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Comparison of national strategies to reduce methicillin-resistant Staphylococcus aureus (MRSA) infections in Japan and England

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Title: Comparison of national strategies to reduce methicillin-resistant Staphylococcus aureus (MRSA) infections in Japan and England
Authors: Mizuno, S
Iwami, M
Kunisawa, S
Naylor, N
Yamashita, K
Kyratsis, Y
Meads, G
Otter, J
Holmes, A
Ahmad, R
Item Type: Journal Article
Abstract: 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 (2000-17), 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: type - mandatory requirements, recommendations, or national campaigns; method - restrictive, persuasive, structural in nature; level of implementation - macro (national), meso (organisational), micro (individual) levels. Healthcare organisational 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 multidisciplinary 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 health system cultures 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.
Issue Date: 1-Nov-2018
Date of Acceptance: 28-Jun-2018
URI: http://hdl.handle.net/10044/1/62817
DOI: https://dx.doi.org/10.1016/j.jhin.2018.06.026
ISSN: 0195-6701
Publisher: Elsevier
Start Page: 280
End Page: 298
Journal / Book Title: Journal of Hospital Infection
Volume: 100
Issue: 3
Copyright Statement: © 2018 Elsevier Ltd. All rights reserved. This manuscript is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International Licence http://creativecommons.org/licenses/by-nc-nd/4.0/
Sponsor/Funder: National Institute for Health Research
National Institute for Health Research
NIHR knowledge mobilisation fellowship
Funder's Grant Number: HPRU-2012-10047
KMRF-2015 04 007
Keywords: Science & Technology
Life Sciences & Biomedicine
Public, Environmental & Occupational Health
Infectious Diseases
Staphylococcus aureus
Antimicrobial resistance
Infection prevention and control
Healthcare-associated infections
Meticillin-resistant Staphylococcus aureus
Communicable Disease Control
Cross Infection
Disease Transmission, Infectious
Health Policy
Methicillin-Resistant Staphylococcus aureus
Staphylococcal Infections
1103 Clinical Sciences
Publication Status: Published
Online Publication Date: 2018-07-07
Appears in Collections:Department of Medicine (up to 2019)