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Table 1 Summary of included studies

From: Infection control link nurses in acute care hospitals: a scoping review

Author details & Location Study design Setting Key findings & Outcomes Methodological comments & limitations
Braekeveld (2016) UK & Belgium Abstract – interactive workshop and questionnaire on perception on the role of link nurses in infection prevention 450 voluntarily participants (link nurses, nurses, head nurses and infection control practitioners) in the UK and Belgium A joint professional profile for infection control link nurses will follow  
Ching (1990) China Cluster randomized controlled trial
– introduction of a guideline for catheter care
1000 bed hospital in Hong Kong -
Control group: three wards (surgical medical and gynecology)
Test group: twenty-four wards
Three specific standards for urinary catheter care were significantly improved by link nurses educating their peers.
Incorrect practices before intervention:
- 63% intervention group
- 68% control group (p = 0.4)
Incorrect practices 5 weeks after intervention:
- 36% intervention group
- 48% control group (p < 0.05)
One hospital
One baseline measurement
No follow up
Differing numbers in control and intervention wards (sampling bias)
Cooper (2001) UK Descriptive paper- outline of the educational theory that underpinned infection control link nurses’ education Education of ICLN should be based on educational theories.  
Cooper (2004) UK Descriptive paper - prologue of action research study A district general hospital Methodological considerations and argumentation for action research.  
Cooper (2004) UK Action research A district general hospital - fourteen wards Three out of four barriers for compliance with hand hygiene were significantly improved 3 months after intervention in 14 clinical areas Small sample size No follow up
Cooper (2005) UK Qualitative research - Focus group Ten ICLN ICLN reported increased feelings of empowerment, ownership and motivation during one focus group with 10 link nurses No information on topic list, non- participants, number of data coders, data saturation, member check
Dawson (2003) UK Narrative review - outline of the role of the ICLN ICLN have a role in surveillance and education or peers. The role of the ICLN is still evolving. In 59% of National Health Services Trusts link nurses are active.  
Graaf de (2013) Netherlands Descriptive paper – outline of the appointment of 8 link nurses to support the infection prevention and control team in a Dutch hospital One hospital 8 link nurses As a result of an outbreak 8 nurses were appointed ICLN
They support the infection and prevention and control unit for 8 h a week and their departments are financially compensated
 
