Comparison of national strategies to reduce meticillin-resistant Staphylococcus aureus infections in Japan and England

Geoffrey Meads, Seiko Mizuno, Michiyo Iwami, Sosumu Kunisawa, Nichola Naylor, Kazutu Yamashita, Yiannis Kyratsis, Alison Holmes, Raheelah Ahmad

Research output: Contribution to journalArticleResearchpeer-review

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 (2000–2017), 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.

Original languageEnglish
Article numberJHI-D-18-00309RI
Pages (from-to)280-298
Number of pages19
JournalJournal of Hospital Infection
Volume100
Issue number3
DOIs
Publication statusPublished - 7 Jul 2018

Keywords

  • Antimicrobial resistance
  • Meticillin-resistant Staphylococcus aureus
  • Infection prevention and control
  • Healthcare-associated infections

Cite this

Meads, G., Mizuno, S., Iwami, M., Kunisawa, S., Naylor, N., Yamashita, K., ... Ahmad, R. (2018). Comparison of national strategies to reduce meticillin-resistant Staphylococcus aureus infections in Japan and England. Journal of Hospital Infection, 100(3), 280-298. [JHI-D-18-00309RI]. https://doi.org/10.1016/j.jhin.2018.06.026
Meads, Geoffrey ; Mizuno, Seiko ; Iwami, Michiyo ; Kunisawa, Sosumu ; Naylor, Nichola ; Yamashita, Kazutu ; Kyratsis, Yiannis ; Holmes, Alison ; Ahmad, Raheelah. / Comparison of national strategies to reduce meticillin-resistant Staphylococcus aureus infections in Japan and England. In: Journal of Hospital Infection. 2018 ; Vol. 100, No. 3. pp. 280-298.
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Meads, G, Mizuno, S, Iwami, M, Kunisawa, S, Naylor, N, Yamashita, K, Kyratsis, Y, Holmes, A & Ahmad, R 2018, 'Comparison of national strategies to reduce meticillin-resistant Staphylococcus aureus infections in Japan and England', Journal of Hospital Infection, vol. 100, no. 3, JHI-D-18-00309RI, pp. 280-298. https://doi.org/10.1016/j.jhin.2018.06.026

Comparison of national strategies to reduce meticillin-resistant Staphylococcus aureus infections in Japan and England. / Meads, Geoffrey; Mizuno, Seiko; Iwami, Michiyo ; Kunisawa, Sosumu; Naylor, Nichola ; Yamashita, Kazutu; Kyratsis, Yiannis; Holmes, Alison ; Ahmad, Raheelah.

In: Journal of Hospital Infection, Vol. 100, No. 3, JHI-D-18-00309RI, 07.07.2018, p. 280-298.

Research output: Contribution to journalArticleResearchpeer-review

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T1 - Comparison of national strategies to reduce meticillin-resistant Staphylococcus aureus infections in Japan and England

AU - Meads, Geoffrey

AU - Mizuno, Seiko

AU - Iwami, Michiyo

AU - Kunisawa, Sosumu

AU - Naylor, Nichola

AU - Yamashita, Kazutu

AU - Kyratsis, Yiannis

AU - Holmes, Alison

AU - Ahmad, Raheelah

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AB - 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.

KW - Antimicrobial resistance

KW - Meticillin-resistant Staphylococcus aureus

KW - Infection prevention and control

KW - Healthcare-associated infections

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DO - 10.1016/j.jhin.2018.06.026

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Meads G, Mizuno S, Iwami M, Kunisawa S, Naylor N, Yamashita K et al. Comparison of national strategies to reduce meticillin-resistant Staphylococcus aureus infections in Japan and England. Journal of Hospital Infection. 2018 Jul 7;100(3):280-298. JHI-D-18-00309RI. https://doi.org/10.1016/j.jhin.2018.06.026