Cui Haijuan, Wang Haitang
Emergency Department, Lianyungang Municipal Oriental Hospilal, Lianyungang City, Jiangsu Province 222042, China.
Emergency Department, Lianyungang Municipal Oriental Hospilal, Lianyungang City, Jiangsu Province 222042, China.
Int Emerg Nurs. 2025 Sep;82:101650. doi: 10.1016/j.ienj.2025.101650. Epub 2025 Jul 11.
Healthcare-associated infections (HAIs) are a significant concern in emergency departments (EDs), where high patient volumes, rapid decision-making, and frequent invasive procedures increase infection risks. Despite existing infection prevention measures, the effectiveness of nursing interventions in reducing HAIs in ED settings remains underexplored.
This study evaluates the efficacy of nursing interventions in reducing HAIs among ED patients through a systematic review and meta-analysis, identifying the most effective strategies and providing evidence-based recommendations for infection control.
A systematic review and meta-analysis were conducted following PRISMA guidelines. A comprehensive search of PubMed, Cochrane Library, Scopus, and Web of Science was performed to identify relevant studies assessing nursing-led interventions for infection prevention in EDs. Eligible studies included randomized controlled trials (RCTs), quasi-experimental studies, and observational research reporting infection rates as primary outcomes. A random-effects model was used to estimate pooled effect sizes, and subgroup analyses explored the relative effectiveness of different intervention types (hygiene protocols, care bundles, patient education, environmental cleaning). Heterogeneity was assessed using I2 statistics, and publication bias was examined using funnel plots and Egger's test.
Ten high-quality studies involving 5,500 patients were included. The pooled odds ratio (OR) for nursing interventions in reducing HAIs was 0.69 (95 % CI: 0.65-0.74, p < 0.001), indicating a 31 % reduction in infection odds. Hygiene protocols demonstrated the greatest efficacy (OR = 0.62, 95 % CI: 0.57-0.68, p < 0.001), followed by care bundles (OR = 0.68, 95 % CI: 0.61-0.75, p < 0.001) and environmental cleaning (OR = 0.75, 95 % CI: 0.68-0.82, p < 0.001). Heterogeneity was moderate (I2 = 40 %), with higher variability in care bundles and environmental cleaning interventions. Sensitivity analyses confirmed the robustness of findings, and publication bias was minimal (Egger's test, p = 0.18).
Nursing interventions significantly reduce HAIs in EDs, with hygiene protocols and care bundles being the most effective. Standardizing infection prevention protocols, integrating evidence-based nursing interventions, and ensuring adherence to best practices can enhance patient safety. Future research should explore the long-term sustainability of these interventions, the impact of multifaceted approaches, and their effectiveness across diverse patient populations.
医疗保健相关感染（HAIs）是急诊科（EDs）的一个重大问题，在急诊科，患者数量众多、决策迅速且侵入性操作频繁，增加了感染风险。尽管存在现有的感染预防措施，但护理干预在降低急诊科环境中HAIs方面的有效性仍未得到充分探索。
本研究通过系统评价和荟萃分析评估护理干预在降低急诊科患者HAIs方面的疗效，确定最有效的策略，并为感染控制提供循证建议。
按照PRISMA指南进行系统评价和荟萃分析。对PubMed、Cochrane图书馆、Scopus和科学网进行全面检索，以识别评估急诊科以护理为主导的感染预防干预措施的相关研究。符合条件的研究包括随机对照试验（RCTs）、准实验研究以及将感染率作为主要结局报告的观察性研究。采用随机效应模型估计合并效应量，亚组分析探讨不同干预类型（卫生规程、护理包、患者教育、环境清洁）的相对有效性。使用I²统计量评估异质性，并使用漏斗图和Egger检验检查发表偏倚。
纳入了10项涉及5500名患者的高质量研究。护理干预降低HAIs的合并优势比（OR）为0.69（95%可信区间：0.65 - 0.74，p < 0.001），表明感染几率降低了31%。卫生规程显示出最大疗效（OR = 0.62, 95%可信区间：0.57 - 0.68, p < 0.001），其次是护理包（OR = 0.68, 95%可信区间：0.61 - 0.75, p < 0.001）和环境清洁（OR = 0.75, 95%可信区间：0.68 - 0.82, p < 0.001）。异质性为中度（I² = 40%），护理包和环境清洁干预的变异性较高。敏感性分析证实了研究结果的稳健性，发表偏倚最小（Egger检验，p = 0.18）。
护理干预可显著降低急诊科的HAIs，卫生规程和护理包最为有效。标准化感染预防规程、整合循证护理干预措施并确保遵守最佳实践可提高患者安全。未来的研究应探讨这些干预措施的长期可持续性、多方面方法的影响及其在不同患者群体中的有效性。