Horton (1988) UK Descriptive paper - outline of a pilot course Sixteen ICLN in various services of a NHS trust Monitoring performance of participants is crucial to the maintenance of high standards  
Jacobsen (1999) Australia Descriptive paper –outline of an educational program / implementation strategy 560 bed adult teaching hospital - Operating Theatre Isolation of the OT can make it more difficult for the ICN to encourage changes in infection control practice. ICLN can help to overcome this difficulty.
Monitoring tools are necessary for long-term evaluation
Macduff (2009) UK Full report - Evaluation of Cleanliness Champions Program using a mix of qualitative and quantitative methods NHS health facilities in Scotland Program has substantive positive influence on the prevention and control of health care associated infections in Scotland No process or outcome measures (as guideline adherence or Healthcare Associated Infection rates stated) Perceived impact stated
Manley (2012) UK NICE guideline - based on two workshops analyzed by an approach termed concept analysis A national role profile and core competences to support link practitioners, their managers or organizations with a ICLN network Consensus based guideline
Lene (2002) Australia Descriptive paper – outline of structure and developments of a link program A general acute care hospital A program requires dedicated coordination, flexible and well planned education and effective support from management  
Lloyd-Smith (2014) Canada Implementation of link nurse program, focus group & economic estimate evaluation Three acute care hospitals - 16 clinical units 8 with link nurses 8 without link nurse Seven link nurses produced an action plan. 10 focus groups with stakeholders led to 5 themes for a successful program Key factor is effective monitoring of effectiveness and sustainability
The program was cost effective. (cost for link nurse program per bed ($490) vs cost for extra infection prevention practitioner per bed ($596))
Convenience sampling, no information on data saturation, no member check are risks for bias
Important and relevant costs and consequences for each alternative were not identified
Millward (1993) UK Cross-sectional - Audit tool & knowledge questionnaire Three districts’ health authorities. One location with link nurse program. Audits on eight infection control topics for 20 wards.
Wards with infection control link nurses obtained higher scores on compliance with infection control standards (p = 0.0006).
Link nurse showed higher scores on knowledge (69%) than non-link nurses (52%) (p = 0.008).
Sample sizes too small for analyses.
Miyachi (2007) Japan Quasi experimental design A 1133-bed University hospital Significant decrease of monthly MRSA rates (from 6.3 to 5.0%) after implementation of link nurse system and during 2 year follow-up.
Increase in monthly use of hand soap (17.3%).
As stated in article, risk of regression to the mean, maturation effects and confounding
Ross (1981) USA Pre-post implementation study - establishing of ICLN on patient units A 650-bed, university-affiliated general hospital Implementation of ICLN and determination of health care associated infections rates in years one. Year two monitoring infection rates.
Education met expectations of link nurses (96%).
In 9 of 11 wards rates were reduced.
No baseline, no follow-up data.
Seto (2013) China Before – after study & participatory action A private 850-bed institution Involving ICLN in brainstorm sessions, poster competition, identification of points of care and monitoring compliance improved hand hygiene practice significantly from 50 to 83%. Use of hand rub increased from 8.1 l/1000 patient days to 9.1 l/1000 patient days. Single centered uncontrolled study, maturation effects
Shabam (2012) Egypt Cross-sectional survey Twenty hospitals, 205 head nurses who work as a ICLN in various departments (medical, surgical, neonatal, pediatric, obstetrics, gynecology, dialysis, outpatients’ clinics, emergency, burn and urology) Survey results showed that ICLN have a role in education (25%), consultation (25%), administration (90%), research (21%) and supervision of safe practice (99%)
The majority of head nurses participated in a training program related to infection prevention and control but not on their ICLN roles
48% of head nurses never performed ICLN roles.
54% had a low level of knowledge on infection prevention and control 79% had a high perception of infection prevention and control
When head nurses’ knowledge and perception increased the performances on the 5 identified roles increased (p = 0.0001)
No description or definition of “perception as a link of infection control”
Sopirala (2014) USA Quality improvement study (pre-post design) A 1191-bed University Medical Center After a 2 year baseline period link nurses were introduced during a year. In that year MRSA rates reduced (28%, p = < 0.01), MRSA bacteremia rates reduced (41%, p = 0.003), hand soap consumption increased(from 19 to 31 oz) as compliance with hand hygiene (from 30 to 93%). No randomization, no follow-up
Sopirala (2018) USA Before – after study evaluating a CAUTI prevention program with two different CAUTI definitions A 699-bed tertiary care academic medical center After a 21 month baseline period (data on urine cultures of 5 ICU units) link nurses were trained in CAUTI prevention, participated in training of colleagues and patients, and committed to ward based actions.
CAUTI rates declined in with new definition (IRR 0.67, 95% CI [0.48–0.93]) CAUTI rates increased with old definition (IRR 1.12,
95% CI [0.88–1.43])
Single centered study, no follow-up
Teare (1996) UK Interventions study - outlining how to design the ICLN network for the hospital District general hospital Implementation in 3 phases: set up, setting standards on wards, management ownership. Infection control practices were divided in 8 areas. ICLN (n = 51) had a role in education of peers and the audit of infection control practices. The link nurse system had a positive effect on clinical practices. Infection rates did not reduce. The infection control team was added to the trusts risk management group. No baseline measurements, no follow-up. No exact numbers given.
Teare (1998) UK Descriptive paper - reporting experiences and encountered benefits Mid-Essex trust Link nurses have a role in education and surveillance. ICLN system has raised awareness and increased the profile for infection control.  
Teare (2001) UK Descriptive paper - outlining a study day for ICLN Mid-Essex trust Six interactive sessions on infection prevention knowledge and governance. A questionnaire
quantified the self-assessed results of ICLN on their wards. This assessment of capabilities and limitations may be useful in the communication with ward management .
 
Tebest (2017) Germany Cross-sectional survey among ICLN (n = 64) University hospital Response rate 29% (n = 29).
Intended services were rarely performed
Barriers were the lack of release from other duties and the lack of acceptance of the role by physicians
One hospital
Small sample
Tsuchida (2007) Japan An intervention study with before and after comparison 560-bed acute hospital located in a major urban area in Japan In year one risk factors for CLABSI in catheter care were identified with the help of 4 link nurses. In the following 2 years interventions were implemented. ICLN educated colleagues and observed catheter care. In those two years CLABSI rates declined from 4.0/1000 catheter days to 1.1/1000 catheter days (p < 0.005) Single centered study, No randomization, no follow-up
Ward (2016) UK Descriptive paper outlining the role of the link nurse Currently there is limited evidence of the efficacy of ICLN in improving practice  
Wilbrandt (2001) Germany prospective controlled study Eight hospitals – four intervention and four controls The concept of link nurses was introduced successfully.
Improvements on the level of process quality (increase of contact moments between INLN and infection control staff) .
No reduction of nosocomial infections.
No randomination
Unclear duration of follow –up
No definition for ‘success’ of the link nurses
Wright (2002) USA Pre-post implementation observational study A 87-bed neonatal intensive care unit at a Children’s hospital Decrease of nosocomial infections
The role of the ICLN is flexible and can be tailored to the specific needs
No N, percentage or 95%CI stated