Table 4 Intervention studies performed in lower-middle income countries, 2005–2018
Study | Study period | Published year | Country | Hospitals | ICUs | Objective | Study design | Intervention | Subjects or observations | Outcomes | Comments |
|---|---|---|---|---|---|---|---|---|---|---|---|
Khan [34] | 7/2006–11/2007 | 2009 | Pakistan | 1 | 1 | Reduce VAP | Quasi-experimental before/after study | 6 h training only | 582 MV patients | VAP rate/100 MV patients from 18 to 13% (p = 0.11) | All patients were surgical and ventilated; MDR A. baumannii, P. aeruginosa and K. pneumoniae most prevalent |
Mathur [18] | 7/2010–9/2010 | 2011 | India | 1 | 1 | Increase HH compliance | Quasi-experimental before/after study | Questionnaires, education & training, monitoring | 1489 HH opportunities | Compliance from 8.4 to 63.1% (p < 0.0001). Housekeeping staff did not increase their HH compliance | Small scale, short term study; not clear whether housekeeping was trained or not |
Jaggi [21] | 9/2004–2/2012 | 2013 | India | 11 | 16 | Prevent CLABSI by multidimensional approach | Quasi-experimental before/after study | Infection prevention bundle, education, monitoring & feedback | 35,650 patients yielding 90,370 CL days | CLABSI/1000 CL days from 6.4 to 3.9 for a RR of 0.61 (0.46–0.81) p = 0.0007. Less S. aureus after intervention but more P. aeruginosa. K. pneumoniae most prevalent pathogen throughout study | Mean age was 1.3 year higher in intervention period |
Mehta [22] | 7/2004–10/2011 | 2013 | India | 14 | 21 | Prevent VAP by multidimensional approach | Quasi-experimental before/after study | Infection prevention bundle, education, monitoring & feedback | 46,945 patients yielding 65,574 MV days | VAP/100 MV days from 17.4 to 10.8 for a RR of 0.62 (0.50–0.78), p = 0.0001 | Patients had little lower ASIS scores in intervention period |
Navao-Ng [56] | 12/2005–12/2010 | 2013 | Philippines | 2 | 4 | Preventing CAUTI by multidimensional approach | Quasi-experimental before/after study | Infection prevention bundle, education, monitoring & feedback | 3183 patients yielding 8720 UC days; observed HH opportunities 4191 | CAUTIs/1000 UC days from 11.0 to 2.66 for a RR 0.24 (0.22–0.53); HH compliance from 57.2 to 78.2% (RR 1.37[1.21–1.54]) | Few HH opportunities in baseline period |
Schultsz [48] | 5/2004–4/2006 | 2013 | Vietnam | 1 | 1 | Prevent exogenous acquisition of MDRO | Quasi-experimental before/after study | HH reinforcement, revising infection prevention procedures, monitoring & feedback, adjust antibiotic policy | 357 patients | VAP/1000 MV days from 56 to 40, UTI/1000 UC days from 12.8 to 15.0 (both not significant). Less cephalosporins, penicillin and carbapenem and more fluoroquinolones, metronidazole and broad-spectrum penicillin used; only MRSA acquisition delayed, not seen for other MDRO | Patients had more severe tetanus + more MV days + longer LOS in year 2; HH compliance only measured in year 2 |
Biswal [23] | 11/2010–5/2013 | 2014 | India | 1 | 7 | Improving HH | Quasi-experimental before/after study | Repeated education & training, posters, adequate supplies of alcohol & soap | 3212 HH opportunities | HH compliance up from 16.5 to 28.2% and 35.1% after 1st and 2nd training week respectively. Significant in all ICUs | Low numbers of opportunities per ICU |
Chakravarthy [24] | 8/2004–7/2011 | 2015 | India | 3 | 3 | Improving HH by multidimensional approach | Quasi-experimental before/after study | Allocation supplies, education & training, reminders, monitoring & feedback | 3612 HH opportunities | HH compliance up from 36.9 to 74.8% for a RR 2.0 (1.7–2.4), p = 0.0001; but not in surgical ICU? poor among ancillary staff; HH improvement maintained over 3 years | Only few observations in surgical ICU |
Thu [49] | 6/2009–4/2011 | 2015 | Vietnam | 1 | 17 | Reducing HAI by HH promotion | Quasi-experimental before/after | Questionnaires, education & training (including patients & visitors), posters & flyers, new sinks, hand alcohol made available | 984 patients and 6046 HH observations | HAI/100 pts: from 31.7 to 20.3% (p = 0.005), all HAI types; HH compliance from 25.7 to 57.5% (p < 0.001) |  |
Rosenthal [33] | 4/2012–8/2014 | 2015 | India | 2 | 5 | CLABSI reduction | RCT, block-randomization | Introduced new IV flush device | 1096 patients yielding 7680 CL days | CLABSI/1000d: 2.21 vs 6.40; RR 0.35 (0.16–0.76); cost effective, Qualys-increasing; shift in microbe species |  |