Bennett Noleen, Tanamas Stephanie K, James Rodney, Ierano Courtney, Malloy Michael J, Watson Eliza, Sluggett Janet K, Dunt David, Thursky Karin, Worth Leon J
VICNISS Coordinating Centre, Melbourne, Victoria, Australia.
Department of Nursing, Melbourne School of Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia.
BMJ Public Health. 2024 May 27;2(1):e000504. doi: 10.1136/bmjph-2023-000504. eCollection 2024 Jun.
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).
Systematic review and meta-analysis.
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of short-listed full-text publications, the European Centre for Disease Control and Prevention website and an unpublished 2016-2022 Australian Aged Care PPS report were also checked.
PPS monitoring HAIs, published and undertaken between January 1991 and June 2023 in LTCFs.
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.
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).
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.
CRD42023406844.
长期护理机构（LTCF）的居民尤其容易获得医疗保健相关感染（HAI）。我们的系统评价和荟萃分析估计了HAI的负担，确定了最常见的HAI，并探讨了机构层面和监测方法差异对LTCF中HAI负担的影响，这是通过现患率研究（PPS）确定的。
系统评价和荟萃分析。
检索了文献数据库MEDLINE（Ovid）、Embase（Ovid）和CINAHL（EBSCOhost），以查找潜在符合条件的英文原创研究出版物。还检查了入围全文出版物的参考文献、欧洲疾病预防控制中心网站以及一份未发表的2016 - 2022年澳大利亚老年护理PPS报告。
1991年1月至2023年6月期间在LTCF中发表并开展的监测HAI的PPS。
两名评审员独立筛选符合条件的PPS，如果纳入，则使用乔安娜·布里格斯研究所（JBI）现患率研究批判性评价工具评估每个PPS的偏倚风险。使用广义线性混合模型进行荟萃分析。
纳入了31篇出版物（包括来自33个国家的123项PPS，涵盖709860名居民）。9项PPS（7.3%）被分配的JBI质量评分高于80%，而30项PPS（24.4%）被分配的评分在70%至80%之间。总体汇总的HAI现患率为3.5%（95%置信区间3.1%至4.0%）；排除偏倚风险较高的PPS（质量评分<70%）后为3.9%（95%置信区间3.2%至4.7%）。在120项PPS中，报告最频繁的HAI是尿路感染（UTI；38.9%）、呼吸道感染（RTI；33.6%）和皮肤或软组织感染（SSTI；23.7%）。HAI现患率因地理区域（p<0.001）、研究年代（p<0.001）和所使用的HAI监测定义（p<0.001）而异。不同机构类型（p = 0.57）或季节（p = 0.46）之间没有差异。
HAI仍然是一个全球公共卫生问题，对LTCF居民的安全构成威胁；仍需要有效的感染预防和控制策略来减少LTCF中的HAI。应优先制定关于UTI、RTI和SSTI预防和管理的具体指南。
PROSPERO注册号：CRD42023406844。
