In Non-outbreak LTC Settings, Hand Hygiene and Oral Care Have a Beneficial Effect on Infection Rates

Healthcare-associated infections in long-term care are associated with substantial morbidity and mortality. While infection prevention and control (IP&C) guidelines are well-defined in the acute-care setting, evidence of effectiveness for long-term care facilities (LTCF) is missing. Bloch, et al. (2023) performed a systematic literature review to examine the effect of IPC measures in the long-term care setting.

The researchers systematically searched PubMed and Cochrane libraries for articles evaluating the effect of IP&C measures in the LTCF setting since 2017, as earlier reviews on this topic covered the timeframe up to this date. Cross-referenced studies from identified articles and from mentioned earlier reviews were also evaluated. They included randomized-controlled trials, quasi-experimental, observational studies, and outbreak reports. The included studies were analyzed regarding study design, type of intervention, description of intervention, outcomes and quality. They also distinguished between non-outbreak and outbreak settings.

The researchers included 74 studies, 34 (46%) in the non-outbreak setting and 40 (54%) in the outbreak setting. The most commonly studied interventions in the non-outbreak setting included the effect of hand hygiene (N = 10), oral hygiene (N = 6), antimicrobial stewardship (N = 4), vaccination of residents (N = 3), education (N = 2) as well as IPC bundles (N = 7). All but one study assessing hand hygiene interventions reported a reduction of infection rates. Further successful interventions were oral hygiene (N = 6) and vaccination of residents (N = 3). In outbreak settings, studies mostly focused on the effects of IPC bundles (N = 24) or mass testing (N = 11). In most of the studies evaluating an IPC bundle, containment of the outbreak was reported. Overall, only four articles (5.4%) were rated as high quality.

In the non-outbreak setting in LTCF, the researchers concluded that hand hygiene and oral hygiene have a beneficial effect on infection rates. In contrast, IP&C bundles, as well as mass testing seem to be promising in an outbreak setting.

Reference: Bloch N, et al. Effective infection prevention and control measures in long-term care facilities in non-outbreak and outbreak settings: a systematic literature review. Antimicrobial Resistance & Infection Control. Vol. 12, article number 113 (2023).