5.1.1.2Letter from Public Authority of Disability Affairs to LTCF that recommends IPC in each LTCF and organizes the communication with MOH 3.1.5.1.1.2 2 months 3.1.5.1.2 Established Guidelines for IPC in LTCF 3.1.5.1.2.1 Preparation of the LTCF guidelines and their endorsement by Public Authority of Disability Affairs 3.1.5.1.2.1 1 year 3.1.5.1.2.2 Dissemination of LTCF Policies and Procedures 3.1.5.1.2.2.1 TOT of LTCF IPC focal persons 3.1.5.1.2.2 1.5 years Strategic objective 3.2 To have the HAI and AMR information digitalized and sent to IPC directorate as a digital report 3.2.1 Software for hospital data entry, analysis and generating both hospital and national reports 3.2.1.1 Subcommittee from IPC directorate sends a letter to Information system department at MOH explaining what is required 3.2.1.1 2 months 3.2 5 years Kuwait national action plan on antimicrobial resistance 2022 218 and asking for the software 3.2.1.2 Health Information system dep. presents projects (either in-house, or ready to buy) with budget providing 3.2.1.2 12 months 3.2.1.3 Agreement between IPC directorate and information system dep. to choose one system 3.2.1.3 1 year 3 months 3.2.1.4 Apply the system in the hospitals 3.2.1.4 1 year 9 months 3.2.1.5 Apply the Digital HAI/AMR System for National data collection from individual hospitals to central IPC directorate 3.2.1.5 2 years 3.2.2 To Shift all hospital information system from paper to digital mode. 3.2.2.1 MOH recommends from hospitals to have an electronic patient and data information system. 3.2.2.1.1 Letter from MOH to hospitals 3.2.2.1.1 2 months Kuwait national action plan on antimicrobial resistance 2022 219 3.2.2.2 Increase the number of hospitals that have digitalized their medical information system - 3.2.2.2 5 years 3.2.3 Connect Infection Control Departments to electronic medical records 3.2.3.1 Connect Infection Control departments in all hospitals with the Heath information system and Laboratory information system at the hospital level 3.2.3.1.1 Letter from MOH to ask all hospitals to connect IC dep. With HIS system and LIS at the hospital level 3.2.3.1.1 2 months 3.2.3.1.2 Decree from MOH to all hospitals who have an electronic Health information system to link their Lab AMR data to the Hospital system 3.2.3.1.2 4 months 3.2.3.2 Develop electronic outbreak reporting system for data entry, analysis and generating reports. 3.2.3.2 3 years 3.2.3.3 Develop electronic reporting system for data entry, analysis and generating hospital/national 3.2.3.3 3 years Kuwait national action plan on antimicrobial resistance 2022 220 reports for bundles of care. 3.2.3.4 Develop electronic infection prevention and control system capable of self identifying HAI and detecting outbreaks 3.2.3.4.1 Electronic system has a function for self diagnosis of HAIs and automatically detects outbreak 3.2.3.4.1 5 years Strategic objective 3.3 Enhance IPC education in all health- related specialties and among HCW. 3.3.1 Include IPC as a core element in education and training of healthcare professionals 3.3.1.1 Include infection control in undergraduate curricula for health care students (medical, nursing, dental and pharmaceutical). 3.3.1.1.1 Prepare module about IPC and AMR to be included in all health specialties in universities/PAAET. 3.3.1.1.1 2 years 3.3 5 years 3.3.1.1.2 MOH letter to Ministry of higher education and The Public Authority for Applied Education and Training to ask to include these modules into the undergrads and graduate health students’ curricula 3.3.1.1.2 2 years Kuwait national action plan on antimicrobial resistance 2022 221 3.3.1.1.3 Modules sent to Kuwait university/ The Public Authority for Applied Education and Training to include it in curricula 3.3.1.1.3 2.5 years 3.3.2 Enhance IPC education among undergraduates and higher education health students 3.3.2.1 Include infection control in continuing education of healthcare workers and mandatory prerequisite for promotion 3.3.2.1.1 Provide IPC courses with CE credits in universities, hospitals, MOH, PAAET, PAAF Include CME Credit 10% IPC 3.3.2.1.1 2 years 3.3.2.1.2 Request that when CE credits for physicians, nurses, or pharmacists is needed, 10% of these credits should be about IPC. 3.3.2.1.2 3 months 3.3.2.1.3 In hospitals, yearly and upon employment, mandatory attendance of IPC lectures 3.3.2.1.3 3 months Kuwait national action plan on antimicrobial resistance 2022 222 3.3.2.2 Hygiene and IPC education provided outside formal teaching programs 3.3.2.2.1 Require IPC education by drug companies, hospitals, LTCFs, FAO, and medical/veterinary associations 3.3.2.2.1.1 Request to include few topics about IPC in conferences agendas 3.3.2.2.1.1 Letter to be sent 3.3.2.2.1.1 6 months Strategic objective 3.4 Prevent occupational infections in HCWs 3.4.1 Develop a comprehensive program of vaccination to protect HCWs from vaccine preventable diseases - - 3.4.1 Available And applied 3.4 5 years 3.4.2 Develop policies and procedures to protect healthcare workers from occupational exposure to infections. - - 3.4.2 Available And applied 3.4.3 Availability of Airborne Isolation Rooms in all hospitals 3.4.3.1 screening mapping and updating the recommendations according to the expected need according to need - 3.4.3.1 5 years 3.4.4 Mandate to hospitals to provide airborne isolation rooms (AII) - - 3.4.4 5 years Kuwait national action plan on antimicrobial resistance 2022 223 available as per the updated recommendations Strategic objective 3.5 Adequate waste management in hospitals 3.5.1 Put National Guidelines 3.5.1.1 National policies, strategies and plans for healthcare waste management is in place 3.5.1.1.1 Unify recommendations between KEPA and MOH 3.5.1.1.1.1 Create a committee from MOH and KEPA that unifies the recommendation and the road map of all types of waste that are generated in healthcare 3.5.1.1.1.1 6 months 3.5 5 years 3.5.1.1.1.2 The committee reviews waste policies that are related to HCF and unifies recommendations and provides the proper ways of supervision 3.5.1.1.1.2 1 year 3.5.2 Supervision of waste disposal from public hospitals 3.5.2.1 Create a committee for the supervision of waste disposal from public hospitals - 3.5.2.1 Available and ongoing 3.5.3 Supervision of waste disposal in private hospitals 3.5.3.1 Create a committee for the supervision of waste disposal in private hospitals - 3.5.3.1 1 year Kuwait national action plan on antimicrobial resistance 2022 224 3.5.4 Waste policies are being audited by KEPA 3.5.4.1 Organization of supervision of waste disposal inside and from private hospitals - 3.5.4.1 1.5 years 3.5.4.2 Designate 1 unit at KEPA to oversee the waste in hospitals 3.5.4.2 1 year Strategic objective 3.6 To enhance infection prevention and control programs in veterinary and agriculture settings 3.6.1 Availability of IPC guidelines in veterinary practices 3.6.1.1 Implementation of OIE guidelines regarding IPC in veterinary field 3.6.1.1.1 Committee in PAAF that regularly checks updates in OIE guidelines regarding IPC in veterinary field, and updates the guidelines accordingly 3.6.1.1.1 6 months 3.6 5 years 3.6.1.1.2 Overseeing the implementation of national IPC guidelines in Vet field and OIE good practices 3.6.1.1.2 Regular audits to farms 3.6.1.1.2 Put a yearly audit plan 3.6.1.1.2 1 year 3.6.2 Include IPC in licensing of Vets 3.6.2.1 Include questions about OIE IPC guidelines and 3.6.2.1.1 Prepare a set of questions related to IPC in Vets to be 3.6.2.1.1 6 months Kuwait national action plan on antimicrobial resistance 2022 225 vaccinations in all vets licensing exams or interviews. included in licensing exams and interviews. 3.6.3 Include IPC in Continuous education of Vets and professionals in Agriculture 3.6.3.1 Prepare a slide bank related to IPC in vet and agriculture, to be given to drug companies that usually do the continuous education activities. - 3.6.3.1 6 months 3.6.3.2 Mandate that all drug company events or seminars include a specific number of slides related to IPC and AMR. - 3.6.3.2 9 months 3.6.4 Include hygiene and infection prevention and control as core content in training of veterinary professionals. 3.6.4.1 Close communication between. FAO and PAAF to put a joint yearly plan of education activities related to IPC. - 3.6.4.1 1 year 3.6.4.2 Include hygiene and infection prevention and control as 3.6.4.2.1 IPC credits mandatory for promotion in Vet. Associations 3.6.4.2.1 6 months Kuwait national action plan on antimicrobial resistance 2022 226 mandatory prerequisite for promotion of for the veterinary workers. B. IPC Monitoring Plan Strategic interventi ons Activity Sub activity Sub-sub activity Sub-sub sub activity Indicator Purpose Calculatio n Frequenc y Data source Method Baseline Strategic Objective 3.1 Emphasize the national infection prevention and control program in healthcare at the National and Health care facility levels. 