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 | |
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] |