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Table 2 Studies on effectiveness of multifaceted infection control measures

From: A review of health system infection control measures in developing countries: what can be learned to reduce maternal mortality

Intervention

Focus

Setting

Design

Duration of intervention

Key findings

Reference

Issue of guidelines

Centres for Disease Control hand hygiene guidelines

40 hospitals, USA

Before and after, no control

2 years, with follow up for 1 year after release of guidelines

All hospitals changed policies, procedures and products after guideline introduced 90% staff were aware of guidelines No change in hand hygiene compliance

Larson et al 2007[36]

Education: Monthly meetings for feedback; posted infection rates in wards; voluntary educational group sessions; distribution of infection control manual

Hand hygiene

Intensive care units in one hospital, Argentina

Before and after, no control

21 months, with 16 month follow up after intervention

Hand washing compliance increased from 23% to 65% Infection rates decreased from 5 to 3 per 100 patient days

Rosenthal et al 2005 [37]

Organisational and systems improvements: Interactive development and placement of posters; distribution of alcohol based hand rub products; support from senior management

Hand hygiene, particularly alcohol based hand rubs

One hospital, Switzerland

Before and after, no control

3 year follow up after intervention

Consumption of alcohol hand rub by volume increased from 4 to 15 litres per 1000 patient days Hand hygiene compliance increased from 48% to 66% Infection rates decreased from 17% to 10%

Pittet et al 2000 [28]

Surveillance, including: Epidemiological analysis; prioritisation of infection during ward rounds; feedback to staff; specialised infection control staff; improved staff to bed ratios

Urinary tract, surgical, bacteremic infections and pneumonia

Representative sample of 4,000 hospitals, USA

Quasi-experiment-al, with regression modelling

5 years

A maximum decrease in infection rates by 32% if all components implemented Most hospitals could only achieve reductions in infection rates of 6% Different combinations of components were optimally effective for different infections

Haley et al 1980 [42] Haley et al 1985 [40]

Continuous quality improvement: Teamwork; analysis of cause-effect using problem based models; prioritisation of specific actions emerging from problem solving

Caesarean section

2 obstetric referral hospitals, Colombia

Segmented time series

2 years

Administration of antibiotic prophylaxis increased from 71% to 95% in hospital A and from 36% to 89% in hospital B

Downward trend in surgical site infection rate in both hospitals

Weinberg et al 2001[45]