Effectiveness of infection prevention and control interventions in reducing health-care-associated infections in long-term care facilities for older people: a systematic review.

Abstract

Existing infection prevention and control measures focus primarily on acute health-care settings; however, residents and staff in long-term care facilities are also at risk of acquiring health-care-associated infections. In this Review, we systematically evaluated the evidence on the effectiveness of infection prevention and control interventions for preventing health-care-associated infections and antimicrobial resistance in long-term care facilities for older people to inform WHO's global guidelines. We searched the databases Cochrane Central Register of Controlled Trials (CENTRAL), Cumulative Index to Nursing and Allied Health Literature (CINAHL), Embase, MEDLINE, and WHO Institutional Repository for Information Sharing (IRIS) for publications from Jan 1, 2009, to Aug 15, 2024, for studies meeting the Cochrane Effective Practice and Organisation of Care design criteria. Two independent reviewers extracted the data and assessed their quality using the Cochrane Effective Practice and Organisation of Care risk-of-bias criteria. 25 studies were included and synthesised narratively. Evidence from the Review supports the effectiveness of multifaceted interventions using the WHO multimodal improvement strategy (six of eight studies), and, to a lesser extent, vaccination (two of two studies). Evidence for other interventions such as education, oral care improvement, air quality improvement, hand hygiene improvement, decolonisation efforts, and surveillance was inconclusive. However, the synthesised evidence is constrained by high (n=19) or unclear (n=6) risk of bias, study heterogeneity, and reliance on studies from high-income settings, thereby affecting generalisability. Furthermore, evidence-based infection prevention guidelines for long-term care should allow adaptability and consider contextual factors influencing implementation.