Multimodal strategies for the implementation of infection prevention and control (IPC) interventions - update of a systematic review for the WHO guidelines on core components of IPC programmes at the facility level.

Abstract

Background: Healthcare-associated infections (HAIs) remain a significant challenge worldwide, and the use of multimodal strategies is recommended by the World Health Organization (WHO) to enhance infection prevention.

Objectives: To update the systematic review on facility-level infection prevention and control (IPC) interventions on the WHO Core Component of using multimodal strategies.

Methods: Data Sources: Medline (via PubMed), EMBASE, CINAHL, and the Cochrane library.

Study eligibility criteria: Randomized controlled studies (RCTs), interrupted time series (ITS), and before-after studies in acute care settings, from 24 November 2015 to 30 June 2023.

Participants: Both paediatric and adult populations.

Interventions: IPC interventions implemented with at least three WHO multimodality elements.

Primary outcomes: HAI, HAI caused by antimicrobial-resistant microorganisms, and hand hygiene (HH) compliance.Assessment of Risk of Bias: Effective practice and organisation of care (EPOC) and integrated quality criteria for review of multiple study designs (ICROMS) tools.Methods of data Synthesis: Descriptive data synthesis.

Results: Of 5678 identified titles and abstracts, 32 publications were eligible for data extraction and analysis. Five non-controlled before-after studies (NCBA) were excluded due to an insufficient ICROMS score. Of the remaining 27 studies, nine reported on the effect of multimodal strategies to reduce device-associated HAIs, four on surgical site infections, eight on infections due to AMR and six on HH compliance. Eleven were controlled studies (RCTs or controlled before-after studies (CBAs)), nine ITS and seven NCBA studies. Twenty-two of the studies originated from high-income countries and the overall quality was medium to low. Twenty studies showed either significant HAI-reductions or HH improvement.

Conclusion: Most studies demonstrate a significant effect on HAI prevention and HH improvement after applying a multimodal strategy. However, the quality of evidence remains low to moderate with few studies from low- or middle-income countries. Future research should focus on higher quality studies in resource limited settings.