Table 1 Included studies from the non-outbreak setting
Author | Design | Setting | Sample size | Topic | Intervention | Study period | Outcome | Results | Mean quality score |
|---|---|---|---|---|---|---|---|---|---|
Chahine et al. (2022) [13] | Quasi-experimental | LTCF | 205 (2015/16) and 253 (218/19) hospital admissions | Antimicrobial Stewardship | AMS mandate consisting of leadership, accountability, drug expertise, acting, tracking, reporting and education | 2015/16 and 2018/19 | MDRO and CDI-Incidence | No statistically significant difference in the combined rate of LTCF-acquired MDRO-I/C and CDI | Medium |
Felsen et al. (2020) [14] | Quasi-experimental | 6 NHs in the USA | Not described | Antimicrobial Stewardship | CDC's core elements for antibiotic stewardship in acute care | 2014–2019 | CDI incidence | Rate of CDI per 10.000 RD decreased | Low |
Nace et al. (2020) [15] | RCT | 25 LTCFs in the USA | Intervention: 512.408 facility resident-days Control: 443.912 facility resident-days | Antimicrobial Stewardship | Multifaceted antimicrobial stewardship intervention, education, guidelines, audit, feedback | 02/2017–04/2018 | CDI incidence | Increase in CDI in control group | Medium |
Salem-Schatz et al. (2020) [16] | Quasi-experimental | 30 LTCFs in the USA | 365.019 patient days in first period 340.468 resident days in second period | Antimicrobial Stewardship | Education, tools | 1. period: 13/2012–06/2013 2. Period: 11/2013–06/2014 | CDI incidence rate | Reduction of CDI | Low |
Mody et al. (2003) [17] | RCT | 2 LTCFs in the USA | 127 persistent carriers | Decolonization | Mupirocin therapy or placebo administered twice daily for 14Â days to nares and/or wound surfaces | Not reported | S.aureus colonization, reduction in S.aureus infections in residents treated with Mupirocin | Mupirocin significantly eradicated colonization in 93% of intervention group while 85% of placebo group remained colonized | Medium |
Baldwin et al. (2010) [19] | cRCT | 32 NHs in Northern Ireland | Intervention: 16 NHs Control: 16 NHs | Education | Education: 2 h session at baseline, and at 3 and 6 months, Audits Control: usual practice | 01/2007–08/2008 | MDRO incidence Infection control audit scores | MRSA prevalence was not significantly different between intervention and control groups Infection control audit scores were significantly higher in intervention group compared with control group at 12 months | Medium |
Freeman-Jobson et al. (2016) [20] | Quasi-experimental | 3 LTCFs in the USA | 42 care workers | Education | Education program (three sections] | Not reported | Knowledge related to UTIs | Knowledge scores improved significantly | Low |
Fendler et al. (2002) [21] | Quasi-experimental | 1 NH in the USA | 275 beds | Hand hygiene | Hand sanitizer provided to 2nd and 3rd floors of facility, remainder of facility served as control and received no hand sanitizer | Not reported | Nosocomial infection rates | Reduction in nosocomial infection rates seen in hand sanitizer group | Medium |
Ho et al. (2012) [22] | cRCT | 18 LTCFs in Hong Kong | Intervention 1: 6 LTCFs Intervention 2: 6 LTCFs Control: 6 LTCFs | Hand hygiene | WHO multi-modal HH interventions: ABHR, gloves, posters, reminders, video clips and performance feedback Intervention 1: slightly powdered gloves Intervention 2: powderless gloves Control: a 2Â h health talk | Not reported | HH adherence, infection rates, MDRO incidence | HH adherence was increased after intervention in intervention groups Risks of respiratory outbreaks and MRSA infections requiring hospitalization were reduced in the intervention group | Low |
Lai et al. (2019) [23] | Cohort study | 11 NHs in Taiwan | 11 NHs | Hand hygiene | Education | 01/2015–12/2016 | Knowledge | Increase in hand hygiene compliance rate, overall knowledge level and use of alcohol-based hand rub | Low |
Mody et al. (2003) [24] | Quasi-experimental | 2 NHs units in the USA | 2 NHs | Hand hygiene | Educational campaign to introduce alcohol based hand rubs | Not reported | Nosocomial infection rates | No difference in nosocomial infection rates after introduction of alcohol based hand rubs | Medium |
Schweon et al. (2013) [25] | Quasi-experimental | 1 NH in the USA | 1 NH | Hand hygiene | HH programme, provision of HH product and wipes, HH education for HCW and patients, Poster as reminder, HH champion, HH compliance monitoring | 05/2009–02/2011 | Infection rates, MDRO incidence | Significant reduction in LRTIs as well as a non-significant reduction in SSTIs Incidence rates of MRSA, VRE,CDI and gastrointestinal illness were not significantly reduced post-intervention | Low |
