| Summary: | Healthcare-acquired infections are a major cause of morbidity and mortality and are estimated to cost the National Health Service £1 billion per year. In order to reduce the burden of these infections, focus has been placed on infection control and antimicrobial stewardship interventions. The overall aim of the present research was to assess the impact of an infection control and antibiotic stewardship intervention on the incidence of hospital-acquired (HA) methicillin resistant Staphylococcus aureus and HA-Clostridium difficile infection (CDI) in Antrim Hospital. The first study described in Chapter 2 demonstrates how a change in environmental disinfectant from sodium dichloroisocyanurate (NaDCC) to chlorine dioxide (CIO2) resulted in a significant decrease in the incidence of HA-MRSA, despite an increase in the use of high risk antibiotics during the study period. The antibiotic stewardship intervention investigated in this research programme involved the introduction of an antibiotic cycling policy in Antrim Hospital. The development of the policy was based on an investigation of the effects of antibiotic use on the incidence of HA-CDI and HA-MRSA in the study site hospital (Chapter 3). Autoregressive Integrated Moving Average (ARIMA) time series analysis identified antibiotics that were significantly associated with HA-CDI and HA-MRSA. Based on these findings an antibiotic cycling policy was developed, which was implemented in Antrim Hospital for a period of eighteen months (Chapter 4). This policy resulted in no effect on the incidence of HA-CDI, however, a rising HA-MRSA trend was observed. The presented work provides a comprehensive assessment of an infection control intervention and is the first study to date to develop and to evaluate an antibiotic cycling policy based on an analysis of local epidemiology data using ARIMA modelling.
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