3.1.1 Create a formal organizati onal structure to ensure proper developm ent and use of infection preventio n and control policies and strategies 3.1.1.1 Infection Control Organizati onal structure is already establishe d and functionin g. - 3.1.1.1 Already available 3.1.1.1 Already available 3.1.1.2 To make official that IPC is part of 3.1.2.1 Decree from MOH about IPC 3.1.2.1 The decree was issued. 3.1.2.1 Already available Kuwait national action plan on antimicrobial resistance 2022 227 the organogra m of each hospital with Terms of Reference and allocated staff departme nt in each hospital with TOR, and staffing organizati on 3.1.1.3 IPC departme nts in hospitals and they work closely with the central IPC Directorat e 3.1.1.3.1 To impose IPC programs in all hospitals 3.1.1.3.1.1 IPC program availabilit y is checked by accreditati on standards 3.1.1.3.1.1 already exists 3.1.1.3.1. 1 Already establishe d 3.1.1.3.2 IPC programs are available in all hospitals and they work under the umbrella of the 3.1.1.3.2 % of Hospitals with IPC programs 3.1.1.3.1. 2 Already establishe d Kuwait national action plan on antimicrobial resistance 2022 228 Central IPC directorat e. 3.1.2 Implemen t laws for mandator y complianc e of the facilities with IPC standards 3.1.2.1 Decree from MOH 3.1.2.1.1 Decree that recomme nds that all HCF have to abide by IPC Recomme ndations. 3.1.2.1.1.1 IPC Directorat e puts the detailed IPC measures that should be required from each HCF, and sent to MOH to be included in ministry 3.1.2.1.1.1 List is sent from IPC Directorat e to MOH Director 3.1.2.1.1.1 Yes/No 3.1.2.1.1.1 Once 3.1.2.1.1.1 IPC Directorat e/ MOH 3.1.2.1.1.1 Checking 3.1.2.1.1. 1 Not available 3.1.2.1.1.2 Decree is issued by MOH 3.1.2.1.1.2 Decree availabilit y and dissemina tion 3.1.2.1.1.2 Abiding by IPC standards is a must in hospitals 3.1.2.1.1.2 Yes/No 3.1.2.1.1.2 once 3.1.2.1.1.2 IPC Directorat e/ MOH 3.1.2.1.1.2 Checking 3.1.2.1.1. 2 Not available 3.1.2.1.2 Medical responsibi lities. Add details IPC standard 3.1.2.1.2.1 Add complianc e to IPC measures and recomme ndations 3.1.2.1.2.1 The Medical responsibi lity list is updated and it includes 3.1.2.1.2.1 To make it official through medical Decisions that obedience 3.1.2.1.2.1 Yes/No 3.1.2.1.2.1 Once /year until they appear in the law 3.1.2.1.2.1 IPC Directorat e/ MOH 3.1.2.1.2.1 Checking 3.1.2.1.2. 1 IPC exists in hospitals and centrally but there Kuwait national action plan on antimicrobial resistance 2022 229 complianc e in hospitals to the list of medical responsibi lities of hospitals as listed by MOH the statement about IPC measures. to IPC measures is a must in Hospitals is no law, so far, that enforces it in the hospitals. 3.1.3 WHO IPC Core compone nt based guidelines are establishe d in all HCF 3.1.3.1 Availabilit y of endorsed IPC based on WHO IPC core compone nts - 3.1.3.1 Available 3.1.3.1 Available 3.1.3.2 IPC policies and procedure s are included in hospital accreditati on standards - 3.1.3.2 Available 3.1.3.2 Available 3.1.3.3 IPC policies and procedure s are being audited regularly by - 3.1.3.3 Available 3.1.3.3 Available Kuwait national action plan on antimicrobial resistance 2022 230 accreditati on bodies 3.1.3.4 National infection control policies and guidelines are distribute d and periodicall y updated 3.1.3.4.1 Regular update of national IPC guidelines 3.1.3.4.1.1 On going, but needs to be speeded up by increasing manpowe r in IPC nationwid e in central office and in hospitals 3.1.3.4.1.1 Proportio n of staff that is needed that has been actually employed 3.1.3.4.1.1 speed up the process of updating policies and guidelines 3.1.3.4.1.1 Number of newly employed in IPC. /Number needed X 100 3.1.3.4.1.1 Once /6 months until all are employed. 3.1.3.4.1.1 IPC Directorat e / MOH 3.1.3.4.1.1 Checking 3.1.3.4.1. 1 The request has been sent to MOH and approval was given, employm ent still in process. 3.1.3.4.2 A direct channel with WHO consultant regarding few queries and new recomme ndations 3.1.3.4.2.1 Communi cate this need to WHO office in Kuwait 3.1.3.4.2.1 .1 Letter from MOH/IPC directorat e to WHO office in Kuwait asking for direct channel with a consultant for queries whenever they occur 3.1.3.4.2.1 .1 Percent of queries to WHO that have been timely answered. 3.1.3.4.2.1 To have a direct channel with a WHO consultant that helps giving answers to questions based on WHO guidelines and recomme ndations 3.1.3.4.2.1 Number of timely answered queries /Number of needed consultati ons X 100 3.1.3.4.2.1 Once/year 3.1.3.4.2.1 MOH/WH O 3.1.3.4.2.1 Checking 3.1.3.4.2. 1 Not available Kuwait national action plan on antimicrobial resistance 2022 231 that might arise 3.1.3.4.2.2 Communi cate this need to Regional WHO office 3.1.3.4.2.2 Request from WCO to Regional office. 3.1.3.4.3 Regular update of National IPC policies and procedure s 3.1.3.4.3.1 Need updating + speeding up the process 3.1.3.4.3.1 % of hospitals that have polices updated in the last 2 years or less. 3.1.3.4.3.1 Number of hospitals with updated policies in the last 2 years or less/Total number of hospitals X 100 3.1.3.4.3.1 Once/Year 3.1.3.4.3.1 Hospitals / Central IPC Directorat e 3.1.3.4.3.1 Checking 3.1.3.4.3. 1 Partially available 3.1.3.5 National IPC Guidelines and policies are being taught 3.1.3.5.1 TOT periodicall y performe d nationally 3.1.3.5.1 % IPC profession als that are trained annually 3.1.3.5.1 To have a unified centralize d training of IPC profession als. 3.1.3.5.1 Number of IPC profession als trained annually /total number of IPC profession als X100 3.1.3.5.1 Once/year 3.1.3.5.1 MOH/ Central IPC Directorat e 3.1.3.5.1 Checking 3.1.3.5.1 Ongoing, Exact numbers are unknown. 3.1.3.5.2 Continuou s 3.1.3.5.2.1 Mandate 3.1.3.5.2.1 Decree is done and 3.1.3.5.2. 1 Yes/no Kuwait national action plan on antimicrobial resistance 2022 232 training of HCW about IPC policies in hospitals is available from MOH that it is mandator y to all HCW to attend at least 1 yearly and 1 upon employm ent sent to hospitals. 3.1.3.5.2.2 Improve attendanc e to these general HCW IPC training sessions 3.1.3.5.2.2 .1 Attendanc e is reported to hospital administr ators and action taken to improve attendanc e 3.1.3.5.2.2 .1 % of HCW that attend the training sessions yearly 3.1.3.5.2.2 .1 Number of HCW attendees /total number of HCW /year X100 3.1.3.5.2.2 .1 Once/year 3.1.3.5.2.2 .1 Hospitals/ Central IPC Directorat e 3.1.3.5.2.2 .1 Data collection 3.1.3.5.2. 2.1 Training is recomme nded and provided, attendanc e is suboptim al 3.1.3.5.2.2 .2 Attendanc e evidence is available in yearly Hospital IPC report Kuwait national action plan on antimicrobial resistance 2022 233 and monitored by IPC Directorat e 3.1.4 Monitor and evaluate complianc e with the IPC guidelines 3.1.4.1 Checklists and audit tools are prepared and applied 3.1.4.1 and 3.1.4.2 Percent of policies that have correspon ding audit tools. 3.1.4.1 and 3.1.4.2 To make audit tools unified nationally and readily available and to facilitate National data collection if needed 3.1.4.1 and 3.1.4.2 Number of policies with audit tools/Tota l number of policies X100 3.1.4.1 and 3.1.4.2 Once/year 3.1.4.1 and 3.1.4.2 IPC directorat e 3.1.4.1 and 3.1.4.2 Checking 3.1.4.1 and 3.1.4.2 Partially available 3.1.4.2 Regular updates of these audit tools 3.1.4.2.1 Check new policies if they have their audit tools prepared and dissemina ted and check old tools if Kuwait national action plan on antimicrobial resistance 2022 234 they need update 3.1.4.3 Audit plan available in hospitals 3.1.4.3.1 Audit plan is checked in standards of the National Accreditat ion Program applied by the Quality and Accreditat ion Directorat e 3.1.4.3.1 Done and ongoing 3.1.4.3.1 Done and ongoing 3.1.4.3.2 Central audit plan is being prepared annually and distribute d to all hospitals 3.1.4.3.2 Done and ongoing 3.1.4.3.2 % of hospitals that perform audit according to the centralize d audit plan and audit. tools. 3.1.4.3.2 Number of hospitals that perform audit according to the centralize d audit plan and audit tools/total number of 3.1.4.3.2 Once/year 3.1.4.3.2 Hospitals/ Digital central IPC program 3.1.4.3.2 Data collection 3.1.4.3.2 Partially performe d Kuwait national action plan on antimicrobial resistance 2022 235 hospitals X100 3.1.4.3.3 Audit report is sent to central IPC directorat e with corrective actions. 3.1.4.3.3 Done and ongoing 3.1.4.3.3 % of hospitals that report the results of their audits to IPC 3.1.4.3.3 Number of hospitals that report the results of their audits to IPC/Total number of hospitals X100 3.1.4.3.3 Once/year 3.1.4.3.3 Hospitals/ Digital central IPC program 3.1.4.3.3 Data collection 3.1.4.3.3 Partially performe d 3.1.4.4 Establish national process indicators 3.1.4.4.1 1st set of process indicators: CLABSI CAUTI VAP 3.1.4.4.1.1 Put the basic training material 3.1.4.4.1.1 Each one of the 4 procedure s has its own bundle establishe d 3.1.4.4.1.1 To improve quality of care by using the bundle approach in all HCF 3.1.4.4.1.1 Yes/No 3.1.4.4.1.1 Checking 3.1.4.4.1.1 MOH/ IPC directorat e 3.1.4.4.1.1 Checking 3.1.4.4.1. 