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

S. Mizuno, M. Iwami, S. Kunisawa, N. Naylor, K. Yamashita, Y. Kyratsis, G. Meads, J. A. Otter, A. H. Holmes, Y. Imanaka, R. Ahmad*

*Corresponding author for this work

Research output: Contribution to JournalArticleAcademicpeer-review


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
Pages (from-to)280-298
Number of pages19
JournalJournal of Hospital Infection
Issue number3
Publication statusPublished - 1 Nov 2018
Externally publishedYes


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


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