Murni Indah, Duke Trevor, Triasih Rina, Kinney Sharon, Daley Andrew J, Soenarto Yati
Department of Pediatrics, Dr Sardjito Hospital, Faculty of Medicine, Universitas Gadjah Mada, Yogyakarta, Indonesia.
Paediatr Int Child Health. 2013 May;33(2):61-78. doi: 10.1179/2046905513Y.0000000054.
Prevention of nosocomial infection is key to providing good quality, safe healthcare. Infection control programmes (hand-hygiene campaigns and antibiotic stewardship) are effective in reducing nosocomial infections in developed countries. However, the effectiveness of these programmes in developing countries is uncertain.
To evaluate the effectiveness of interventions for preventing nosocomial infections in developing countries.
A systematic search for studies which evaluated interventions to prevent nosocomial infection in both adults and children in developing countries was undertaken using PubMed. Only intervention trials with a randomized controlled, quasi-experimental or sequential design were included. Where there was adequate homogeneity, a meta-analysis of specific interventions was performed using the Mantel-Haenzel fixed effects method to estimate the pooled risk difference.
Thirty-four studies were found. Most studies were from South America and Asia. Most were before-and-after intervention studies from tertiary urban hospitals. Hand-hygiene campaigns that were a major component of multifaceted interventions (18 studies) showed the strongest effectiveness for reducing nosocomial infection rates (median effect 49%, effect range 12.7-100%). Hand-hygiene campaigns alone and studies of antibiotic stewardship to improve rational antibiotic use reduced nosocomial infection rates in three studies [risk difference (RD) of -0.09 (95%CI -0.12 to -0.07) and RD of -0.02 (95% CI -0.02 to -0.01), respectively].
Multifaceted interventions including hand-hygiene campaigns, antibiotic stewardship and other elementary infection control practices are effective in developing countries. The modest effect size of hand-hygiene campaigns alone and negligible effect size of antibiotic stewardship reflect the limited number of studies with sufficient homogeneity to conduct meta-analyses.
预防医院感染是提供高质量、安全医疗服务的关键。感染控制计划（手卫生运动和抗生素管理）在发达国家有效降低了医院感染率。然而，这些计划在发展中国家的有效性尚不确定。
评估发展中国家预防医院感染干预措施的有效性。
使用PubMed系统检索评估发展中国家成人和儿童预防医院感染干预措施的研究。仅纳入随机对照、准实验或序贯设计的干预试验。在有足够同质性的情况下，使用Mantel-Haenzel固定效应方法对特定干预措施进行荟萃分析，以估计合并风险差异。
共找到34项研究。大多数研究来自南美洲和亚洲。大多数是来自城市三级医院的干预前后研究。作为多方面干预主要组成部分的手卫生运动（18项研究）在降低医院感染率方面显示出最强的有效性（中位效应49%，效应范围12.7-100%）。在三项研究中，单独的手卫生运动和改善抗生素合理使用的抗生素管理研究降低了医院感染率[风险差异（RD）分别为-0.09（95%CI -0.12至-0.07）和RD为-0.02（95%CI -0.02至-0.01）]。
包括手卫生运动、抗生素管理和其他基本感染控制措施在内的多方面干预在发展中国家是有效的。单独的手卫生运动效果适中，抗生素管理效果可忽略不计，这反映了具有足够同质性以进行荟萃分析的研究数量有限。
