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Table 4 Intervention studies performed in lower-middle income countries, 2005–2018

From: Infections and antimicrobial resistance in intensive care units in lower-middle income countries: a scoping review

Study Study period Published year Country Hospitals ICUs Objective Study design Intervention Subjects or observations Outcomes Comments
Khan [34] 7/2006–11/2007 2009 Pakistan 1 1 Reduce VAP Quasi-experimental before/after study 6 h training only 582 MV patients VAP rate/100 MV patients from 18 to 13% (p = 0.11) All patients were surgical and ventilated; MDR A. baumannii, P. aeruginosa and K. pneumoniae most prevalent
Mathur [18] 7/2010–9/2010 2011 India 1 1 Increase HH compliance Quasi-experimental before/after study Questionnaires, education & training, monitoring 1489 HH opportunities Compliance from 8.4 to 63.1% (p < 0.0001). Housekeeping staff did not increase their HH compliance Small scale, short term study; not clear whether housekeeping was trained or not
Jaggi [21] 9/2004–2/2012 2013 India 11 16 Prevent CLABSI by multidimensional approach Quasi-experimental before/after study Infection prevention bundle, education, monitoring & feedback 35,650 patients yielding 90,370 CL days CLABSI/1000 CL days from 6.4 to 3.9 for a RR of 0.61 (0.46–0.81) p = 0.0007. Less S. aureus after intervention but more P. aeruginosa. K. pneumoniae most prevalent pathogen throughout study Mean age was 1.3 year higher in intervention period
Mehta [22] 7/2004–10/2011 2013 India 14 21 Prevent VAP by multidimensional approach Quasi-experimental before/after study Infection prevention bundle, education, monitoring & feedback 46,945 patients yielding 65,574 MV days VAP/100 MV days from 17.4 to 10.8 for a RR of 0.62 (0.50–0.78), p = 0.0001 Patients had little lower ASIS scores in intervention period
Navao-Ng [56] 12/2005–12/2010 2013 Philippines 2 4 Preventing CAUTI by multidimensional approach Quasi-experimental before/after study Infection prevention bundle, education, monitoring & feedback 3183 patients yielding 8720 UC days; observed HH opportunities 4191 CAUTIs/1000 UC days from 11.0 to 2.66 for a RR 0.24 (0.22–0.53); HH compliance from 57.2 to 78.2% (RR 1.37[1.21–1.54]) Few HH opportunities in baseline period
Schultsz [48] 5/2004–4/2006 2013 Vietnam 1 1 Prevent exogenous acquisition of MDRO Quasi-experimental before/after study HH reinforcement, revising infection prevention procedures, monitoring & feedback, adjust antibiotic policy 357 patients VAP/1000 MV days from 56 to 40, UTI/1000 UC days from 12.8 to 15.0 (both not significant). Less cephalosporins, penicillin and carbapenem and more fluoroquinolones, metronidazole and broad-spectrum penicillin used; only MRSA acquisition delayed, not seen for other MDRO Patients had more severe tetanus + more MV days + longer LOS in year 2; HH compliance only measured in year 2
Biswal [23] 11/2010–5/2013 2014 India 1 7 Improving HH Quasi-experimental before/after study Repeated education & training, posters, adequate supplies of alcohol & soap 3212 HH opportunities HH compliance up from 16.5 to 28.2% and 35.1% after 1st and 2nd training week respectively. Significant in all ICUs Low numbers of opportunities per ICU
Chakravarthy [24] 8/2004–7/2011 2015 India 3 3 Improving HH by multidimensional approach Quasi-experimental before/after study Allocation supplies, education & training, reminders, monitoring & feedback 3612 HH opportunities HH compliance up from 36.9 to 74.8% for a RR 2.0 (1.7–2.4), p = 0.0001; but not in surgical ICU? poor among ancillary staff; HH improvement maintained over 3 years Only few observations in surgical ICU
Thu [49] 6/2009–4/2011 2015 Vietnam 1 17 Reducing HAI by HH promotion Quasi-experimental before/after Questionnaires, education & training (including patients & visitors), posters & flyers, new sinks, hand alcohol made available 984 patients and 6046 HH observations HAI/100 pts: from 31.7 to 20.3% (p = 0.005), all HAI types; HH compliance from 25.7 to 57.5% (p < 0.001)  
Rosenthal [33] 4/2012–8/2014 2015 India 2 5 CLABSI reduction RCT, block-randomization Introduced new IV flush device 1096 patients yielding 7680 CL days CLABSI/1000d: 2.21 vs 6.40; RR 0.35 (0.16–0.76); cost effective, Qualys-increasing; shift in microbe species  
  1. VAP (ventilator-associated pneumonia), MV (mechanical ventilation), RR (risk ratio), MDR (multidrug-resistant), CAUTI (catheter-associated urinary tract infection), UC (urinary catheter), HH (hand hygiene), MDRO (multidrug-resistant organism), CLABSI (central line-associated blood stream infection), CL (central line), HAI (hospital-acquired infection), RCT (randomized controlled trial), IV (intravenous)