Healthcare-associated infections in long-term care facilities: a systematic review and meta-analysis of point prevalence studies
Objectives Residents of long-term care facilities (LTCFs) are especially vulnerable to acquiring healthcare-associated infections (HAIs). Our systematic review and meta-analysis estimated the burden of HAIs, identified the most frequent HAIs and explored the impact of facility-level and surveillance...
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BMJ Publishing Group
2024-05-01
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| Series: | BMJ Public Health |
| Online Access: | https://bmjpublichealth.bmj.com/content/2/1/e000504.full |
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| author | Karin Thursky David Dunt Leon J Worth Rodney James Stephanie K Tanamas Janet K Sluggett Noleen Bennett Courtney Ierano Michael J Malloy Eliza Watson |
| author_facet | Karin Thursky David Dunt Leon J Worth Rodney James Stephanie K Tanamas Janet K Sluggett Noleen Bennett Courtney Ierano Michael J Malloy Eliza Watson |
| author_sort | Karin Thursky |
| collection | DOAJ |
| description | Objectives Residents of long-term care facilities (LTCFs) are especially vulnerable to acquiring healthcare-associated infections (HAIs). Our systematic review and meta-analysis estimated the burden of HAIs, identified the most frequent HAIs and explored the impact of facility-level and surveillance methodological differences on HAI burden in LTCFs, as determined by point prevalence studies (PPS).Design Systematic review and meta-analysis.Data sources Bibliographic databases MEDLINE (Ovid), Embase (Ovid) and CINAHL (EBSCOhost) were searched for potentially eligible English-language original research publications. References of short-listed full-text publications, the European Centre for Disease Control and Prevention website and an unpublished 2016–2022 Australian Aged Care PPS report were also checked.Eligibility criteria PPS monitoring HAIs, published and undertaken between January 1991 and June 2023 in LTCFs.Data extraction and synthesis Two reviewers independently screened for eligible PPS and if included, assessed risk of bias for each PPS using the Joanna Briggs Institute (JBI) critical appraisal tool for prevalence studies. Meta-analysis was performed using a generalised linear mixed model.Results 31 publications (including 123 PPS from 33 countries encompassing 709 860 residents) were included. Nine PPS (7.3%) were allocated a JBI quality score greater than 80% while 30 PPS (24.4%) were allocated a score between 70% and 80%. The overall pooled HAI point prevalence was 3.5% (95% CI 3.1% to 4.0%); 3.9% (95% CI 3.2% to 4.7%) when higher bias-risk PPS (<70% quality score) were excluded. Of 120 PPS, the most frequently reported HAIs were urinary tract (UTIs; 38.9%), respiratory tract (RTIs; 33.6%) and skin or soft tissue (SSTIs; 23.7%) infections. HAI point prevalence varied by geographical region (p<0.001), study decade (p<0.001) and HAI surveillance definitions used (p<0.001). There was no difference across facility types (p=0.57) or season (p=0.46).Conclusions HAIs remain a global public health problem and threat to the safety of LTCF residents; effective infection prevention and control strategies to reduce HAIs in LTCFs are still required. Guidance specifically about the prevention and management of UTIs, RTIs and SSTIs should be prioritised.PROSPERO registration number CRD42023406844. |
| format | Article |
| id | doaj-art-820aa938b5174a008ff6aef4f083418a |
| institution | OA Journals |
| issn | 2753-4294 |
| language | English |
| publishDate | 2024-05-01 |
| publisher | BMJ Publishing Group |
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| spelling | doaj-art-820aa938b5174a008ff6aef4f083418a2025-08-20T02:13:55ZengBMJ Publishing GroupBMJ Public Health2753-42942024-05-012110.1136/bmjph-2023-000504Healthcare-associated infections in long-term care facilities: a systematic review and meta-analysis of point prevalence studiesKarin Thursky0David Dunt1Leon J Worth2Rodney James3Stephanie K Tanamas4Janet K Sluggett5Noleen Bennett6Courtney Ierano7Michael J Malloy8Eliza Watson9Royal Melbourne Hospital Guidance Group, Royal Melbourne Hospital, Melbourne, Victoria, AustraliaThe University of Melbourne, Melbourne, Victoria, AustraliaVICNISS Coordinating Centre, Melbourne, Victoria, AustraliaDepartment