1 Not available 3.1.4.4.1.2 Update of the already available bundle of care in each of the mentione d bundles, by 3.1.4.4.1.2 Prepare the updated bundles 3.1.4.4.1.2 Availabilit y of 3 updated bundles 3.1.4.4.1.2 To make quality of care up to-date regarding the 3 procedure s and to improve outcome 3.1.4.4.1.2 Yes or no x 3 (For each bundle) 3.1.4.4.1.2 Once /6 months until availabilit y 3.1.4.4.1.2 IPC directorat e 3.1.4.4.1.2 Checking 3.1.4.4.1. 2 Old version of bundles available Kuwait national action plan on antimicrobial resistance 2022 236 including new evidence based items to the bundle 3.1.4.4.1.3 Train the IPC profession als nationwid e on the updated bundles 3.1.4.4.1.3 .1 TOT workshop s 3.1.4.4.1.3 % IPC profession als trained about the new bundles 3.1.4.4.1.3 To dissemina te the updated bundles to all IPC profession als nationally 3.1.4.4.1.3 Number of IPC profession als trained about the new bundles /Total number of IPC profession als. 3.1.4.4.1.3 Once/year 3.1.4.4.1.3 IPC directorat e/Hospital s 3.1.4.4.1.3 Data collection 3.1.4.4.1. 3 IPC profession als have been trained on the older version of the bundles. 3.1.4.4.1.4 Engage all HCW with the bundles by training, audit and feedback. 3.1.4.4.1.4 .1 Prepare the ground in the hospitals: Letter to hospital directors about the bundles project its importanc 3.1.4.4.1.4 .1 Letter sent or not 3.1.4.4.1.4 .1 Yes /No 3.1.4.4.1.4 .1 Once 3.1.4.4.1.4 .1 IPC directorat e/ MOH 3.1.4.4.1.4 .1 Checking 3.1.4.4.1. 4.1 Not available Kuwait national action plan on antimicrobial resistance 2022 237 e and its processes 3.1.4.4.1.4 .2 Update the material to be taught to HCW by IPC profession als, according to the updated bundles. 3.1.4.4.1.4 .2 % of material directed to HCW that has been updated 3.1.4.4.1.4 .2 To synchroni ze the teaching of the IPC bundle material with the training of the HCW other than the IPC profession als. 3.1.4.4.1.4 .2 Updated bundle material directed to HCW/Nu mber of bundles x100 3.1.4.4.1.4 .2 Once/Year 3.1.4.4.1.4 .2 IPC directorat e/Hospital training material 3.1.4.4.1.4 .2 Checking 3.1.4.4.1. 4.2 The material to be taught to HCW is based on. the classical bundle training 3.1.4.4.1.4 .3 In hospital training sessions by IPC profession als to all concerned HCW. Include Bundle training in the yearly IPC training 3.1.4.4.1.4 .3 Complianc e with performa nce indicator for each bundle 3.1.4.4.1.4 .3 To increase the complianc e to bundles to prevent HAI and improve the quality of care 3.1.4.4.1.4 .3 Once/Year 3.1.4.4.1.4 .3 Hospitals 3.1.4.4.1.4 .3 Checking 3.1.4.4.1. 4.3 The material to be taught to HCW is based on. the classical bundle training Kuwait national action plan on antimicrobial resistance 2022 238 and in peri employm ent training. 3.1.4.4.1.4 .4 Auditing complianc e to these bundles on monthly basis and report to IPC directorat e monthly 3.1.4.4.1.4 .4 Process Indicator for each of the 3 bundles: For each bundle: % Complianc e by the specific bundle /opportun ities of audit for each bundle 3.1.4.4.1.4 .4 To increase the complianc e with the updated bundles and improve the related quality of care 3.1.4.4.1.4 .4 % of auditing opportuni ties that are compliant with the bundle checklist/t otal number of audited complianc e with updated bundle X 100 3.1.4.4.1.4 .4 twice/yea r 3.1.4.4.1.4 .4 Hospitals Central Digital IPC system 3.1.4.4.1.4 .4 Data collection 3.1.4.4.1. 4.4 There are already process indicators related to the old bundles 3.1.4.4.2 Update outcome indicators for the 3 bundles above (CLABSI, CAUTI, VAP) 3.1.4.4.2.1 Review updated CDC outcome indicators and update already measured 3.1.5.4.2.1 Number of outcome indicator tools and benchmar k is updated. 3.1.5.4.2.1 To be in line with internatio nal data benchmar k. 3.1.5.4.2.1 Number of updates outcome bundles 3.1.5.4.2.1 Once until all 3 indicators are updates 3.1.5.4.2.1 IPC Directorat e 3.1.5.4.2.1 Checking 3.1.5.4.2. 1 Outcome bundles methodol ogy need revision and update Kuwait national action plan on antimicrobial resistance 2022 239 according to new CDC/ guidelines bundles outcome indicators accordingl y 3.1.4.4.3 Integrate process and outcome indicators for each bundle, and use in the analysis and corrective actions 3.1.4.4.3.1 Put a road map for integratin g analysis of outcome and process indicators related to the bundles 3.1.5.4.3.1 Proportio n of bundles whose analysis integrates process and outcome data 3.1.5.4.3.1 To use all the available data and means to improve outcome results 3.1.5.4.3.1 Number of bundles whose analysis integrates process and outcome data/3 3.1.5.4.3.1 Once/6 months 3.1.5.4.3.1 IPC Directorat e 3.1.5.4.3.1 Data collection 3.1.5.4.3. 1 Process and outcome bundles are not being interprete d together yet 3.1.4.4.4 Introduce SSI bundle 3.1.4.4.4.1 preparatio n of material 3.1.5.4.4.1 material that is prepared 3.1.5.4.4.1 To track and minimize SSI 3.1.5.4.4.1 Yes/no 3.1.5.4.4.1 Once 3.1.5.4.4.1 IPC Directorat e 3.1.5.4.4.1 Literature search WHO/Inte rnational literature 3.1.5.4.4. 1 Not done 3.1.4.4.4.2 Implemen tation of SSI bundle 3.1.4.4.4.2 .1 Teaching of IPC profession als by central IPC directorat e 3.1.5.4.4.2 % hospitals start submittin g process and outcome indicators for SSI. 3.1.5.4.4.2 To measure SSI complianc e to bundles elements and to track SSI incidence 3.1.5.4.4.2 Number of hospitals start submittin g process and outcome indicators for SSI/ 3.1.5.4.4.2 Once/Year 3.1.5.4.4.2 Hospitals/ IPC directorat e 3.1.5.4.4.2 Checking 3.1.5.4.4. 2 Not available Kuwait national action plan on antimicrobial resistance 2022 240 Total number of hospitals x100 3.1.4.4.4.2 .2 Teaching of healthcar e providers inside the hospitals by IPC profession als 3.1.4.4.4.2 .3 Data collection 3.1.5 IPC programs/ office in LTCF working in close cooperati on with IPC directorat e in MOH 3.1.5.1 Mandate from MOH that IPC program/ with employee with TOR and specified budget are available in LTCF 3.1.5.1.1 Communi cation between MOH and Public Authority of Disability Affairs regarding IPC in LTCF and being overseen 3.1.5.1.1.1 Letter from MOH to Public Authority of Disability Affairs asking to establish IPC in each LTCF and to have the 3.1.5.1.1.1 Present Kuwait national action plan on antimicrobial resistance 2022 241 the central and the “branches ”. by the IPC directorat e personnel work closely with IPC directorat e delegate to LTCF. 3.1.5.1.1.2 Letter from Public Authority of Disability Affairs to LTCF that recomme nds IPC in each LTCF and organizes the communic ation with MOH 3.1.5.1.1.2 Letter sent 3.1.5.1.1.2 Yes /No 3.1.5.1.1.2 Once 3.1.5.1.1.2 MOH 3.1.5.1.1.2 Checking 3.1.5.1.1. 2 Partially available 3.1.5.1.2 Establishe d Guidelines for IPC in LTCF 3.1.5.1.2.1 Preparatio n of the LTCF guidelines and their endorsem ent by Public Authority 3.1.5.1.2.1 Availabilit y of the endorsed guidelines and set of policies and procedure s 3.1.5.1.2.1 Proper unified IPC practices at LTCF 3.1.5.1.2.1 Yes /No 3.1.5.1.2.1 Once 3.1.5.1.2.1 MOH 3.1.5.1.2.1 Checking 3.1.5.1.2. 1 Not available Kuwait national action plan on antimicrobial resistance 2022 242 of Disability Affairs 3.1.5.1.2.2 Dissemina tion of LTCF Policies and Procedure s 3.1.5.1.2.2 .1 TOT of LTCF IPC focal persons 3.1.5.1.2.2 % focal IPC persons in LTCF trained on the guidelines /total number of LTCF IPC focal persons. 3.1.5.1.2.1 Proper unified IPC practices at LTCF 3.1.5.1.2.1 Number of focal persons trained /total number of focal persons *100 3.1.5.1.2.1 Once/year 3.1.5.1.2.1 MOH 3.1.5.1.2.1 Checking 3.1.5.1.2. 1 Not available Strategic objective 3.2 To have the HAI and AMR information digitalized and sent to IPC directorate as a digital report 3.2.1 Software for hospital data entry, analysis and generatin g both hospital and national reports 3.2.1.1 Subcommi ttee from IPC directorat e sends a letter to Informati on system departme nt at MOH explaining what is required and asking for the software 3.2.1 Software developed and working 3.2.1 Simplify the follow-up on tracking AMR/HAI data by MOH IPC directorat e 3.2.1 Yes/No 3.2.1 Once 3.2.1 MOH/ IPC directorat e 3.2.1 Checking 3.2.1 Not available 3.2.1.2 See above Kuwait national action plan on antimicrobial resistance 2022 243 Informati on system dep. presents projects (either in house, or ready to buy) with budget providing 3.2.1.3 Agreemen t between IPC directorat e and informatio n system dep. to choose one system See above 3.2.1.4 Apply the system in the hospitals See above 3.2.1.5 Apply the Digital HAI/AMR System for National data See above Kuwait national action plan on antimicrobial resistance 2022 244 collection from individual hospitals to central IPC directorat e 3.2.2 To Shift all hospital informatio n system from paper to digital mode. 3.2.2.1 MOH recomme nds from hospitals to have an electronic patient and data informatio n system. 