The preventable proportion of healthcare-associated infections 2005–2016: Systematic review and meta-analysis

Abstract

ObjectiveThe preventable proportion of healthcare-associated infections (HAIs) may decrease over time as standards of care improve. We aimed to assess the proportion of HAIs prevented by multifaceted infection control interventions in different economic settings.MethodsIn this systematic review and meta-analysis, we searched OVID Medline, EMBASE, CINAHL, PubMed, and The Cochrane Library for studies published between 2005 and 2016 assessing multifaceted interventions to reduce catheter-associated urinary tract infections (CAUTIs), central-line–associated bloodstream infections (CLABSIs), surgical site infections (SSIs), ventilator-associated pneumonia (VAP), and hospital-acquired pneumonia not associated with mechanical ventilation (HAP) in acute-care or long-term care settings. For studies reporting raw rates, we extracted data and calculated the natural log of the risk ratio and variance to obtain pooled risk ratio estimates.ResultsOf the 5,226 articles identified by our search, 144 studies were included in the final analysis. Pooled incidence rate ratios associated with multifaceted interventions were 0.543 (95% confidence interval [CI], 0.445–0.662) for CAUTI, 0.459 (95% CI, 0.381–0.554) for CLABSI, and 0.553 (95% CI, 0.465–0.657) for VAP. The pooled rate ratio was 0.461 (95% CI, 0.389–0.546) for interventions aiming at SSI reduction, and for VAP reduction initiatives, the pooled rate ratios were 0.611 (95% CI, 0.414–0.900) for before-and-after studies and 0.509 (95% CI, 0.277–0.937) for randomized controlled trials. Reductions in infection rates were independent of the economic status of the study country. The risk of bias was high in 143 of 144 studies (99.3%).ConclusionsPublished evidence suggests a sustained potential for the significant reduction of HAI rates in the range of 35%–55% associated with multifaceted interventions irrespective of a country’s income level.

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“…Although HAIs are a significant challenge for healthcare systems, it is believed that more than 30% of HAIs could be prevented by correct IPC measures [6,20]. Unfortunately, adherence to best practices and guidelines is very low [10,21].…”

“…The global HAI prevalence has been reported to be up to 15.5% in low and middle income countries, and the number is growing [1][2][3][4][5]. On the other hand, 35 to 55% of HAIs can be reduced by applying multimodal infection control measures [6].…”

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“…The International Nosocomial Infection Control Consortium stated in 2008 that not only is the risk of healthcare-associated infections (HAI) higher in developing countries, but also its impact on patients and health systems [6]. A systematic review has shown that 35-55% of HAI are preventable [7].…”

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“…The extent to which HAIs can be prevented remains largely debatable. Several reviews suggest that up to 70% of HAIs are potentially preventable (Umscheid et al, 2011, Schreiber et al, 2018. With improvements in infection prevention and reductions in infection rates, the proportion of potentially preventable HAIs continues to decrease, resulting in an infection prevention law of diminishing returns (Schreiber et al, 2018).…”

“…Several reviews suggest that up to 70% of HAIs are potentially preventable (Umscheid et al, 2011, Schreiber et al, 2018. With improvements in infection prevention and reductions in infection rates, the proportion of potentially preventable HAIs continues to decrease, resulting in an infection prevention law of diminishing returns (Schreiber et al, 2018). As the principle tenet of medicine is first do no harm, infection prevention programs should relentlessly pursue reliable, sustainable, and practical strategies for heightened patient safety (Bearman et al, 2019).…”