Hospital- and System-Wide Interventions for Health Care-Associated Infections: A Systematic Review. (December 2021)

• Record Type: Journal Article
• Authors: Maurer, Nicholas R.; Hogan, Tory H.; Walker, Daniel M.
• Is Part Of: Medical care research and review. Volume 78:Number 6(2021)
• Page Start: 643
• Page End: 659
• Publication Date: 2021-12
• Subjects: health care-associated infections -- quality improvement -- hospitals -- patient safety -- health-system; Medical care -- United States -- Periodicals; Medical care -- Periodicals; Medical care -- Research -- United States -- Periodicals; Medical care -- Research -- Periodicals; Medical economics -- United States -- Periodicals; Medical economics -- Periodicals; 362.10973
• DOI: 10.1177/1077558720952921
• Languages: English
• ISSNs: 1077-5587

Abstract

Hospitals face increasing pressure to reduce health care-associated infections (HAI) due to their costs and evidence of preventability. However, there is limited synthesis of evidence regarding interventions that can be successfully implemented hospital- or system-wide. Using Donabedian's structure-process-outcome model, we conducted a systematic literature review from 2008 to early 2019, identifying 96 studies with 214 outcomes examining the relationship between hospital- or system-wide interventions and HAIs. This literature's methodologic and reporting quality was generally poor. The most common HAIs studied were methicillin-resistant Staphylococcus aureus (22%) and Clostridium difficile (21%). 97 outcomes showed a desirable change, 72 showed no significant effect, 17 showed conflicting effects, and 3 found undesirable effects; 25 outcomes were from studies without a statistical analysis. Our findings highlight structural and process approaches meriting additional research and policy exploration, and identify recommendations for future investigation and reporting of hospital and system-wide HAI interventions to address gaps in existing literature.