3.2.2.1.1 Letter from MOH to hospitals 3.2.2.1.1 Letter is sent 3.2.2.1.1 Yes /No 3.2.2.1.1 Once 3.2.2.1.1 MOH 3.2.2.1.1 Checking 3.2.2.1.1 Partially available in some hospitals 3.2.2.2 Increase the number of hospitals that have digitalized their medical informatio n system - 3.2.2.2 % hospitals with digital informatio n system 3.2.2.2 improving all aspects of patient care 3.2.2.2 Number of hospitals with electronic medical records/T otal number of hospitals *100 3.2.2.2 Once/year 3.2.2.2 Hospitals 3.2.2.2 Checking 3.2.2.2 Partially available in some hospitals 3.2.3 Connect Infection Control 3.2.3.1 Connect Infection Control departme 3.2.3.1.1 Letter from MOH to ask all 3.2.3.1.1 % IC dep connected with 3.2.3.1.1 proper HAI surveillan ce and 3.2.3.1.1 Number of IC dep connected with 3.2.3.1.1 Once/year 3.2.3.1.1 Hospitals/ IPC directorat e / MOH 3.2.3.1.1 Checking 3.2.3.1.1 partially available in some hospitals Kuwait national action plan on antimicrobial resistance 2022 245 Departme nts to electronic medical records nts in all hospitals with the Heath informatio n system and Laborator y informatio n system at the hospital level hospitals to connect IC dep. with HIS and LIS at the hospital level HIS/LIS in hospitals preventio n thus improving patient care HIS/LIS in hospitals /Total number of hospitals *100 3.2.3.1.2 Decree from MOH to all hospitals who have an electronic Health informatio n system to link their Lab AMR data to the Hospital system 3.2.3.1.2 % of IC dep connected with electronic AMR data in hospitals 3.2.3.1.2 Better HAI and AMR surveillan ce on the national level 3.2.3.1.2 number of IC dep connected with electronic AMR data in hospitals /Total number of hospitals *100 3.2.3.1.2 Once/year 3.2.3.1.2 Hospitals/ IPC directorat e/ MOH 3.2.3.1.2 Checking 3.2.3.1.2 Not available 3.2.3.2 Develop electronic 3.2.3.2 electronic outbreak 3.2.3.2 Better managem 3.2.3.2 Yes/No 3.2.3.2 Once 3.2.3.2 Hospitals 3.2.3.2 Checking 3.2.3.2 Not available Kuwait national action plan on antimicrobial resistance 2022 246 outbreak reporting system for data entry, analysis and generatin g reports. reporting system available ent and control of outbreaks 3.2.3.3 Develop electronic reporting system for data entry, analysis and generatin g hospital/n ational reports for bundles of care. 3.2.3.3 Bundles data collection, analysis and generatin g hospitals /national reports is done through. an electronic advanced system Yes/No 3.2.3.3 Better monitorin g and auditing of bundles of care 3.2.3.3 Yes/No 3.2.3.3 Once 3.2.3.3 Hospitals /IPC directorat e 3.2.3.3 Checking 3.2.3.3 Not available 3.2.3.4 Develop electronic infection preventio n and control system capable of 3.2.3.4.1 Electronic system has a function for self diagnosis of HAIs and 3.2.3.4. % of HAIs and outbreaks in hospitals are automatic ally 3.2.3.4.1 Better tracking and managem ent of HAIs and outbreaks and 3.2.3.4.1 Number HAIs and outbreaks detected/ Total number of HAIs and outbreaks 3.2.3.4.1 Once/year 3.2.3.4.1 IPC directorat e/ Hospitals 3.2.3.4.1 Checking 3.2.3.4.1 Not available Kuwait national action plan on antimicrobial resistance 2022 247 self identifyin g HAI and detecting outbreaks automatic ally detects outbreak detected by the IT system preventin g spread Strategic Objective 3.3 Enhance IPC education in all health- related specialties and among HCW. 3.3.1 Include IPC as a core element in education and training of healthcar e profession als 3.3.1.1 Include infection control in undergrad uate curricula for health care students (medical, nursing, dental and pharmace utical). 3.3.1.1.1 Prepare module about IPC and AMR to be included in all health specialties in universitie s/PAAET. 3.3.1.1.1 Module is available 3.3.1.1.1 To provide all health specialties with IPC material to be taught in undergrad uate and post graduate education 3.3.1.1.1 Yes/No 3.3.1.1.1 Once 3.3.1.1.1 IPC Directorat e 3.3.1.1.1 Checking 3.3.1.1.1 Not available 3.3.1.1.2 MOH letter to MOHE and PAAET to ask to include this modules into the undergrad s and graduate 3.3.1.1.2 Letters sent 3.3.1.1.2 To make it official and speed up the inclusion of these modules into the curricula 3.3.1.1.2 Yes/No 3.3.1.1.2 Once 3.3.1.1.2 IPC Directorat e 3.3.1.1.2 Checking 3.3.1.1.2 Not sent yet Kuwait national action plan on antimicrobial resistance 2022 248 health students’ curricula 3.3.1.1.3 Modules sent to Kuwait university / PAAET to include it in curricula 3.3.1.1.3 % health specialties that include IPC module 3.3.1.1.3 To incorporat e IPC training in all health specialties including dentistry 3.3.1.1.3 Health specialties programs that include IPC module/T otal health specialties programs X 100 3.3.1.1.3 Once/6 months until all programs do include IPC modules 3.3.1.1.3 Universiti es/PAAET 3.3.1.1.3 Data collection 3.3.1.1.3 Partially available 3.3.2 Enhance IPC education among undergrad uates and higher education health students 3.3.2.1 Include infection control in continuing education of healthcar e workers and mandator y prerequisi te for promotio n 3.3.2.1.1 Provide IPC courses with CE credits in universitie s, hospitals, MOH, PAAET PAAF Include CME Credit 3.3.2.1.1 Number of IPC courses/ year 3.3.2.1.1 To provide opportuni ty of IPC education among non-IPC HCW and to promote IPC as a job among students and HCW 3.3.2.1.1 Number/ year 3.3.2.1.1 Once/year 3.3.2.1.1 Universiti es/PAAET KIMS 3.2.2.1.1 Data collection 3.3.2.1.1 Not available Kuwait national action plan on antimicrobial resistance 2022 249 10% IPC 3.3.2.1.2 Request that when CE credits for physicians , nurses, or pharmacis ts is needed, 10% of these credits should be about IPC. 3.3.2.1.2 % profession als have 10% of their CE credits are related to IPC 3.3.2.1.2 To provide IPC education to all HCW, and not to IPC profession als alone 3.3.2.1.2 Number of HC profession als that have CE related to IPC/Total number of profession als who are requested to have CE credits. 3.3.2.1.2 Once/year 3.3.2.1.2 Syndicates of HC profession als (MDs, nurses, pharmacis ts, dentists, physiothe rapists, technician s) 3.3.2.1.2 Data collection 3.3.2.1.2 Not available 3.3.2.1.3 In hospitals, yearly and upon employm ent, mandator y attendanc e of IPC lectures 3.3.2.1.3 % hospitals that mandated that all employee get IPC training upon employm ent and yearly IPC lecture. 3.3.2.1.3 To update and remind and engage HCW with IPC 3.3.2.1.3 Number of hospitals that have this program /total number of hospitals 3.3.2.1.3 Once/year 3.3.2.1.3 Hospitals 3.3.2.1.3 Data collection 3.3.2.1.3 Partially available 3.3.2.2 Hygiene and IPC education provided 3.3.2.2.1 Require IPC education by drug 3.3.2.2.1.1 Request to include few topics about IPC 3.3.2.2.1.1 .1 Letter to be sent 3.3.2.2.1.1 .1 Yes/No 3.3.2.2.1.1 .1 Yes/No 3.3.2.2.1.1 .1 Once/conf erence 3.3.2.2.1.1 .1 conferenc e organizers 3.3.2.2.1.1 .1 Checking 3.3.2.2.1. 1.1 Not available Kuwait national action plan on antimicrobial resistance 2022 250 outside formal teaching programs companie s, hospitals, LTCFs, FAO, and medical/v eterinary associatio ns in conferenc es agendas Strategic Objective 3.4 Prevent occupational infections in HCWs 3.4.1 Develop a comprehe nsive program of vaccinatio n to protect HCWs from vaccine preventab le diseases - - 3.4.1 % of HCWs profession als that are vaccinate d 3.4.1 Prevent vaccine preventab le diseases 3.4.1 Number of HCW who are vaccinate d/Total number of HCW*100 3.4.1 Once/year 3.4.1 MOH Hospitals/ Public Health Directorat e 3.4.1 Checking 3.4.1 Partially available 3.4.2 Develop policies and procedure s to protect healthcar e workers from - - 3.4.2 Yes/No 3.4.2 Prevent occupatio nal exposure to infections among HCW 3.4.2 Yes/No 3.4.2 Once 3.4.2 Hospitals 3.4.2 Checking 3.4.2 Partially available Kuwait national action plan on antimicrobial resistance 2022 251 occupatio nal exposure to infections. 3.4.3 Availabilit y of Airborne Isolation Rooms in all hospitals 3.4.3.1 screening mapping and updating the recomme ndations according to the expected need according to need - 3.4.3.1 Yes/No 3.4.3.1 proper managem ent of airborne infections and improving quality of care 3.4.3.1 Yes/No 3.4.3.1 Once 3.4.3.1 Hospitals 3.4.3.1 Checking 3.4.3.1 Partially available 3.4.4 Mandate to hospitals to provide airborne isolation rooms (AII) available as per the updated recomme ndations - - 3.4.4 Percent hospitals have enough AII rooms as per MOH recomme ndation 3.4.4 Prevent spread of airborne infections plus proper managem ent 3.4.4 Number of hospitals with enough AII rooms /total number of hospitals* 100 3.4.4 Once/year 3.4.4 MOH Hospitals 3.4.4 Checking 3.4.4 Partially available Strategic Objective 3.5 Adequate waste management in hospitals 3.5.1 3.5.1.1 3.5.1.1.1 3.5.1.1.1.1 - 3.5.1.1.1.1 3.5.1.1.1.1 Yes/No 3.5.1.1.1.1 Once 3.5.1.1.1.1 MOH 3.5.1.1.1.1 Checking 3.5.1.1.1. 1 Kuwait national action plan on antimicrobial resistance 2022 252 Put National Guidelines National policies, strategies and plans for healthcar e waste managem ent is in place Unify recomme ndations between KEPA and MOH Create a committe e from MOH and KEPA that unifies the recomme ndation and the road map of all types of waste that are generated in healthcar e Committe e members are nominate d KEPA Not available 3.5.1.1.1.2 The committe e reviews waste policies that are related to HCF and unifies recomme ndations and provides the proper ways of 3.5.1.1.1.2 Percent chapters that represent conflict between recomme ndations of the 2 ministries that have been reviewed and unified 3.5.1.1.1.2 Unify recomme ndation and thus proper methods of supervisio n 3.5.1.1.1.2 number of chapters edited /total number of chapters* 100 3.5.1.1.1.2 Once 3.5.1.1.1.2 MOH KEPA 3.5.1.1.1.2 Checking 3.5.1.1.1. 