Teesing et al. (2021) [26] | cRCT | 66 units in 33 NHs in the Netherlands | Intervention: 976 beds Control:886 beds | Hand hygiene | Multimodal intervention including a combination of activities for changing hygiene policy and the individual behavior of nurses, E-learning, 3 live lessons, posters, and a photo competition, hand hygiene compliance measurements | 10/2016–10/2017 | Infection rates, MDRO incidence | Significantly more gastroenteritis and significantly less influenza-like illness in the intervention arm No significant differences of pneumonia, urinary tract infections, and MRSA infections in the intervention arm compared to the control arm | Medium |
Temime et al. (2018) [27] | cRCT | 26 NHs in France | Intervention: 13 NHs Control: 13 NHs | Hand hygiene | Bundle of HH-related measures: increased availability of alcohol-based handrub, HH promotion, staff education, and local work groups | 04/2014–04/2015 | Primary: infection rates Secondary: mortality | No data for primary endpoint The intervention group showed significantly lower mortality | Medium |
Yeung et al. (2011) [28] | cRCT | 6 LTCFs in Hong Kong | Intervention: 3 LTCFs (73 staff, 244 residents) Control: 3 LTCFs (115 staff, 379 residents) | Hand hygiene | Pocket-sized containers of ABHR, a 2-h seminar, reminder materials and posters Control: basic life support education and workshops and usual HH practices | 01/2007–11/2007 | HH adherence, infection rates | Increase in HH adherence and reduction of the incidence of infections | Low |
Banks M et al. (2021) [29] | Quasi-experimental | 1 LTCF in the USA | 180 beds | Hand Hygiene | HH technology, badge measures alcohol concentration on health care workers hands, or time washing hands | 2017–2019 | HH adherence, CDI rates | Increase in compliance with hand hygiene, reduction of CDI rate | Low |
Sassi et al. (2015) [30] | Quasi-experimental | 1 LTCF in the USA | Fomites Before: 106 samples After: 105 samples Staff hands Before: 28 samples After: 29 samples | Hand hygiene | Training: active ingredients, safety precautions, effective times, recommended times to use the product and recommended methods, Product placement: hand sanitizer, wipes, antiviral tissue and gloves | Not reported | MDRO incidence | There was a 16.7% reduction in the number of MS-2 positive, significant reduction in recovered MS-2 on sampled fomites and staff hands | Low |
Peterson et al. (2016) [18] | cRCT | 12 nursing units at 3 LTCFs in the USA | Between 850—900 beds | IPC Bundle | Universal decolonization for MRSA, active surveillance (all admissions), annual instruction on HH, enhanced cleaning of surfaces (every 4 months) | 03/2011–03/2013 | MRSA incidence | Significant reduction in rate difference between intervention group and control group | Low |
Bellini et al. (2015) [31] | cRCT | 104 NHs in Switzerland | Intervention: 53 NHs (2338 residents) Control: 51 NHs (2412 residents) | IPC Bundle | Universal MRSA screening, topical decolonization of carriers, disinfection of environment, standard precautions and training sessions Control: standard precautions alone | 06/2010–12/2011 | MRSA incidence | No significant reduction in prevalence of MRSA carriers | High |
Koo et al. (2016) [32] | cRCT | 12 NHs in the USA | Intervention: 6 NHs Control: 6 NHs | IPC Bundle | Interactive educational program: Pre-emptive barrier precautions with gloves and gown, monthly MDRO and infection surveillance with feedback, NH staff education Control: own IPC practices and given knowledge tests | Not reported | Knowledge about IPC topics | Knowledge scores increased significantly after each educational module | Medium |
Mody et al. (2015) [33] | cRCT | 12 NHs in the USA | Intervention: 6 NHs Control: 6 NHs | IPC Bundle | Pre-emptive barrier precaution, active surveillance for MDROs and infections with feedback, NH staff education on IPC practices and HH promotion Control: own IPC practices | Not reported | MDRO incidence | Intervention group had a significant decrease in overall MDRO prevalence, and lower rates of MRSA acquisition and first new CAUTI | High |
McConeghy et al. (2017) [34] | cRCT | 5 NHs in the USA | 481 and 380 long-stay residents | IPC Bundle | Education, cleaning products, and audit of compliance and feedback | 10/2015–05/2016 | Infection rates | No significant reduction for both total infections and LRTIs | Medium |
