title: Impact of infection control interventions on rates of Staphylococcus aureus bacteraemia in National Health Service acute hospitals, East Midlands, UK, using interrupted time-series analysis.
abstract: BACKGROUND
  Reducing healthcare-associated infection (HCAI) is a UK national priority. Multiple national and regional interventions aimed at reduction have been implemented in National Health Service acute hospitals, but assessment of their effectiveness is methodologically challenging.
  
  
  OBJECTIVE
  To assess the effectiveness of national and regional interventions undertaken between 2004 and 2008 on rates of meticillin-resistant Staphylococcus aureus (MRSA) and meticillin-sensitive Staphylococcus aureus (MSSA) bacteraemia within acute hospitals in the East Midlands, using interrupted time-series analysis.
  
  
  METHODS
  We used segmented regression to compare rates of MRSA and MSSA bacteraemia in the pre-intervention, implementation, and post-intervention phases for combined intervention packages in eight acute hospitals.
  
  
  RESULTS
  Most of the change in MSSA and MRSA rates occurred during the implementation phase. During this phase, there were significant downward trends in MRSA rates for seven of eight acute hospital groups; in four, this was a steeper quarter-on-quarter decline compared with the pre-intervention phase, and, in one, an upward trend in the pre-intervention phase was reversed. Regarding MSSA, there was a significant positive effect in four hospital groups: one upward trend during the pre-intervention phase was reversed, two upward trends plateaued, and in one hospital group an indeterminate trend decreased significantly. However, there were significant increasing trends in quarterly MSSA rates in four hospital groups during the implementation or post-intervention periods.
  
  
  CONCLUSIONS
  The impact of interventions varied by hospital group but the overall results suggest that national and regional campaigns had a beneficial impact on MRSA and MSSA bacteraemia within the East Midlands.
authors: Public Health England, Institute of Population Health, Nottingham City Hospital, Nottingham, UK. Electronic address: sophie.newitt@phe.gov.uk.
authors: S
authors: S
authors: Newitt
authors: University of Nottingham, Division of Epidemiology and Public Health, Nottingham City Hospital, Nottingham, UK.
authors: P R
authors: PR
authors: Myles
authors: Public Health England, Institute of Population Health, Nottingham City Hospital, Nottingham, UK.
authors: J A
authors: JA
authors: Birkin
authors: Public Health England, Institute of Population Health, Nottingham City Hospital, Nottingham, UK.
authors: V
authors: V
authors: Maskell
authors: Health Protection Agency, East Midlands, UK.
authors: R C B
authors: RC
authors: Slack
authors: Public Health England, Institute of Population Health, Nottingham City Hospital, Nottingham, UK; University of Nottingham, Division of Epidemiology and Public Health, Nottingham City Hospital, Nottingham, UK.
authors: J S
authors: JS
authors: Nguyen-Van-Tam
authors: University of Nottingham, Division of Epidemiology and Public Health, Nottingham City Hospital, Nottingham, UK.
authors: L
authors: L
authors: Szatkowski
mesh_terms: D016470:Bacteremia / Q000453:epidemiology* / Q000517:prevention & control; D003428:Cross Infection / Q000453:epidemiology*; D006761:Hospitals / Q000592:standards*; D006801:Humans; D017053:Infection Control / Q000379:methods*; D065186:Interrupted Time Series Analysis / Q000379:methods; D008712:Methicillin / Q000627:therapeutic use; D055624:Methicillin-Resistant Staphylococcus aureus / Q000302:isolation & purification*; D009313:National Health Programs; D012044:Regression Analysis; D012680:Sensitivity and Specificity; D013203:Staphylococcal Infections / Q000453:epidemiology* / Q000382:microbiology / Q000517:prevention & control; D013211:Staphylococcus aureus / Q000302:isolation & purification*; D006113:United Kingdom / Q000453:epidemiology
chemical_list: D008712:Methicillin
keywords: Healthcare-associated infection; MRSA; MSSA; Time-series analysis