2 Not available Kuwait national action plan on antimicrobial resistance 2022 253 supervisio n 3.5.2 Supervisio n of waste disposal from public hospitals 3.5.2.1 Create a committe e for the supervisio n of waste disposal from public hospitals - 3.5.2.1 Available and ongoing 3.5.3 Supervisio n of waste disposal in private hospitals 3.5.3.1 Create a committe e for the supervisio n of waste disposal in private hospitals - 3.5.3.1 Yes/No 3.5.3.1 overseein g proper waste disposal 3.5.3.1 Yes/No 3.5.3.1 Once 3.5.3.1 private hospitals 3.5.3.1 Checking 3.5.3.1 Not available 3.5.4 Waste policies are being audited by KEPA 3.5.4.1 Organizati on of supervisio n of waste disposal inside and from private hospitals - 3.5.4.1 % Public hospitals are being audited for waste disposal. 3.5.4.1 Ensure proper waste managem ent and preventio n of environm ent contamin ation 3.5.4.1 Number of audited hospitals/ total number of hospitals *100 3.5.4.1 Once/year 3.5.4.1 KEPA 3.5.4.1 Checking 3.5.4.1 Not available 3.5.4.2 - - 3.5.4.2 3.5.4.2 Yes/No 3.5.4.2 Once 3.5.4.2 KEPA 3.5.4.2 Checking 3.5.4.2 Kuwait national action plan on antimicrobial resistance 2022 254 Designate 1 unit at KEPA to oversee the waste in hospitals % Private hospitals where waste managem ent is being supervise d Not available Strategic Objective 3.6 To enhance infection prevention and control programs in veterinary and agriculture settings 3.6.1 Availabilit y of IPC guidelines in veterinary practices 3.6.1.1 Implemen tation of OIE guidelines regarding IPC in veterinary field 3.6.1.1.1 Committe e in PAAF that regularly checks updates in OIE guidelines regarding IPC in veterinary field, and updates the guidelines accordingl y 3.6.1.1.1 Committe e is formed 3.6.1.1.1 To have up-to date guidelines and to have local responsibl e bodies involved rather than internatio nal NGOs alone. 3.6.1.1.1 Guidelines availabilit y and Update at least once/3 years 3.6.1.1.1 Once/year 3.6.1.1.1 PAAF 3.6.1.1.1 Checking the guidelines . 3.6.1.1.1 Guideline s available, need improved governanc e 3.6.1.1.2 Overseein g the implemen tation of national IPC guidelines 3.6.1.1.2 Regular audits to farms 3.6.1.1.2 Put a yearly audit plan 3.6.1.1.2 % Farms that are being audited yearly for IPC measures. 3.6.1.1.2 To check the applicatio n of IPC guidance in farms 3.6.1.1.2 Number of farms that are being audited yearly for IPC 3.6.1.1.2 Once/year 3.6.1.1.2 Farms 3.6.1.1.2 Data collection 3.6.1.1.2 Not performe d Kuwait national action plan on antimicrobial resistance 2022 255 in Vet field and OIE good practices measures/ Total number of farms X 100 3.6.2 Include IPC in licensing of Vets 3.6.2.1 Include questions about OIE IPC guidelines and vaccinatio ns in all vets licensing exams or interviews . 3.6.2.1.1 Prepare a set of questions related to IPC in Vets to be included in licensing exams and interviews . 3.6.2.1.1 Availabilit y of IPC questions in licensing exams (Yes/No) 3.6.2.1.1T o promote revision of IPC practices in preparatio n for pre employm ent interviews and exams 3.6.2.1.1 Yes/No 3.6.2.1.1 Yearly 3.6.2.1.1 PAAF Exam material 3.6.2.1.1 Checking 3.6.2.1.1 Not available 3.6.3 Include IPC in Continuou s education of Vets and profession als in Agricultur e 3.6.3.1 Prepare a slide bank related to IPC in vet and agricultur e, to be given to drug companie s that usually do the continuou s - 3.6.3.1 Yes/No 3.6.3.1 Improve IPC knowledg e among profession als in vet/agricu lture fields 3.6.3.1 Yes/No 3.6.3.1 Once 3.6.3.1 PAAF 3.6.3.1 Checking 3.6.3.1 Not available Kuwait national action plan on antimicrobial resistance 2022 256 education activities. 3.6.3.2 Mandate that all drug company events or seminars include a specific number of slides related to IPC and AMR. - 3.6.3.2 Mandate available or not 3.6.3.2 To oblige drug companie s that are almost the only provider of CE, to include IPC in their presentati ons. 3.6.3.2 Mandate issued: Yes/No 3.6.3.2 Once 3.6.3.2 PAAF 3.6.3.2 Checking 3.6.3.2 Not available 3.6.4 Include hygiene and infection preventio n and control as core content in training of veterinary profession als. 3.6.4.1 Close communic ation between. FAO and PAAF to put a joint yearly plan of education activities related to IPC. - 3.6.3.2 Joint education plan between FAO and PAAF that includes IPC related training 3.6.3.2 To provide CE by nonprofit organizati ons to eliminate the possibility of commerci al bias while teaching IPC 3.6.3.2 Plan available: Yes/No 3.6.3.2 Once/year 3.6.3.2 PAAF FAO 3.6.3.2 Checking 3.6.3.2 Not available 3.6.4.2 3.6.4.2.1 - - 3.6.4.2.1 3.6.4.2.1 3.6.4.2.1 3.6.4.2.1 Once 3.6.4.2.1 3.6.4.2.1 Checking 3.6.4.2.1 Kuwait national action plan on antimicrobial resistance 2022 257 Include hygiene and infection preventio n and control as mandator y prerequisi te for promotio n of for the veterinary workers. IPC credits mandator y for promotio n in Vet. Associatio ns Mandate available or not To enhance IPC education and update among vets. Mandate issued yes/no Vet associatio n Not available Kuwait national action plan on antimicrobial resistance 2022 258 Annex 5 A. Antimicrobial Use Strategic Plan Activity Sub-activity Sub-sub-activity Date Milestone for strategic objective Strategic Objective 4.1 Ensure governance of antibiotic axis pillar and follow up of the activities of this pillar 4.1.1 Identify who will be the ABX arm pillar focal point in each ministry/authority and assign the TOR 4.1.1 6 months 4.1 2 years 4.1.2 Prepare clear TOR of the focal person for ABX in each ministry/ authority 4.1.2 2 months 4.1.3 Assign the job to a defined person/position in each ministry/ authority, and nomination by the director of each ministry. 4.1.3 3 months 4.1.4 Put TOR and reimbursement plan for the different tasks. 4.1.4 3 months 4.1.5 Nominate the stakeholders for the task force of the pillar 4.1.5 4 months Strategic Objective 4.2 Ensure uninterrupted access to high-quality antimicrobial medicines 4.2.1 Put clear criteria for standards of quality safety and efficiency of ABX 4.2.1 System is in place 4.2 Available 4.2.2 Put a system of controlling that all available ABX in the country should meet the international standards listed above 4.2.2 Already available, Only ABX that are licensed by WHO, EMEA or FDA, are allowed in the market Kuwait national action plan on antimicrobial resistance 2022 259 otherwise they are not allowed to be in the market. 4.2.3 All ABX should be tested by a system that identifies counterfeit prior to licensing. 4.2.3 Available 4.2.4 Put regulations that prohibit the sale of counterfeit products 4.2.4 Available 4.2.5 The system that controls quality assurance of ABX has the authority to stop counterfeit products from being licensed and marketed 4.2.5 available Strategic Objective 4.3 Develop and enforce legislation and regulations on prescription and dispensing of medicine including antibiotics 4.3.1 Develop and implement national essential medicine list guided by the WHO Model List of Essential Medicines 4.3.1.1 Finalize the essential medicine list that is being prepared at MOH 4.3.1.1 6 months 4.3 4 years 4.3.2 Mandate that every institution has an essential medicine list 4.3.2 6 months 4.3.3 Each institution has an essential medicine list and this is checked in accreditation standards include checking the availability of the essential medicine list 4.3.3.1 Mandate from MOH that once the national essential medicine list is available, all hospitals including public and private hospitals should formulate their own list 4.3.3.1 8 months 4.3.3.2 Include the availability of essential medicine list into the license renewal 4.3.3.2.1 Private hospital renewal license 4.3.3.2.1 8 months Kuwait national action plan on antimicrobial resistance 2022 260 conditions of private hospitals checklist should include the availability of essential medicine list 4.3.4 Re imbursement plan is based on essential medicine list in public and private hospitals 4.3.4 8 months Strategic Objective 4.4 Start AMS program in primary healthcare 4.4.1 Create a technical group that puts national ABX use guidelines for outpatient care based on International guidelines and National AMR profiles: can be a subcommittee from the national task force for the ABX pillar for proper use of ABX 4.4.1.1 Put TOR and renewal conditions of the focal group of stakeholders 4.4.1.1 3 months 4.4 5 years 4.4.1.2 Assign the members of this committee 4.4.1.2 3 months 4.4.1.3 Put TOR and official renewal time for the guidelines committee 4.4.1.3 3 months 4.4.2 Guidelines in primary healthcare are available and are regularly updated 4.4.2 6 months 4.4.2.1 Training workshop about ABX guidelines in primary healthcare 4.4.2.1 5 years 4.4.3 Apply AMS in primary healthcare: Monitoring ABX consumption and Link prescription to diagnoses 4.4.3.1 Project ABX consumption documentation and surveillance in primary