Characteristics of the included systematic reviews
| Author, year Search dates Quality of review | Number of included studies (included study designs) | Healthcare setting(s) | Organisms | Outcomes of interest | Key findings |
| Abad et al, 2020 November 30, 2019 Good9 | 87 (all observational) | Hospital | Cohorting 60 studies cohorted patient and staff, 27 studies cohorted patients alone Multiple MDRO (C. diff, MRSA, VRE, CRE, Acinetobacter) | Infection or colonisation Infection for C. diff, infection for MRSA, infection for VRE. CBE and ESBL and more | Effect of cohorting on C. diff and MDRO 77 of 87 studies showed a decline in infection or colonisation rates after a multifaceted approach that included cohorting. 65 of 87 studies were in the setting of an outbreak and thus evidence is less certain for endemic settings |
| Afonso et al, 2013 November 1, 2012 Good10 | 15 (9 RCTs) | Hospital settings included intensive care, hospital and pre-surgical settings (five studies about paediatric populations) | Chlorhexidine wipes Multiple (Acinetobacter, Klebsiella, Psuedomonas, E. coli, C. diff, other MDRO unspecified) | Infection or colonisation outcomes (HAIs, VAP, CLABSI, BSI) | Most included studies favour the use of chlorhexidine wipes to prevent the spread of pathogens, including MDRO |
| Chang et al, 2019 July 9, 2018 Good11 | 8 (4 RCTs) | Hospital+LTC (mostly ICU, includes two paediatric studies) | Universal gloving Multiple MDRO (MRSA, VRE, C. diff) | HAI HAI (mostly but not only MRSA, VRE, C. diff) | Pooled analysis of 7 studies of universal gloving showed a reduced incident rate ratio of 0.80 (95% CI 0.67, 0.96). Stratified analyses showed no statistically significant association of the intervention in adult ICUs, whereas results were statistically significant in the paediatric ICU setting. Restricting the analysis to only RCTs resulted in a non-significant result. |
| Dancer and King, 2021 March 1, 2020 Good12 | 43 (1 RCT) | Hospital+LTC | Decontamination devices (UV, hydrogen peroxide) Multiple (C. diff, MRSA, CRE, MDRGN, VRE) | HAI rates Infection | Automated decontamination devices (hydrogen peroxide or UV light) on HAI rates organisms include C. diff, MRSA, CRE, etc. Most studies reported either reductions in HAI rates or resolution of an outbreak, but confounding is likely |
| Huang et al, 2016 March 1, 2015 Good13 | 15 (1 RCT) | ICU | Chlorhexidine baths Mixed HAIs (CLABSI, CAUTI, VAP) or MDROs (MRSA, VRE) | Infection or colonisation CLABSI, CAUTI, VAP | Effectiveness of daily chlorhexidine bathing on numerous organisms—restricted to ICU patients. Pooled analysis of results from one RCT and seven observational studies showed a risk ratio of 0.78 (95% CI 0.68, 0.91) for reduction in MRSA acquisition |
| Kleyman et al, 2021 August 1, 2019 Good14 | 12 in quantitative analysis (no RCTs) | Hospital | Contact precautions MRSA, VRE | Infection or colonisation MRSA and VRE Infections | Discontinuation of contact precautions on MRSA and VRE. Pooled analysis of 11 studies showed a risk ratio of 0.84 (95% CI 0.71, 1.01) in HAI from MRSA, favouring stopping contact precautions. Pooled analysis of 7 studies showed a risk ratio of 0.82 (95% CI 0.72, 0.94) in HAI from VRE, favouring stopping precautions. |
| O’Horo et al, 2012 Inception– May 2011 Good15 | 12 (1 RCT) | Mostly ICU (one LTACH study) | Chlorhexidine baths N/A | BSI (mainly CLABSI, some non-CLABSI) Healthcare-associated bloodstream infection incidence, including CLABSI | Inpatient daily chlorhexidine bathing. Pooled analysis of 12 studies showed an OR of 0.44 (95% CI 0.33, 0.59) in reduction in blood stream infections. |
| Purssell et al, 2020 Inception– 2018 Good16 | 26 (no RCTs) | Hospital | Isolation precautions N/A | Non-infectious adverse impacts/mental health/patient experience Psychological (anxiety, depression scores) and non-psychological (non-infectious) outcomes (eg, attention from HCW, errors, falls, ulcers) | Non-infection-related impact of isolation precautions on patients in isolation. Pooled analysis of 8 studies showed an SMD of 1,45 (95% CI 0.56, 2.34) for more anxiety in patients who were isolated. Pooled analysis of 8 studies showed an SMD of 1.28 (95% CI 0.47, 2.09) for more depression in patients who were isolated. |
| Wong et al, 2022 Database inception– 2020 Good17 | 11 studies included in quantitative analysis (5 RCTs) | LTC | Multiple (vertical, eg, decolonisation; horizontal, eg, decontamination, barrier precautions, training/adherence) Multiple MDROs (MRSA, other MDROs) | Infection or colonisation Primary MRSA colonisation; secondary other MDRO colonisation, all MDRO infections | Prevention of MDROs in long-term care setting, with interventions including vertical (decolonisation) as well as horizontal strategies (admin, barrier precautions, training, environmental cleaning, performance improvement, source control). 11 studies included in the meta-analysis showed no statistically significant benefit for MRSA outcomes. |
BSI, bloodstream infection; CAUTI, catheter-associated urinary tract infection; C. diff, Clostridioides difficile; CLABSI, central line-associated bloodstream infection; CRE, carbapenem-resistant Enterobacterales; E. coli, Escherichia coli; HAI, healthcare-associated infection; ICU, intensive care unit; LTACH, long-term acute care hospital; LTC, long-term care; MDRGN, multidrug-resistant Gram-negative bacteria; MDRO, multidrug-resistant organism; MRSA, methicillin-resistant Staphylococcus aureus; RCT(s), randomised controlled trial(s); SMD, standardised mean difference; UV, ultraviolet; VAP, ventilator-associated pneumonia; VRE, vancomycin-resistant Enterococcus.