Comparison of national strategies to reduce meticillin-resistant Staphylococcus aureus infections in Japan and England. Issue 3 (November 2018)

• Record Type: Journal Article
• Authors: Mizuno, S.; Iwami, M.; Kunisawa, S.; Naylor, N.; Yamashita, K.; Kyratsis, Y.; Meads, G.; Otter, J.A.; Holmes, A.H.; Imanaka, Y.; Ahmad, R.
• Is Part Of: Journal of hospital infection. Volume 100:Issue 3(2018)
• Page Start: 280
• Page End: 298
• Publication Date: 2018-11
• Subjects: Meticillin-resistant Staphylococcus aureus -- Antimicrobial resistance -- Infection prevention and control -- Healthcare-associated infections; Cross infection -- Periodicals; Cross infection -- Prevention -- Periodicals; Nosocomial infections -- Periodicals; Nosocomial infections -- Prevention -- Periodicals; Cross Infection -- Periodicals; Cross Infection -- prevention & control -- Periodicals; Infection Control -- Periodicals; Electronic journals; 614.44
• DOI: 10.1016/j.jhin.2018.06.026
• Languages: English
• ISSNs: 0195-6701

Abstract

Summary: Background: National responses to healthcare-associated infections vary between high-income countries, but, when analysed for contextual comparability, interventions can be assessed for transferability. Aim: To identify learning from country-level approaches to addressing meticillin-resistant Staphylococcus aureus (MRSA) in Japan and England. Methods: A longitudinal analysis (2000–2017), comparing epidemiological trends and policy interventions. Data from 441 textual sources concerning infection prevention and control (IPC), surveillance, and antimicrobial stewardship interventions were systematically coded for: (a) type: mandatory requirements, recommendations, or national campaigns; (b) method: restrictive, persuasive, structural in nature; (c) level of implementation: macro (national), meso (organizational), micro (individual) levels. Healthcare organizational structures and role of media were also assessed. Findings: In England significant reduction has been achieved in number of reported MRSA bloodstream infections. In Japan, in spite of reductions, MRSA remains a predominant infection. Both countries face new threats in the emergence of drug-resistant Escherichia coli . England has focused on national mandatory and structural interventions, supported by a combination of outcomes-based incentives and punitive mechanisms, and multi-disciplinary IPC hospital teams. Japan has focused on (non-mandatory) recommendations and primarily persuasive interventions, supported by process-based incentives, with voluntary surveillance. Areas for development in Japan include resourcing of dedicated data management support and implementation of national campaigns for healthcare professionals and the public. Conclusion: Policy interventions need to be relevant to local epidemiological trends, while acceptable within the health system, culture, and public expectations. Cross-national learning can help inform the right mix of interventions to create sustainable and resilient systems for future infection and economic challenges.