Table 4 Interventional studies in infection prevention and control – Systematic review on implementation of infection prevention and control in acute care hospitals in Mainland China, 2012–2017

Multimodal strategies

Mu X, 2016, Guizhou [53]

To assess the effectiveness of an intervention program on HH

Single centre; 26,586 HH opportunities in the intervention period

The intervention included improving HH facilities, education on HH, and quarterly reports on HH compliance and ABHR consumption

1266 HH opportunities during baseline

NCBA; quasi-experimental. Surveillance of HH compliance, ABHR consumption, use of paper towels

HH compliance improved from 37.78% at baseline to 75.90% after intervention (P < 0.001); ABHR consumption increased from 7.40 ml per patient-day at baseline to 12.15 ml after intervention (P = 0.004); paper towels use increased from 4.07 sheets per patient-day at baseline to 7.48 sheets after intervention (P < 0.001)

High

Su D, 2015, Multi-region [54]

To assess the impact of INICC HH intervention

Multi-centre (5 ICUs of 3 hospitals); 1368 HH observations in interventional period

Administrative support; availability of ABHR and soap at the point of care; education and training on HH indications, reminders at the workplace, and HH surveillance with performance feedback

711 HH observations during baseline

NCBA. HH compliance during baseline and intervention

HH compliance increased from 51.5% during baseline to 80.1% during intervention (P = 0.004)

High

Zhou Q, 2015, Shanghai [55]

To assess the impact of a CLABSI prevention programme

Single centre; 51 newborns in intervention; 91 newborns in follow-up

HH training; dedicated PICC team, all-inclusive central line cart, pre-packaged kits; daily evaluation of central line necessity; simulation training

29 newborns in pre-intervention

NCBA. CLABSI incidence density in baseline and intervention period

CLABSI ID decreased from 16.7 per 1000 central line-days at baseline to 7.6 in intervention (P = 0.08), and to 5.2 in follow-up (P < 0.01)

High

Zhou Q, 2013, Shanghai [56]

To assess the efficacy of a VAP prevention programme in a NICU

Single centre; 169 neonates in partial intervention; 216 neonates in full intervention

HH training; waste disposal; isolation precaution measures; laminar airflow; use of ventilators (disinfection); reduction of ventilator- and antimicrobial days

106 neonates in pre-intervention

NCBA. VAP-incidence density surveillance

VAP ID decreased from 48.8 per 1000 ventilator-days in baseline to 25.7 in partial intervention, and to 18.5 in full intervention (P < 0.001)

High

Tao L, 2012, Shanghai [57]

To assess the impact of a VAP prevention programme

Single centre; 3 ICUs (surgical, cardiothoracic, medical); 4112 patients in 2006; 4405 in 2007; 3992 in 2008; 3330 in 2009

Oral care with chlorhexidine twice daily, HH promotion, and semi-recumbent position

3250 patients during baseline (2005)

NCBA. Process and outcome surveillance (VAP incidence density) with feedback

VAP ID decreased from 24.1 per 1000 ventilator-days in 2005 to 16.6 in 2006, 9.5 in 2007, 7.5 in 2008, and 5.7 in 2009 (P = 0.0001)

High

Other IPC intervention

Li Q, 2017, Zhejiang [63]

To assess the impact of relocating a NICU and improving environmental cleaning on MRSA

Single centre; 800 environmental surface samples during intervention

Reprocessing microfiber cloths; disinfection of cots, incubators, screens, syringe pumps, carts, and isolation rooms

100 environmental surface samples during baseline

NCBA. MRSA in environmental surface samples

Significant decrease of MRSA-positive surfaces from 44.0% at baseline to 2.5% at intervention (P < 0.001)

High

Lin Y, 2015, Fujian [64]

To evaluate the effect of chlorhexidine mouthwash before major heart surgery on VAP

Single centre; 47 patients

Gargling 3 × 30 s 30 min after each meal and 5 min after tooth brushing either with 0.2% chlorhexidine or normal saline on the day before major heart surgery

47 patients

RCT. Blind and random assignment of cardiac surgery patients to the 0.2% chlorhexidine or normal saline group

Significantly less VAP in the intervention group (8.5% vs. 23.4%; P = 0.049)

High