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

J Hosp Infect. 2015 May;90(1):28-37. doi: 10.1016/j.jhin.2014.12.016. Epub 2015 Jan 15.


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.

Aim: 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.

Findings: 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.

Conclusion: 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.

Keywords: Healthcare-associated infection; MRSA; MSSA; Time-series analysis.

MeSH terms

  • Bacteremia / epidemiology*
  • Bacteremia / prevention & control
  • Cross Infection / epidemiology*
  • Hospitals / standards*
  • Humans
  • Infection Control / methods*
  • Interrupted Time Series Analysis / methods
  • Methicillin / therapeutic use
  • Methicillin-Resistant Staphylococcus aureus / isolation & purification*
  • National Health Programs
  • Regression Analysis
  • Sensitivity and Specificity
  • Staphylococcal Infections / epidemiology*
  • Staphylococcal Infections / microbiology
  • Staphylococcal Infections / prevention & control
  • Staphylococcus aureus / isolation & purification*
  • United Kingdom / epidemiology


  • Methicillin