Interventions to improve professional adherence to guidelines for prevention of device-related infections - The Cochrane

Abstract

Plain language summary

Healthcare-associated infections (HAIs) are a major threat to patient safety, and are associated with mortality rates varying from 5% to 35%. Important risk factors associated with HAIs are the use of invasive medical devices (e.g. central lines, urinary catheters and mechanical ventilators) that breach the body's normal defence mechanisms, and poor staff adherence to infection prevention practices during insertion and care for the devices when in place.
We identified 13 studies: one cluster randomised controlled trial (CRCT) and 12 interrupted time series (ITS) studies, involving 40 hospitals, 51 intensive care units (ICUs), 27 wards and more than 1406 healthcare professionals and 3504 patients, which assessed the impact of different interventions to reduce the occurrence of device-related infections for inclusion in this review. We judged all studies to be at moderate to high risk of bias.
The effect sizes were small with the largest median effect for studies addressing central line associated blood stream infections (CLABSIs) occurring immediately after the implementation of an intervention to improve adherence to guidelines, in the majority of studies this change was not sustained over longer follow-up times. The median effect for studies aiming to reduce ventilator-associated pneumonia (VAP) was somewhat greater and was sustained up to 12 months follow-up. The results of six studies that reported adherence/non-adherence with infection control recommendations showed very varying adherence scores ranging from 14% to 98%.
The low to very low quality of the evidence of the studies included in this review provides insufficient evidence to determine with certainty which interventions are most effective in changing professional behaviour and in what contexts. However, interventions that may be worth further study are educational interventions consisting of more than one active element and that are repeatedly administered over time, and interventions employing dedicated personnel, who are focused on a certain aspect of care that is supported by evidence e.g. dentists/dental auxiliaries providing oral care. If healthcare organisations and policy makers wish to improve professional adherence to guidelines for the prevention of device-related infections, funding of well designed studies to generate high quality evidence is needed to guide policy.