healthcare 4.4.3.1.1 Put a proposal for this project 4.4.3.1.1 8 months Kuwait national action plan on antimicrobial resistance 2022 261 4.4.3.2 Start collecting data and link it to diagnosis 4.4.3.2 10 months 4.4.3.3 Data analysis and feedback to prescribers 4.4.3.3 1 year 4.4.3.4 Employ more pharmacists in primary healthcare 4.4.3.4 1 year 4.4.3.5 Improve manpower with professionals for the AMS project in primary healthcare 4.4.3.5.1 Train available pharmacists on AMS and clinical pharmacy principles 4.4.3.5.1 18 months 4.4.3.5.2 Employ new clinical pharmacist specialized in AMS and 1 full time clinical microbiologist in primary healthcare directorate 4.4.3.5.2 18 months 4.4.4 Update the digital system that is available in primary healthcare to integrate the ABX guidelines into the electronic system in the form of pop-ups 4.4.4 2 years Strategic Objective 4.5 Apply AMS In Public and Private hospitals 4.5.1 Improve and measure appropriate use of antimicrobial agents in healthcare 4.5.1.1 Nominate who will be the AMS focal person (Could be the ABX pillar focal person) 4.5.1.1 3 months 4.5 5 years Kuwait national action plan on antimicrobial resistance 2022 262 4.5.2 Identify the National AMS Task force (Could be a subcommittee of the ABX pillar Task force) the National AMS Technical team 4.5.2.1 AMS technical group is assigned (subgroup from the ABX technical committee. +other specialists like IT, etc) 4.5.2.1 3 months 4.5.2.2 TOR of the technical groups are well defined They include: guidelines for inpatient and outpatient care. put or endorse diagnostic pathways, treatment and national AMS targets 4.5.2.2 3 months 4.5.3 Put national guidelines either de novo or Endorse existing international guidelines with regular updates 4.5.3.1 MOH puts national guidelines for common community acquired infections (CAI) 4.5.3.1 6 months 4.5.3.2 Hospitals put institutional guidelines for treatment of Healthcare associated (HAI) according to their local epidemiology, with the help of taskforce members 4.5.3.2.1 Mandate for hospitals to issue HAI treatment guidelines based on local epidemiology and with the help of taskforce members 4.5.3.2.1 6 months 4.5.3.2.2 Organize the work of taskforce members with the different hospitals to assist in putting their own HAI guidelines 4.5.3.2.2 8 months 4.5.3.2.3 4.5.3.2.3 Kuwait national action plan on antimicrobial resistance 2022 263 HAI treatment guidelines should be reviewed every year once/ year 4.5.3.3 Dissemination and implementation of these treatment guidelines in hospital practice. 4.5.3.3.1 Workshops for discussion and endorsement of these guidelines with practicing physicians all over the country 4.5.3.3.1 1 year 4.5.3.3.2 Distribution of educational material in the form of booklets, brochures, posters, &pocket cards, or equivalent softcopies available on mobile phones 4.5.3.3.2 1 year 4.5.3.3.3 Post the guidelines on the MOH website and integrate them into the intranet of each hospital 4.5.3.3.3 1yr, 3 months 4.5.3.3.4 Integrate the guidelines into the electronic medical record, in the form of pop-ups 4.5.3.3.4 2 years 4.5.4 Make AMS programs mandatory in each hospital (presence of AMS team/ committee) 4.5.4.1 Mandate by MOH for this issue 4.5.4.1 1 y 6 months 4.5.4.2 Build AMS manpower 4.5.4.2.1 Train microbiologists, clinical pharmacists and Infectious 4.5.4.2.1 1 y 6 months Kuwait national action plan on antimicrobial resistance 2022 264 Disease specialists on AMS through national workshops Strategic Objective 4.6 Quality control of antimicrobials used in animals and plants 4.6 ABX used in the agriculture/ veterinary are under the same control as those used in humans Pharmaceutical and Herbal Medicines Registration and Control Administration/The Dug Inspection Control 4.6 Already available 4.6 available Strategic Objective 4.7 Restrict the use of critically important ABX to human health in the veterinary field 4.7.1 Establish the list of critically important antibiotics for humans in the animal sector. 4.7.1 3 months 4.7 2 years 4.7.2 Determine from this list which antibiotics should be restricted for use to humans 4.7.2 3 months 4.7.3 Issue a decree that the critically important ABX to human health are not to be used in animals whether in individual treatment or in herd therapy 4.7.3 6 months 4.7.4 Prohibit the importation of these critically important ABX for vet use 4.7.4.1 Decree that prohibits the importation and sale of these ABX in the vet field 4.7.4.1 6 months Strategic Objective 4.8 Organize the use of antimicrobial agents in terrestrial and aquatic animals and agriculture. Kuwait national action plan on antimicrobial resistance 2022 265 4.8.1 Put (or endorse) guidelines regarding the use of ABX in animals and agriculture 4.8.1 8 months 4.8 5 years 4.8.2 Disseminate these guidelines among veterinarians 4.8.2.1 Booklets/ Brochures/app that summarize the key points in these guidelines. 4.8.1.1 18 months 4.8.2.1 Regular workshops for veterinary specialists regarding the application of these guidelines 4.8.2.1 1 year 4.8.3 Restrict selling ABX for animal and agriculture health to exclusively prescriptions by vets 4.8.3.1 Decree that vet pharmacies should dispense ABX only according to vet prescriptions, and should submit these prescriptions with the evidence of selling to PAAF. 4.8.3.1 2 years 4.8.4 Control the use of ABX in animals 4.8.4.1. Detection of the ABX residues in milk, meat, poultry and eggs 4.8.4.1. Already available 4.8.4.1. Already available Strategic Objective 4.9 Capacity building among vets in antimicrobial use and AMR 4.9.1 Provide training courses for vets for ABX use according to guidelines and provide certificate. 4.9.1 2 years 4.9 4 years 4.9.2 Study baseline consumption imported antibiotics in this field 4.9.2.1 Pharmaceutical Dep in PAAF Committee that will study and document this consumption 4.9.2.1 2 years Kuwait national action plan on antimicrobial resistance 2022 266 and compare it to international benchmark B. Antimicrobial Use Monitoring Plan Activity Sub-activity Sub-sub activity Indicator Purpose Calculation Frequency Data source Method Baseline Strategic Objective 4.1 Ensure governance of antibiotic axis pillar and follow up of the activities of this pillar 4.1.1 Identify who will be the ABX arm pillar focal point in each ministry /authority and assign the TOR 4.1.1 available 4.1.2 Prepare clear TOR of the focal person for ABX in each ministry authority 4.1.2 Yes/No 4.1.2 proper organization and follow up on the work in this pillar 4.1.2 Yes/No 4.1.2 Once 4.1.2 AMR committee 4.1.2 Checking 4.1.2 Not available 4.1.3 Assign the job to a defined person/posit ion in each 4.1.3 Proportion of ministries/au thorities where ABX 4.1.3 proper monitoring and surveillance on the work in this pillar 4.1.3 number of ministries / authorities with assigned 4.1.3 once 4.1.3 AMR Inter ministerial executive committee 4.1.3 checking 4.1.3 not available Kuwait national action plan on antimicrobial resistance 2022 267 ministry authority, and nomination by the director of each ministry/ authority. arm focal person is assigned focal persons/tota l number of concerned ministries/au thorities*10 0 4.1.4 Put TOR And reimbursem ent plan for the different tasks. 4.1.4 Yes/No 4.1.4 proper organization and follow up on the work of this axis 4.1.4 Yes/No 4.1.4 Once 4.1.4 MOH NMCG/ Focal person 4.1.4 Checking 4.1.4 Not available 4.1.5 Nominate the stakeholders for the task force of the pillar 4.1.5 ABX use task force group is formed Yes/No 4.1.5 assign responsibiliti es to specific persons regarding the work in this pillar 4.1.5 Yes/No 4.1.5 Once 4.1.5 MOH PAAF KEPA PAFN 4.1.5 Checking 4.1.5 Not available Strategic Objective 4.2 Ensure uninterrupted access to high-quality antimicrobial medicines 4.2.1 Put clear criteria for standards of quality safety and efficiency of ABX 4.2.1 System is in place 4.2.2 Put a system of controlling 4.2.2 Already available Kuwait national action plan on antimicrobial resistance 2022 268 that all available ABX in the country should meet the international standards listed above otherwise they are not allowed to be in the market. 4.2.3 All ABX should be tested by a system that identifies counterfeit prior to licensing. 