Multimodal strategies for the implementation of infection prevention and control (IPC) interventions - update of a systematic review for the WHO guidelines on core components of IPC programmes at the facility level

Ashlesha Sonpar; Chandra Omar Hundal; Joan E E Totté; Jiancong Wang; Sabine D Klein; Anthony Twyman; Benedetta Allegranzi; Walter Zingg

doi:10.1016/j.cmi.2025.01.011

Multimodal strategies for the implementation of infection prevention and control (IPC) interventions - update of a systematic review for the WHO guidelines on core components of IPC programmes at the facility level

Clin Microbiol Infect. 2025 Jan 23:S1198-743X(25)00016-3. doi: 10.1016/j.cmi.2025.01.011. Online ahead of print.

Authors

Ashlesha Sonpar¹, Chandra Omar Hundal², Joan E E Totté³, Jiancong Wang⁴, Sabine D Klein⁵, Anthony Twyman⁶, Benedetta Allegranzi⁷, Walter Zingg⁸

Affiliations

¹ Clinic for Infectious Diseases and Hospital Hygiene, University Hospital Zurich, Zurich, Switzerland; Faculty of Medicine, University of Zurich, Zurich, Switzerland. Electronic address: ashlesha.sonpar@usz.ch.
² Clinic for Infectious Diseases and Hospital Hygiene, University Hospital Zurich, Zurich, Switzerland; Faculty of Medicine, University of Zurich, Zurich, Switzerland. Electronic address: Chandra.Hundal@protonmail.ch.
³ Clinic for Infectious Diseases and Hospital Hygiene, University Hospital Zurich, Zurich, Switzerland; Department of Medical Microbiology, University Medical Centre Utrecht, Utrecht, the Netherlands. Electronic address: j.e.e.totte-2@umcutrecht.nl.
⁴ Clinic for Infectious Diseases and Hospital Hygiene, University Hospital Zurich, Zurich, Switzerland; Faculty of Medicine, University of Zurich, Zurich, Switzerland. Electronic address: Jiancong.Wang@outlook.com.
⁵ University Library, University of Zurich, Zurich, Switzerland. Electronic address: sabine.klein@ub.uzh.ch.
⁶ Infection Prevention and Control Unit, Integrated Health Services, World Health Organization, Geneva, Switzerland. Electronic address: twymana@who.int.
⁷ Infection Prevention and Control Unit, Integrated Health Services, World Health Organization, Geneva, Switzerland. Electronic address: allegranzib@who.int.
⁸ Clinic for Infectious Diseases and Hospital Hygiene, University Hospital Zurich, Zurich, Switzerland; Faculty of Medicine, University of Zurich, Zurich, Switzerland. Electronic address: Walter.Zingg@usz.ch.

PMID: 39863071
DOI: 10.1016/j.cmi.2025.01.011

Abstract

Background: Healthcare-associated infections (HAIs) remain a significant challenge worldwide, and the use of multimodal strategies is recommended by the World Health Organization (WHO) to enhance infection prevention.

Objectives: To update the systematic review on facility-level infection prevention and control (IPC) interventions on the WHO Core Component of using multimodal strategies.

Methods: Data Sources: Medline (via PubMed), EMBASE, CINAHL, and the Cochrane library.

Study eligibility criteria: Randomized controlled studies (RCTs), interrupted time series (ITS), and before-after studies in acute care settings, from 24 November 2015 to 30 June 2023.

Participants: Both paediatric and adult populations.

Interventions: IPC interventions implemented with at least three WHO multimodality elements.

Primary outcomes: HAI, HAI caused by antimicrobial-resistant microorganisms, and hand hygiene (HH) compliance.Assessment of Risk of Bias: Effective practice and organisation of care (EPOC) and integrated quality criteria for review of multiple study designs (ICROMS) tools.Methods of data Synthesis: Descriptive data synthesis.

Results: Of 5678 identified titles and abstracts, 32 publications were eligible for data extraction and analysis. Five non-controlled before-after studies (NCBA) were excluded due to an insufficient ICROMS score. Of the remaining 27 studies, nine reported on the effect of multimodal strategies to reduce device-associated HAIs, four on surgical site infections, eight on infections due to AMR and six on HH compliance. Eleven were controlled studies (RCTs or controlled before-after studies (CBAs)), nine ITS and seven NCBA studies. Twenty-two of the studies originated from high-income countries and the overall quality was medium to low. Twenty studies showed either significant HAI-reductions or HH improvement.

Conclusion: Most studies demonstrate a significant effect on HAI prevention and HH improvement after applying a multimodal strategy. However, the quality of evidence remains low to moderate with few studies from low- or middle-income countries. Future research should focus on higher quality studies in resource limited settings.

Keywords: Infection prevention and control; antimicrobial resistance; core components; healthcare-associated infection; multimodal strategies; systematic review; update.

Publication types

Review