Approaches to multidrug-resistant organism prevention and control in long-term care facilities for older people: a systematic review and meta-analysis

Wong, Valerie Wing Yu; Huang, Ying; Wei, Wan In; Wong, Samuel Yeung Shan; Kwok, Kin On

doi:10.1186/s13756-021-01044-0

Antimicrobial Resistance & Infection Control

Table 1 Characteristics of included studies

From: Approaches to multidrug-resistant organism prevention and control in long-term care facilities for older people: a systematic review and meta-analysis

References	Country	Study design	Control type	MDRO type	Measured outcomes	Staff compliance measured	Interventions (duration, months)	No. of residents analyzed (baseline)	Summary findings
Baldwin et al. [28]	Northern Ireland	Clustered RCT	Concurrent	MRSA	Colonization	Y	ED + PI (3, 6, 12)	793	No effect
Bellini et al. [44]	Switzerland	Clustered RCT	Concurrent	MRSA	Colonization; infections	N	DC + EC + ED (12)	4750	No effect¹
Ben-David et al. [45]	Israel	Uncontrolled before-after	Historical	CRE	Acquisition	N	AE + BP + ED + PI (84)	~ 20000²	Reduction³
Bowler et al. [46]	United States	Uncontrolled before-after	Historical	MRSA	Colonization	N	DC + EC + ED (13)	687	Reduction³
Chuang et al. [47]	Hong Kong SAR, China	Clustered RCT	Concurrent	MRSA	Colonization	Y	BP + EC + ED + HH + PI (6, 9, 12, 15)	2776	No effect
Hequet et al.⁴ [48]	Switzerland	Clustered RCT	Concurrent	MRSA	Colonization	N	DC + EC + ED (12, 60)	NS	No effect
Ho et al. [49]	Hong Kong SAR, China	Clustered RCT	Concurrent	MRSA	Infections	Y	AE + ED + HH + PI (4)	2407	Reduction³
Horner et al. [50]	United Kingdom	Uncontrolled before-after	Historical	MRSA	Colonization	Y	ED + PI (6, 9, 12, 18, 24)	2237⁵	No effect
Jaqua-Stewart et al. [51]	United States	Uncontrolled before-after	Historical	MRSA	Colonization; infections	N	BP + DC + ED + SC (12, 39)	42	Reduction³
Kauffman et al. [52]	United States	Uncontrolled before-after	Historical	MRSA	Colonization	N	DC (7⁶, 5⁷)⁸	321	Reduction^3,9
Mody et al. [53]	United States	Clustered RCT	Concurrent	MRSA; VRE; GNB	Colonization; infections	Y¹⁰	BP + ED + HH + PI (24)	418	Reduction³
Morgan et al. [54]	United States	Controlled before-after	Concurrent	MRSA	Acquisition; infections	N	BP (48)	75,414	No effect
Ostrowsky et al. [55]	United States	Uncontrolled before-after	Historical	VRE	Colonization	Y¹¹	BP + EC + ED + HH (12, 24)	5221	Reduction³
Peterson et al.¹² [56]	United States	Clustered RCT	Concurrent	MRSA	MRSA infections	N	DC + EC + ED + SC (12, 24)	7069	Reduction³
Schora et al. [57]	United States	Clustered RCT	Concurrent	MRSA	Colonization	N	DC + EC + ED + SC (12, 24)	4424	Reduction³
Schweon et al. [61]	United States	Uncontrolled interrupted time series	Historical	MRSA; VRE; C.diff	Infections	Y	AE + ED + HH + PI (22)	NS	No effect
Silverblatt et al. [58]	United States	Uncontrolled interrupted time series	Historical	VRE	Colonization	N	BP + DC + ED + HH (28)	NS	Absence of outcome
Singh et al. [59]	United States	Uncontrolled before-after	Historical	C.diff	C.diff infections	N	AE + BP + EC + ED + HH (33)	~ 9381¹³	Reduction³
Thomas et al. [60]	United States	Uncontrolled before-after	Historical	MRSA	Colonization; MRSA infections	N	BP + ED (3)	164	Reduction³

AE, administrative engagement; BP, barrier precautions; BSI, bloodstream infection; C.diff., Clostridium difficile; DC, decolonization; ED, education; EC, environmental cleaning; GNB, Gram-negative bacteria; HH, hand hygiene; MRSA, methicillin-resistant Staphylococcus aureus; PI, performance improvement; NS, not specified; SC, source control; UC, usual care; VRE, vancomycin-resistant enterococci
¹Colonization prevalence declined in both groups. Absence of invasive infections in both groups
²The sample size was not specified. We reported the number of beds in nursing homes
³Statistically significant reduction
⁴Extended study from Bellini et al. [44]
⁵Since the information was insufficient in survey two and three, we only included participants from survey one and four
⁶In Phase one, residents were decolonized in their anterior nares only for seven months
⁷In Phase two, residents were decolonized in both their anterior nares and wound for five months
⁸We only included results from Phase one in the quantitative analysis since the results from Phase two might be affected by the carryover effect
⁹Reductions were reported when decolonization was applied in both nares and wounds but not nares only
¹⁰A structured 30-min observations monitored HCW activities and their use of barrier precautions, but results were not reported
¹¹The authors used self-reported questionnaires to monitor the staff compliance before and after the interventions implemented
¹²Schora et al. [57] and Peterson et al. [56] are based on the same study with the same study sample
¹³The authors reported there were a total of 9,288,098 resident days. We estimated there were around 9381 residents after dividing the number of resident days with 30 days and 33 months

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