4.2.3 System already in place 4.2.4 Put regulations that prohibit the sale of counterfeit products 4.2.4 System already in place 4.2.5 The system that controls quality assurance of ABX has the authority to stop 4.2.5 System already In place Kuwait national action plan on antimicrobial resistance 2022 269 counterfeit products from being licensed and marketed Strategic Objective 4.3 Develop and enforce legislation and regulations on prescription and dispensing of medicine including antibiotics 4.3.1 Develop and implement national essential medicine list guided by the WHO Model List of Essential Medicines 4.3.1.1 Finalize the essential medicine list that is being prepared at MOH 4.3.1.1 List is issued Yes/No 4.3.1.1 regulate prescription and dispensing of medications including antimicrobial s 4.3.1.1 Yes/No 4.3.1.1 Once 4.3.1.1 MOH Central Medical Stores Directorate 4.3.1.1 Checking 4.3.1.1 task in progress 4.3.2 Mandate that every institution has an essential medicine list 4.3.2 Yes/No 4.3.2 regulate prescription and dispensing of medications including antimicrobial s on the facility level 4.3.2 Yes/No 4.3.2 Once 4.3.2 MOH Undersecret ary general ABX focal person 4.3.2 Checking 4.3.2 Not available 4.3.3 Each institution has an essential medicine list and this is checked in accreditation standards 4.3.3.1 Mandate from MOH that once the national essential medicine list is available, 4.3.3.1 Yes/No 4.3.3.1 put a legal frame for the prescription and dispensing of medicines including 4.3.3.1 Yes/No 4.3.3.1 Once 4.3.3.1 MOH Undersecret ary general ABX focal person 4.3.3.1 Checking 4.3.3.1 Not available Kuwait national action plan on antimicrobial resistance 2022 270 include checking the availability of the essential medicine list all hospitals including public and private hospitals should formulate their own list antimicrobial s 4.3.3.2 Include the availability of essential medicine list into the license renewal conditions of private hospitals 4.3.3.2.1 Private hospital renewal license checklist should include the availability of essential medicine list 4.3.3.2.1 Licensing checklist includes the item of essential medicine list or not 4.3.3.2.1 having an essential list is an obligation and represents a standard of good practice of medicine 4.3.3.2.1 Yes/No 4.3.3.2.1 Once 4.3.3.2.1 MOH/ Medical Licensing Dep 4.3.3.2.1 Checking 4.3.3.2.1 Not available 4.3.4 Re imbursemen t plan is based on essential medicine list in public and private hospitals 4.3.4 % of reimbursed ABX that are listed in the essential medicine list 4.3.4 making essential list an obligation as a standard of good practice of medicine 4.3.4 number of reimbursed antibiotics/t otal number of available antibiotics*1 00 4.3.4 once/year 4.3.4 MOH 4.3.4 data collection 4.3.4 Not available Strategic Objective 4.4 Start AMS program in primary healthcare 4.4.1 Create a technical group that puts national ABX use guidelines 4.4.1.1 Put TOR and renewal conditions of the 4.4.1.1 TOR put Yes or no 4.4.1.1 organize the AMS work that this taskforce is 4.4.1.1 Yes/No 4.4.1.1 Once 4.4.1.1 MOH/ National Committee of proper ABX use 4.4.1.1 Checking 4.4.1.1 Not available Kuwait national action plan on antimicrobial resistance 2022 271 for outpatient care based on International guidelines and National AMR profiles: can be a subcommitte e from the national task force for the ABX pillar for proper use of ABX focal group of stakeholders responsible for 4.4.1.2 Assign the members of this committee 4.4.1.2 TOR put Yes or no 4.4.1.2 oversee AMS work in this sector 4.4.1.2 Yes/No 4.4.1.2 Once 4.4.1.2 MOH National Committee of proper ABX use. 4.4.1.2 Checking 4.4.1.2 Not available 4.4.1.3 Put TOR and official renewal time for the guidelines committee 4.4.1.3 TOR put Yes or no 4.4.1.3 oversee guideline developmen t 4.4.1.3 Yes/No 4.4.1.3 Once 4.4.1.3 MOH National Committee of proper ABX use. 4.4.1.3 Checking 4.4.1.3 Not available 4.4.2 Guidelines in primary 4.4.2 Guidelines available 4.4.2 ensure judicious 4.4.2 Yes/No 4.4.2 Once 4.4.2 Primary Healthcare 4.4.2 Checking 4.4.2 Not available Kuwait national action plan on antimicrobial resistance 2022 272 healthcare are available and are regularly updated Yes or no antimicrobial use in primary healthcare Directorate/ technical committee/ National Committee of proper ABX use. 4.4.2.1 Training workshop about ABX guidelines in primary healthcare 4.4.2.1 Proportion of primary healthcare physician who attend every year 4.4.2.1 primary care physicians rationally prescribe antimicrobial s 4.4.2.1 number of primary care physicians who attend the training workshops/t otal number of primary healthcare physicians *100 4.4.2.1 Once/year 4.4.2.1 Primary healthcare/ technical committee 4.4.2.1 Checking 4.4.2.1 Not available 4.4.3 Apply AMS in primary healthcare: Monitoring ABX consumption and Link prescription to diagnoses 4.4.3.1 Project ABX consumption documentati on and surveillance in primary healthcare 4.4.3.1.1 Put a proposal for this project 4.4.3.1.1 Project is put 4.4.3.1.1 follow-up on managemen t of antimicrobial s in primary healthcare 4.4.3.1.1 Yes/No 4.4.3.1.1 Once 4.4.3.1.1 Primary healthcare and AMR committee 4.4.3.1.1 Checking 4.4.3.1.1 Not available 4.4.3.2 Start collecting data and link it to diagnosis 4.4.3.2 Proportion of primary healthcare centers that are feeding 4.4.3.2 assessment of the practice in these centers and 4.4.3.2 Number of primary healthcare centers that are feeding 4.4.3.2 Once/year 4.4.3.2 National Committee for ABX use /Primary 4.4.3.2 Data Collection 4.4.3.2 Not available Kuwait national action plan on antimicrobial resistance 2022 273 data into the project thus ability to give feedback to prescribers data into the project/Total number of primary healthcare centers *100 healthcare Directorate 4.4.3.3 Data analysis and feedback to prescribers 4.4.3.3 Proportion of primary healthcare centers that receive annual report with feedback about ABX prescription 4.4.3.3 improvemen t of practice and thus standard of care and proper application of AMS in this sector 4.4.3.3 Number of primary healthcare centers that receive annual report with feedback about ABX prescription/ Total number of primary Health care centers *100 4.4.3.3 Once/year 4.4.3.3 primary healthcare directorate 4.4.3.3 Data collection 4.4.3.3 Not available 4.4.3.4 Employ more pharmacists in primary healthcare 4.4.3.4 Number of pharmacists that are employed 4.4.3.4 Surveil, monitor on the proper use of antibiotics in primary healthcare 4.4.3.4 Yes/NO 4.4.3.4 Once 4.4.3.4 Primary healthcare directorate/ Pharmaceuti cal Services Directorate 4.4.3.4 Checking 4.4.3.4 Not available 4.4.3.5 Improve manpower with professionals for the AMS 4.4.3.5.1 Train available pharmacists on AMS and clinical 4.4.3.5.1 Number of pharmacists in primary healthcare who have a 4.4.3.5.1 oversee AMS practices by qualified pharmacists 4.4.3.5.1 Yes/No 4.4.3.5.1 Once 4.4.3.5.1 Primary healthcare directorate /Pharmaceut 4.4.3.5.1 Checking 4.4.3.5.1 Not available Kuwait national action plan on antimicrobial resistance 2022 274 project in primary healthcare pharmacy principles certificate in AMS training ical Services Directorate 4.4.3.5.2 Employ new clinical pharmacist specialized in AMS and 1 full time clinical microbiologi st in primary healthcare directorate 4.4.3.5.2 Clinical pharmacists are employed, Yes/No 4.4.3.5.2 oversee AMS practices in primary healthcare by qualified professionals (pharmacist and microbiologi st) 4.4.3.5.2 Yes/No 4.4.3.5.2 Once 4.4.3.5.2 Primary healthcare directorate /Pharmaceut ical Services Directorate 4.4.3.5.2 Checking 4.4.3.5.2 Not available 4.4.4 Update the digital system that is available in primary healthcare to integrate the ABX guidelines into the electronic system in the form of pop-ups 4.4.4 updated electronic system available or not 4.4.4 facilitate AMS application through user friendly software 4.4.4 Yes/No 4.4.4 Once 4.4.4 Primary Heath care directorate/ /Information System Dep. 4.4.4 Checking 4.4.4 Not available Strategic Objective 4.5 Apply AMS In Public and Private hospitals 4.5.1 4.5.1.1 4.5.1.1 4.5.1.1 4.5.1.1 Yes/No 4.5.1.1 Once 4.5.1.1 MOH 4.5.1.1 Checking 4.5.1.1 Not available Kuwait national action plan on antimicrobial resistance 2022 275 Improve and measure appropriate use of antimicrobial agents in healthcare Nominate who will be the AMS focal person (Could be the ABX pillar focal person) AMS focal person is nominated oversee AMS work in hospitals 4.5.2 Identify the National AMS Task force (Could be a subcommitte e of the ABX pillar Task force) the National AMS Technical team 4.5.2.1 AMS technical group is assigned (subgroup from the ABX technical committee. +other specialists like IT, etc) 4.5.2.1 Task force members are nominated Yes/No 4.5.2.1 oversee AMS work in hospitals 4.5.2.1 Yes/No 4.5.2.1 Once 4.5.2.1 MOH 4.5.2.1 Checking 4.5.2.1 Not available 4.5.2.2 TOR of the technical groups are well defined They include: guidelines for inpatient and outpatient care. 4.5.2.2 TOR put 4.5.2.2 oversee AMS work in hospitals 4.5.2.2 Yes/No 4.5.2.2 Once 4.5.2.2 MOH 4.5.2.2 Checking 4.5.2.2 Not available Kuwait national action plan on antimicrobial resistance 2022 276 put or endorse diagnostic pathways, treatment and national AMS targets 4.5.3 Put national guidelines either de novo or Endorse existing international guidelines with regular updates 4.5.3.1 MOH puts national guidelines for common community acquired infections (CAI) 4.5.3.1 CAI guidelines developed Yes/No 4.5.3.1 ensure proper prescribing and use of antimicrobial s 4.5.3.1 Yes/No 4.5.3.1 Once 4.5.3.1 AMS Task force Group 4.5.3.1 Checking 4.5.3.1 Not available Hospitals put institutional guidelines for treatment of Healthcare associated infections (HAI) according to their local epidemiolog y, with the help of taskforce members 4.5.3.2.1 Mandate for hospitals to issue HAI treatment guidelines based on local epidemiolog y and with the help of taskforce members 4.5.3.2.1 Mandate issued Yes/No 4.5.3.2.1 putting HAI guideline is obligatory 4.5.3.2.1 Yes/No 4.5.3.2.1 Once 4.5.3.2.1 MOH/task force 4.5.3.2.1 Checking 4.5.3.2.1 Not available 4.5.3.2.2 4.5.3.2.2 4.5.3.2.2 4.5.3.2.2 4.5.3.2.2 4.5.3.2.2 4.5.3.2.2 4.5.3.2.2 Kuwait national action plan on antimicrobial resistance 2022 277 Organize the work of taskforce members with the different hospitals to assist in putting their own HAI guidelines Proportion of hospitals that have HAI guidelines based on their own epidemiolog y. to see if hospitals abide by developing institutional HAI guidelines number of hospitals with HAI guidelines/T otal number of hospitals*10 0 Once/year MOH/ Hospitals data collection Partially available in some hospitals 4.5.3.2.3 HAI treatment guidelines should be reviewed every year 4.5.3.2.3 Proportion of hospitals that have guidelines updated 4.5.3.2.3 continuous follow-up and reduction of inappropriat e antibiotic use 4.5.3.2.3 number of hospitals with HAI guidelines updated/Tot al number of hospitals*10 0 4.5.3.2.3 Once/year 4.5.3.2.3 MOH/ Hospitals 4.5.3.2.3 data collection 4.5.3.2.3 Partially available in some hospitals 4.5.3.3 Disseminatio n and implementat ion of these treatment guidelines in hospital practice. 