The Ohio State University, Columbus, OH, USA.
Med Care Res Rev. 2021 Dec;78(6):643-659. doi: 10.1177/1077558720952921. Epub 2020 Aug 26.
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 (22%) and (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.
由于医疗保健相关感染（HAI）的成本和可预防的证据，医院面临着越来越大的降低 HAI 的压力。然而，对于可以在医院或系统范围内成功实施的干预措施，证据的综合有限。我们使用 Donabedian 的结构-过程-结果模型，从 2008 年到 2019 年初进行了系统的文献综述，确定了 96 项研究，其中 214 项研究了医院或系统范围的干预措施与 HAI 之间的关系。这些文献的方法学和报告质量普遍较差。研究中最常见的 HAI 是耐甲氧西林金黄色葡萄球菌（22%）和耐万古霉素肠球菌（21%）。97 项结果显示出理想的变化，72 项结果显示没有显著效果，17 项结果显示存在冲突效果，3 项结果显示存在不良效果；25 项结果来自没有进行统计分析的研究。我们的研究结果强调了结构和过程方法值得进一步研究和政策探索，并为未来调查和报告医院和系统范围内的 HAI 干预措施提出了建议，以解决现有文献中的差距。
