Evaluation of preventive interventions addressing healthcare-associated infections and antimicrobial resistance: a systematic review.

Abstract

<h4>Background</h4>Infection prevention and control (IPC) measures are widely used in healthcare settings to reduce the incidence of healthcare-associated infections (HAIs) and limit the spread of antimicrobial resistance (AMR). A systematic review of the scientific literature was conducted to assess the combined and cumulative effects of IPC practices and AMR determinants on the epidemiological trends of HAIs.<h4>Methods</h4>A systematic search was performed across PubMed/MEDLINE, Scopus and Web of Science using a combination of Medical Subject Headings (MeSH) terms and keywords related to HAI, AMR and IPC strategies. The search yielded 8300 articles. After duplicate removal, 6939 articles were screened by title and abstract; 297 were reviewed in full text, and 39 studies met the eligibility criteria and were included in the final analysis.<h4>Results</h4>Across 39 studies, hand hygiene promotion, multi-modal IPC programmes and targeted bundles were most consistently reported alongside lower HAI rates (particularly urinary tract infections and surgical site infections). For ventilator-associated pneumonia, reductions were reported in studies evaluating continuous aspiration of subglottic secretions, oral care protocols, ventilator bundles and environmental interventions (including enhanced ultraviolet germicidal irradiation), although definitions and study designs varied. Chlorhexidine gluconate bathing and environmental cleaning measures were frequently associated with lower incidence of HAI/AMR. Antimicrobial stewardship interventions were associated with reduced inappropriate antibiotic use and, in several settings, reductions in the incidence of HAI and/or AMR.<h4>Conclusions</h4>The available evidence suggests that integrated IPC and antimicrobial stewardship initiatives may contribute to reductions in HAI and AMR. However, the predominance of observational and before-and-after designs, heterogeneity in interventions and outcome definitions, and limited reporting on implementation fidelity limit causal inference.