Effectiveness of national and sub-national interventions for prevention and control of healthcare-associated infections in acute hospitals in high- and upper-middle-income counties: systematic review update

This systematic review (PROSPERO: CRD42021297376), commissioned and funded (2021/1194919-0), by the World Health Organization, aimed to update a review of national-level infection prevention and control (IPC) interventions to inform their IPC Core Components guidelines. CENTRAL, CINAHL, Embase, MEDLINE and WHO IRIS were searched for studies meeting Cochrane’s Effective Practice and Organisation of Care (EPOC) design criteria, published 19 April 2017- 14 October 2021. Primary research studies examining national IPC interventions in acute hospitals in any country with outcomes related to healthcare-associated infection rates were included. Two independent reviewers performed data extraction and quality assessment, using the EPOC risk of bias criteria. Thirty-six studies were categorised per intervention type and synthesized narratively: care bundles (n=2), care bundles with implementation strategies (n=9), IPC programmes (n=16) and regulations (n=9). Designs included 21 interrupted timeseries, nine controlled before-and-after studies, four cluster-randomised and two nonrandomised trials. Evidence supports the effectiveness of care bundles with implementation strategies. Evidence for IPC programmes and regulations was inconclusive as studies were heterogeneous regarding populations, interventions, and outcomes. The overall risk of bias was high. Recommendations include care bundles should involve implementation strategies and further research on national IPC interventions is required using robust study designs and in low-income settings.