Educational interventions for prevention of healthcare-associated infection: a systematic review.

BACKGROUND Healthcare-associated infections (HCAIs) are associated with considerable morbidity and mortality. Education of healthcare providers is a fundamental measure to prevent HCAI. OBJECTIVE To perform a systematic review to determine the effect of educational strategies of healthcare providers for reducing HCAI. DATA SOURCE Multiple computerized databases for the years 1966 to November 1, 2006, supplemented by manual searches for relevant articles. STUDY SELECTION English-language controlled studies and randomized trials that included an educational intervention and provided data on the incidence of one or more kinds of HCAIs were included. DATA EXTRACTION Data were extracted on study design, patient population, type of intensive care unit, details of the educational intervention, target group for intervention, incidence of HCAI, duration of follow-up, and costs of intervention. Both investigators abstracted data using a standard data abstraction form; study quality was also assessed. DATA SYNTHESIS A total of 26 studies used a number of different educational programs targeting varied study populations of healthcare providers to determine their effect on HCAI rates. Most were pre-post intervention studies and were implemented in the intensive care setting. There was a statistically significant decrease in infection rates after intervention in 21 studies, with risk ratios ranging from 0 to 0.79. The beneficial effect of education was apparent in teaching and nonteaching institutions and in lesser-developed countries and developed nations. LIMITATIONS Only English language studies were included. Because of the study designs and limitations of the individual studies, a causal association between educational interventions and reduced HCAI rates cannot be made. CONCLUSIONS The implementation of educational interventions may reduce HCAI considerably. Cluster randomized trials using validated educational interventions and costing methods are recommended to determine the independent effect of education on reducing HCAI and the cost-savings that may be realized with this approach.