Mody et al. (2021) [35] | cRCT | 6 NHs in the USA | Intervention: 113 patients Control: 132 patients | IPC Bundle | Enhanced barrier precautions, chlorhexidine bathing, MDRO surveillance, environmental cleaning, education and feedback, hand hygiene promotion | 09/2016–08/2018 | MDRO incidence | Reduced overall prevalence of MDRO | Medium |
Ben-David et al. (2019) [36] | Quasi-experimental | 330 LTCFs in Israel | 330 LTCFs | IPC Bundle | Education, screening, isolation | 2009–2015 | MDRO incidence | Incidence of MDRO acquisition declined in all facility types to approximately 50% from baseline | Low |
Trick et al. (2004) [37] | cRCT | 1 skilled NH in the USA | 283 residents | Isolation | Healthcare workers assigned to either the contact isolation group or routine glove use group without contact isolation | 06/1998–12/1999 | MDRO incidence | No difference in acquisition of VRE/MRSA with glove use without contact isolation compared to contact isolation group | High |
Adachi et al. (2002) [38] | RCT | 2 NHs in Japan | 141 residents | Oral hygiene | Professional oral care weekly by dental hygienists in intervention group, usual care in control group | Not reported | Oral health | Professional oral care by dental hygienist reduced microorganisms related to pneumonia | Low |
Ishikawa et al. (2008) [39] | Quasi-experimental | 3 NHs in Japan | 202 residents | Oral hygiene | Provided professional oral care by a dental hygienist once a week with varying modality, intensity and frequency | Not reported | Oral health | Levels of oropharyngeal bacteria decreased across all 3 facilities when weekly professional care was instituted | Low |
Kulberg et al. (2010) [40] | Quasi-experimental | 1 NH in Sweden | 43 residents | Oral hygiene | Dental hygiene education led by dental hygienist for nursing staff; residents were given electronic toothbrushes,recommended to use chlorhexidine gel twice daily | 2008 | Oral health | Reduction in plaque scores | Low |
Maeda and Akagi (2014) [41] | Cohort study | 1 LTCF in Japan | Intervention: 31 residents Control: 32 residents | Oral hygiene | Oral care protocol (at least twice per day), tooth and tongue brushing using a toothbrush, and oral mucosa brushing using a sponge brush and a 0.2% chlorhexidine solution, moisturizing the inner mouth with glyceryl poly methacrylate gel, salivary gland massage Control: oral care not performed regularly | 07/2011–06/2013 | Pneumonia rates | Reduction in the incidence of pneumonia | Medium |
Quagliarello et al. (2009) [42] | RCT | 1 LTCF in the USA | 52 residents (30 in oral hygiene intervention group, 20 in swallowing intervention group) | Oral hygiene | Oral hygiene group assigned to manual oral brushing plus chlorhexidine mouth rinse at different frequencies daily, no control Swallowing group assigned to 90 degree feeding posture, swallowing techniques or manual brushing daily | Not reported | Oral health | Significant reduction in plaque scores at end of oral care intervention | Medium |
Yoneyama et al. (2002) [43] | RCT | 11 NHs in Taiwan | 417 residents | Oral hygiene | Enforced oral hygiene measures and oral cleaning by dental hygienists once a week, control group received usual care | 1996–1998 | Pneumonia rates | Incidence of pneumonia was lower in intervention group | Medium |
Cabezas et al. (2021) [44] | Cohort study | NH in Spain | 28.000 residents, 26.000 NH Staff, 60.000 HCW | Vaccination | Participants (NH-Residents, NH-staff and HCW) were followed until outcome (SARS-Cov2 infection, hospital admission, death) occurs, vaccination as a time varying exposure | 12/2020–05/2021 | SARS-CoV-2 infection rates, hospital admission or death with Covid-19 | Vaccination was associated with 80–91% reductions in symptomatic and asymptomatic SARS-CoV-2 infections among nursing home residents, nursing home staff, and healthcare workers and led to ≥ 95% reductions in covid-19 related hospital admission and mortality among nursing home residents | Low |
Goldin et al. (2022) [45] | Cohort study | 454 LTCFs in Israel | 43.596 residents | Vaccination | BNT162b2 mRNA COVID-19 (Comirnaty) Vaccine | 12/2020–05/2021 | SARS-CoV-2 infection rates | Mortality from COVID-19 was 21.9% in the vaccinated population and 30.6% in the unvaccinated population | Medium |
Maruyama et al. (2010) [46] | RCT | 9 hospitals and 23 NHs in Japan | 1006 residents | Vaccination | Residents received pneumococcal vaccine, control group received placebo | 03/2006–03/2009 | Pneumonia rates | Significant reduction of pneumonia incidence | High |