TY - JOUR
T1 - Effectiveness of national and subnational interventions for prevention and control of health-care-associated infections in acute hospitals in high-income and upper-middle-income counties: a systematic review update
AU - Price, Lesley
AU - Gozdzielewska, Lucyna
AU - Hendry, Katie
AU - McFarland, Agi
AU - Reilly, Jacqui
N1 - Funding Information:
We would also like to acknowledge the Scottish Healthcare Associated Infection Prevention Institute research consortium who financially supported a post of the staff member (LG) who has contributed to this Review. This systematic review was supported by funding from WHO (2021/1194919-0). Glasgow Caledonian University (Glasgow, UK) was responsible for conducting and sponsoring this Review.
PY - 2023/9
Y1 - 2023/9
N2 - This systematic review, commissioned and funded by WHO, aimed to update a review of infection prevention and control (IPC) interventions at a national level to inform a review of their IPC Core Components guidelines (PROSPERO CRD42021297376). CENTRAL, CINAHL, Embase, MEDLINE, and WHO IRIS were searched for studies meeting Cochrane’s Effective Practice and Organisation of Care (EPOC) design criteria, published from April 19, 2017, to Oct 14, 2021. Primary research studies examining national IPC interventions in acute hospitals in any country with outcomes related to rates of health-care-associated infections were included. Two independent reviewers extracted data and assessed quality using the EPOC risk of bias criteria. 36 studies were categorised per intervention type and synthesised narratively: care bundles (n=2), care bundles with implementation strategies (n=9), IPC programmes (n=16), and regulations (n=9). Designs included 21 interrupted time-series, nine controlled before-and-after studies, four cluster-randomised trials, and two non-randomised trials. Evidence supports the effectiveness of care bundles with implementation strategies. However, 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 the involvement of implementation strategies in care bundles and for further research on national IPC interventions with robust study designs and in low-income and middle-income settings.
AB - This systematic review, commissioned and funded by WHO, aimed to update a review of infection prevention and control (IPC) interventions at a national level to inform a review of their IPC Core Components guidelines (PROSPERO CRD42021297376). CENTRAL, CINAHL, Embase, MEDLINE, and WHO IRIS were searched for studies meeting Cochrane’s Effective Practice and Organisation of Care (EPOC) design criteria, published from April 19, 2017, to Oct 14, 2021. Primary research studies examining national IPC interventions in acute hospitals in any country with outcomes related to rates of health-care-associated infections were included. Two independent reviewers extracted data and assessed quality using the EPOC risk of bias criteria. 36 studies were categorised per intervention type and synthesised narratively: care bundles (n=2), care bundles with implementation strategies (n=9), IPC programmes (n=16), and regulations (n=9). Designs included 21 interrupted time-series, nine controlled before-and-after studies, four cluster-randomised trials, and two non-randomised trials. Evidence supports the effectiveness of care bundles with implementation strategies. However, 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 the involvement of implementation strategies in care bundles and for further research on national IPC interventions with robust study designs and in low-income and middle-income settings.
KW - effectiveness
KW - interventions
KW - infection Prevention & Control
KW - systematic review
KW - hospitals
KW - healthcare associated infection (HAI)
U2 - 10.1016/S1473-3099(23)00049-X
DO - 10.1016/S1473-3099(23)00049-X
M3 - Review article
C2 - 37023784
AN - SCOPUS:85153525404
SN - 1473-3099
VL - 23
SP - e347-e360
JO - The Lancet Infectious Diseases
JF - The Lancet Infectious Diseases
IS - 9
ER -