Infection Prevention and Control in Asia: Current Evidence and Future Milestones

The Asia-Pacific region is a geographic source for emerging infectious diseases, including multidrug-resistant (MDR) organisms (MDROs) and pathogens with pandemic potential. Risks for emerging infectious diseases in this geographic region are complex and are presumed to include ecological, socioeconomic, and technological processes favorable to microbial transmission dynamics. In resource-limited settings, relative to resource-adequate settings, there continues to be a paucity of data in support of infection prevention and control, and patient safety interventions to ensure that regional, if not national, healthcare systems work effectively to improve infection prevention and control interventions. In addition, several viral pandemics and annual influenza strains have originated in the Asia-Pacific region, which, together, has global implications for population health. The prevention, control, and reporting of MDROs and healthcare-associated infections (HAIs) benefit from effective data dissemination plans and harmonized surveillance systems. HAIs compromise patient safety because they are preventable and serve as a reservoir for MDROs, which are associated with excess length of hospital stay, increased antimicrobial drug exposure, and excess costs [1–5]. In the Asia-Pacific region, the risks of HAIs have been estimated to be 2–20 times higher than in developed countries, with up to 25% of hospitalized patients reported to have acquired infections [4]. Although infection prevention and control is well recognized in the Asia-Pacific region, there are inconsistencies in the quality of evidence and dedicated resources to enhance current infection prevention practices, surveillance, and patient safety [4–6]. Existing evidence gaps include education, organizational and cultural barriers, physician and nursing champions, administrative support, infrastructure, fiscal resources, and key leadership that endorse implementation of infection prevention and control as a core component of patient safety programs across the AsiaPacific region [6, 7]. This issue of Clinical Infectious Diseases focuses on 3 key themes of infection prevention and control in healthcare settings across the Asia-Pacific regions: (1) epidemiology and evidence to support prevention and control interventions, (2) enhancements to infection prevention and control in healthcare settings, and (3) practices associated with the containment of emerging infectious diseases and outbreaks. The epidemiological data and evidence to support prevention and control interventions include 2 national survey studies for best practices and 4 epidemiology studies. A survey from Thailand and Japan relative to the United States compared evidence-based practices for prevention of HAIs and identified a modifiable gap associated with quality improvement for hospitals in these Asian-Pacific countries. A second national survey focused on policy, process, and outcomes associated with methicillin-resistant Staphylococcus aureus (MRSA) and MDR Acinetobacter baumannii interventions in Thailand. Higher compliance (>75%) with bundled approaches was associated with reduction in MRSA, where containment of MDR A. baumannii necessitated bundle compliance along with additional infection control interventions. Four other publications describe the complex clinical factors, molecular epidemiology, and transmission dynamic associated with prevalent and emerging MDROs in Singapore and South Korea (eg, MRSA, community-associated MRSA, and carbapenem-resistant Enterobacteriaceae). Together, these studies provide information on the epidemiology of infection prevention and control and the transmission dynamic of MDROs in AsiaPacific settings. The second theme in this issue on infection prevention and control in the Asia-Pacific region is the innovative use of molecular diagnostics, electronically linked administrative data, and information technology to enhance infection prevention and control. Findings from 4 meta-analyses or S U P P L E M E N T A R T I C L E