of Infectious Diseases, National Centre for Antimicrobial Stewardship, The University of Melbourne, Melbourne, Victoria, AustraliaVICNISS Coordinating Centre, Melbourne, Victoria, AustraliaRegistry of Senior Australians (ROSA), Healthy Ageing Research Consortium, South Australian Health and Medical Research Institute, Adelaide, South Australia, AustraliaVICNISS Coordinating Centre, Melbourne, Victoria, AustraliaDepartment of Infectious Diseases, National Centre for Antimicrobial Stewardship, The University of Melbourne, Melbourne, Victoria, AustraliaVICNISS Coordinating Centre, Melbourne, Victoria, AustraliaVICNISS Coordinating Centre, Melbourne, Victoria, AustraliaObjectives Residents of long-term care facilities (LTCFs) are especially vulnerable to acquiring healthcare-associated infections (HAIs). Our systematic review and meta-analysis estimated the burden of HAIs, identified the most frequent HAIs and explored the impact of facility-level and surveillance methodological differences on HAI burden in LTCFs, as determined by point prevalence studies (PPS).Design Systematic review and meta-analysis.Data sources Bibliographic databases MEDLINE (Ovid), Embase (Ovid) and CINAHL (EBSCOhost) were searched for potentially eligible English-language original research publications. References of short-listed full-text publications, the European Centre for Disease Control and Prevention website and an unpublished 2016–2022 Australian Aged Care PPS report were also checked.Eligibility criteria PPS monitoring HAIs, published and undertaken between January 1991 and June 2023 in LTCFs.Data extraction and synthesis Two reviewers independently screened for eligible PPS and if included, assessed risk of bias for each PPS using the Joanna Briggs Institute (JBI) critical appraisal tool for prevalence studies. Meta-analysis was performed using a generalised linear mixed model.Results 31 publications (including 123 PPS from 33 countries encompassing 709 860 residents) were included. Nine PPS (7.3%) were allocated a JBI quality score greater than 80% while 30 PPS (24.4%) were allocated a score between 70% and 80%. The overall pooled HAI point prevalence was 3.5% (95% CI 3.1% to 4.0%); 3.9% (95% CI 3.2% to 4.7%) when higher bias-risk PPS (<70% quality score) were excluded. Of 120 PPS, the most frequently reported HAIs were urinary tract (UTIs; 38.9%), respiratory tract (RTIs; 33.6%) and skin or soft tissue (SSTIs; 23.7%) infections. HAI point prevalence varied by geographical region (p<0.001), study decade (p<0.001) and HAI surveillance definitions used (p<0.001). There was no difference across facility types (p=0.57) or season (p=0.46).Conclusions HAIs remain a global public health problem and threat to the safety of LTCF residents; effective infection prevention and control strategies to reduce HAIs in LTCFs are still required. Guidance specifically about the prevention and management of UTIs, RTIs and SSTIs should be prioritised.PROSPERO registration number CRD42023406844.https://bmjpublichealth.bmj.com/content/2/1/e000504.full |
| spellingShingle | Karin Thursky David Dunt Leon J Worth Rodney James Stephanie K Tanamas Janet K Sluggett Noleen Bennett Courtney Ierano Michael J Malloy Eliza Watson Healthcare-associated infections in long-term care facilities: a systematic review and meta-analysis of point prevalence studies BMJ Public Health |
| title | Healthcare-associated infections in long-term care facilities: a systematic review and meta-analysis of point prevalence studies |
| title_full | Healthcare-associated infections in long-term care facilities: a systematic review and meta-analysis of point prevalence studies |
| title_fullStr | Healthcare-associated infections in long-term care facilities: a systematic review and meta-analysis of point prevalence studies |
| title_full_unstemmed | Healthcare-associated infections in long-term care facilities: a systematic review and meta-analysis of point prevalence studies |
| title_short | Healthcare-associated infections in long-term care facilities: a systematic review and meta-analysis of point prevalence studies |
| title_sort | healthcare associated infections in long term care facilities a systematic review and meta analysis of point prevalence studies |
| url | https://bmjpublichealth.bmj.com/content/2/1/e000504.full |
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