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

Ashlesha Sonpar, Chandra Omar Hundal, Joan E.E. Totté,Jiancong Wang, Sabine D. Klein,Anthony Twyman,Benedetta Allegranzi,Walter Zingg

Clinical Microbiology and Infection（2025）SCI 1区SCI 2区

Clinic for Infectious Diseases and Hospital Hygiene | University Library

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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.

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Key words

antimicrobial resistance,core components,healthcare-associated infection,Infection prevention and control,multimodal strategies,systematic review,update

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【要点】：本文更新了关于使用多模式策略实施感染预防与控制（IPC）干预措施的系统性回顾，以支持世界卫生组织关于设施层面IPC计划核心组成部分的指南，发现多模式策略对降低医院感染和改善手卫生依从性具有显著效果，但证据质量仍处于中低水平。

【方法】：研究采用系统性回顾的方法，数据来源于Medline、EMBASE、CINAHL和Cochrane图书馆，纳入了从2015年11月24日至2023年6月30日在急性护理环境中进行的随机对照试验（RCTs）、中断时间序列（ITS）和前后研究。

【实验】：在5678个标题和摘要中筛选出32篇符合条件的出版物进行数据提取和分析，排除了5个非控制性前后研究。共27项研究，其中9项报道了多模式策略对降低设备相关医院感染的效果，4项关于手术部位感染，8项关于抗微生物药物耐药感染，6项关于手卫生依从性。研究结果显示，20项研究显示出医院感染显著降低或手卫生改善。