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 language | English |
|---|---|
| Pages (from-to) | 280-298 |
| Number of pages | 19 |
| Journal | Journal of Hospital Infection |
| Volume | 100 |
| Issue number | 3 |
| DOIs | |
| Publication status | Published - 1 Nov 2018 |
| Externally published | Yes |
Funding
We would like to thank the following people for participating in the shared learning meetings supported by The Daiwa Anglo-Japanese Foundation : Dr H. Uematsu ( Kyoto University , Japan). Dr E. Castro-Sánchez, J. Allibone, Dr G. Birgand, Dr E. Charani, Dr C. Costelloe, Dr M. Gharbi, Dr M. McLeod, Dr T.M. Rawson ( Imperial College London ). This study was initiated through reciprocal UK–Japan visits in 2017, by researchers from Kyoto University and Imperial College London sharing best practice in order to best address global antimicrobial resistance, funded by The Daiwa Anglo-Japanese Foundation (Daiwa Foundation Award 8216/12167 ). R.A., N.N., A.H. are supported by the National Institute for Health Research Health Protection Research Unit (NIHR HPRU) [ HPRU-2012-10047 ] in Healthcare Associated Infection and Antimicrobial Resistance at Imperial College London in partnership with Public Health England . R.A. is supported by NIHR Fellowship in knowledge mobilization at Imperial College London. The views expressed are those of the author(s) and not necessarily those of the National Health Service, the NIHR, the Department of Health, or Public Health England. Appendix A
| Funders | Funder number |
|---|---|
| Daiwa Foundation | 8216/12167 |
| NIHR HPRU | |
| National Institute on Disability and Rehabilitation Research | |
| National Institute for Health Research | HPRU-2012-10047 |
| Daiwa Anglo-Japanese Foundation | |
| Imperial College London | |
| Japan Society for the Promotion of Science | 16H02634 |
| Public Health England | |
| Kyoto University |
Keywords
- Antimicrobial resistance
- Healthcare-associated infections
- Infection prevention and control
- Meticillin-resistant Staphylococcus aureus
