Quasi-experimental studies have found that multimodal interventions can prevent and control transmission of carbapenem-resistant organisms, but the quality of these studies is low, according to a recent analysis.
To inform World Health Organization guidelines, researchers conducted a systematic review and reanalysis of studies that assessed the impact of practices and procedures to prevent and control transmission of carbapenem-resistant organisms (Enterobacteriaceae, Acinetobacter baumannii, and Pseudomonas aeruginosa) in inpatient health care facilities. The 17 included studies, which were compatible with effective practice and organization of care quality criteria, assessed interventions in interrupted time series analyses and ranged in duration from 15.6 months to 7.0 years. Results were published online on Nov. 23 by Clinical Infectious Diseases.
Most infection prevention and control measures were implemented using a multimodal approach (i.e., three or more components implemented in an integrated way). Among all studies of carbapenem-resistant organisms, the most common intervention components were contact precautions (90%), active surveillance cultures (80%), monitoring, audit, and feedback of measures (80%), patient isolation or cohorting (70%), hand hygiene (50%), and environmental cleaning (40%). Nearly all studies of these interventions found a significant reduction in trend over time and/or immediate change. However, the quality of studies was very low to low, and all studies were classified as having a high risk of bias.
The review authors noted limitations, such as potential publication bias within the included studies and the difficulty of ascertaining the effectiveness of single interventions contained in multimodal infection control and prevention strategies. The results should be interpreted in the context of local epidemiological setting, resource implications, acceptability, values, and preferences, they added.
While it would be helpful to know which element or elements of a bundle perform the bulk of the work, a future meta-analysis of studies with more similar characteristics might not be necessary, even if it provides more evidence-based guidance, according to an accompanying editorial. “Instead of reanalyzing prior work and interventions, perhaps we just need to get better at these basic [infection prevention and control] elements and focus research efforts and investments on developing the next novel intervention to prevent [health care-acquired infections],” the editorialist wrote.