4.5.3.3.1 Workshops for discussion and endorsemen t of these guidelines with practicing physicians all over the country 4.5.3.3.1 Number of regions where guidelines workshops have been performed 4.5.3.3.1 proper application of guidelines recommend ations 4.5.3.3.1 Yes/No 4.5.3.3.1 Once/year 4.5.3.3.1 MOH 4.5.3.3.1 Checking 4.5.3.3.1 Not available Kuwait national action plan on antimicrobial resistance 2022 278 4.5.3.3.2 Distribution of educational material in the form of booklets, brochures, posters, &pocket cards, or equivalent softcopies available on mobile phones 4.5.3.3.2 Proportion of hospitals that have the softcopies available on the mobile phones of staff 4.5.3.3.2 facilitate disseminatio n and implementat ion of these treatment guidelines in hospital practice 4.5.3.3.2 Number of hospitals that have the softcopies available on the mobile phones of staff/Total number of hospitals*10 0 4.5.3.3.2 Once/year 4.5.3.3.2 MOH/Hospit als 4.5.3.3.2 data collection 4.5.3.3.2 not available 4.5.3.3.3 Post the guidelines on the MOH website and integrate them into the intranet of each hospital 4.5.3.3.3 Proportion of hospitals that have the guidelines posted on their intranet 4.5.3.3.3 facilitate access to these treatment guidelines 4.5.3.3.3 Number of hospitals that have the guidelines posted on their intranet/Tot al number of hospitals*10 0 4.5.3.3.3 Once/year 4.5.3.3.3 MOH/Hospit als 4.5.3.3.3 data collection 4.5.3.3.3 not available 4.5.3.3.4 Integrate the guidelines into the electronic medical record, in 4.5.3.3.4 Proportion of hospitals that have guidelines recommend ations integrated in 4.5.3.3.4 remind prescribers on a regular basis of recommend ations and facilitate 4.5.3.3.4 Number of hospitals that have guidelines recommend ations integrated in 4.5.3.3.4 Once/year 4.5.3.3.4 Hospitals 4.5.3.3.4 data collection 4.5.3.3.4 Not available Kuwait national action plan on antimicrobial resistance 2022 279 the form of pop-ups the electronic medical records system implementat ion of AMS at the bedside the electronic medical records system /Total number of hospitals*10 0 4.5.4 Make AMS programs mandatory in each hospital (presence of AMS team/ committee) 4.5.4.1 Mandate by MOH for this issue 4.5.4.1 Mandate issued Yes/No 4.5.4.1 standardize the application of AMS in hospitals and make it obligatory 4.5.4.1 Yes/No 4.5.4.1 Once 4.5.4.1 MOH 4.5.4.1 Checking 4.5.4.1 Not available 4.5.4.2 Build AMS manpower 4.5.4.2.1 Train microbiologi sts, clinical pharmacists and Infectious Disease specialists on AMS through national workshops 4.5.4.2.1 Percent microbiologi sts and clinical pharmacists that have attended at least 1 AMS workshop 4.5.4.2.1 build a strong AMS workforce for better implementat ion of AMS standards in hospitals 4.5.4.2.1 Number of microbiologi sts and clinical pharmacists that have attended at least 1 AMS workshop/T otal number of these professionals *100 4.5.4.2.1 Once/year 4.5.4.2.1 Task force 4.5.4.2.1 Data collection 4.5.4.2.1 Not available Strategic Objective 4.6 Quality control of antimicrobials used in animals and plants 4.6 Already available Kuwait national action plan on antimicrobial resistance 2022 280 4.6 ABX used in the agriculture/ veterinary are under the same control as those used in humans Pharmaceuti cal and Herbal Medicines Registration and Control Administrati on/The Dug Inspection Control Strategic Objective 4.7 Restrict the use of critically important ABX to human health in the veterinary field 4.7.1 Establish the list of critically important antibiotics for humans in the animal sector. 4.7.1 List put Yes/No 4.7.1 limit the use of critically important ABX in the animal sector. 4.7.1 Yes/No 4.7.1 Once 4.7.1 ABX task force 4.7.1 Checking 4.7.1 Not available 4.7.2 Determine from this list which antibiotics should be restricted for 4.7.2 List put Yes/No 4.7.2 limit the use of critically important ABX in the animal sector. 4.7.2 Yes/No 4.7.2 Once 4.7.2 ABX task force 4.7.2 Checking 4.7.2 Not available Kuwait national action plan on antimicrobial resistance 2022 281 use to humans 4.7.3 Issue a decree that the critically important ABX to human health are not to be used in animals whether in individual treatment or in herd therapy 4.7.3 Decree issued Yes /No 4.7.3 put a legal frame work for restricting the use of critically important antibiotics 4.7.3 Yes/No 4.7.3 Once 4.7.3 ABX task force 4.7.3 Checking 4.7.3 Not available 4.7.4 Prohibit the importation of these critically important ABX for vet use 4.7.4.1 Decree that prohibits the importation and sale of these ABX in the vet field 4.7.4.1 Decree is issued Yes/No 4.7.4.1 put a legal framework and reinforce the prohibition of importation and sale of critically important ABX in the vet field 4.7.4.1 Yes/No 4.7.4.1 Once 4.7.4.1 PAAF 4.7.4.1 Checking 4.7.4.1 Not available Strategic Objective 4.8 Organize the use of antimicrobial agents in terrestrial and aquatic animals and agriculture. 4.8.1 Put (or endorse) guidelines 4.8.1 Guidelines are established 4.8.1 ensure proper antimicrobial 4.8.1 Yes/No 4.8.1 Once 4.8.1 PAAF 4.8.1 Checking 4.8.1 Not available Kuwait national action plan on antimicrobial resistance 2022 282 regarding the use of ABX in animals and agriculture Yes/No use in these fields 4.8.2 Disseminate these guidelines among veterinarians 4.8.2.1 Booklets/ Brochures/a pp that summarize the key points in these guidelines. 4.8.1.1 Proportion of Vet clinics that have easy access to these updated guidelines 4.8.1.1 facilitate access and implementat ion of guidelines recommend ations 4.8.1.1 Number of Vet clinics that have easy access to these updated guidelines/to tal number of vet clinics*100 4.8.1.1 Once/year 4.8.1.1 PAAF 4.8.1.1 data collection 4.8.1.1 not available 4.8.2.1 Regular workshops for veterinary specialists regarding the application of these guidelines 4.8.2.1 proportion of veterinary specialists attending these workshops 4.8.2.1 proper implementat ion of these guidelines 4.8.2.1 NUMBER of veterinary specialists attending these workshops/t otal number of specialists*1 00 4.8.2.1 Once/year 4.8.2.1 PAAF 4.8.2.1 data collection 4.8.2.1 Not available 4.8.3 Restrict selling ABX for animal and agriculture health to exclusively 4.8.3.1 Decree that vet pharmacies should dispense ABX only according to vet 4.8.3.1 Decree is issued Yes/No 4.8.3.1 put a legal framework for restricting sale of antibiotics in these fields 4.8.3.1 Yes/No 4.8.3.1 Once 4.8.3.1 PAAF 4.8.3.1 Checking 4.8.3.1 Not available Kuwait national action plan on antimicrobial resistance 2022 283 prescriptions by vets prescriptions , and should submit these prescriptions with the evidence of selling to PAAF. 4.8.4 Control the use of ABX in animals 4.8.4.1. Detection of the ABX residues in milk, meat, poultry and eggs 4.8.4.1. Already available 4.8.4.1. Abx use in food is controlled Strategic Objective 4.9 Capacity building among vets in antimicrobial use and AMR 4.9.1 Provide training courses for vets for ABX use according to guidelines and provide certificate. 4.9.1 Proportion of vets that have a yearly certificate 4.9.1 make sure that vets properly prescribe and dispense antimicrobial s 4.9.1 number of vets who attend the certification training/tota l number of vets *100 4.9.1 once/year 4.9.1 PAAF 4.9.1 data collection 4.9.1 Not available 4.9.2 Study baseline consumption imported antibiotics in this field Pharmaceuti cal Dep in PAAF Committee that will study and document this consumption and compare it to 4.9.2.1 Report issued Yes/No 4.9.2.1 see how much vets are abiding to guidelines and to be able to compare to international data 4.9.2.1 Yes/No 4.9.2.1 Once 4.9.2.1 PAAF 4.9.2.1 Checking 4.9.2.1 Not available Kuwait national action plan on antimicrobial resistance 2022 284 international benchmark Kuwait national action plan on antimicrobial resistance 2022 285