Infection Prevention in Long-Term Care: A Systematic Review of Randomized and Nonrandomized Trials

Authors

  • Mayuko Uchida MSN,

    Corresponding author
    1. Center for Interdisciplinary Research to Prevent Infections, School of Nursing, Columbia University, New York, New York
    • Center for Health Policy, School of Nursing, Columbia University, New York, New York
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  • Monika Pogorzelska-Maziarz PhD, MPH,

    1. Center for Health Policy, School of Nursing, Columbia University, New York, New York
    2. Center for Interdisciplinary Research to Prevent Infections, School of Nursing, Columbia University, New York, New York
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  • Philip W. Smith MD,

    1. College of Medicine, University of Nebraska Medical Center, Lincoln, Nebraska
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  • Elaine Larson PhD, RN

    1. Center for Health Policy, School of Nursing, Columbia University, New York, New York
    2. Center for Interdisciplinary Research to Prevent Infections, School of Nursing, Columbia University, New York, New York
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Address Correspondence to May Uchida, Center for Health Policy, Columbia University School of Nursing, 617 W. 168th Street Suite 239, New York, NY 10032. E-mail: mu2188@columbia.edu

Abstract

The purpose of this systematic review was to critically review and synthesize current evidence and the methodological quality of nonpharmacological infection-prevention interventions in long-term care (LTC) facilities for older adults. Two reviewers searched three electronic databases for studies published over the last decade assessing randomized and nonrandomized trials designed to reduce infections in older adults in which primary outcomes were infection rates and reductions of risk factors related to infections. To establish clarity and standardized reporting of findings, the Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist was used. Data extracted included study design, sample size, type and duration of interventions, outcome measures reported, and findings. Two reviewers independently assessed study quality using a validated quality assessment tool. Twenty-four articles met inclusion criteria; the majority were randomized control trials (67%) in which the primary purpose was to reduce pneumonia (66%). Thirteen (54%) studies reported statistically significant results in favor of interventions on at least one of their outcome measures. The methodological clarity of available evidence was limited, placing them at potential risk of bias. Gaps and inconsistencies surrounding interventions in LTC are evident. Future interventional studies need to enhance methodological rigor using clearly defined outcome measures and standardized reporting of findings.

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