Sixty-one articles (containing 71 studies) were included that demonstrated adequate adjustment for trends. Six of the 71 studies were rated as being of higher quality; the others were of medium or lower quality. Detailed breakdowns of the quality assessment results were provided in the report.
Only studies that reported on both infection and adherence rates (30 studies) were included in the key findings across the infections. In all of these studies controls received usual care. Moderate strength of evidence was found for improvement of infection and adherence rates when audit and feedback plus provider reminder systems (eight studies) or audit and feedback alone (11 studies) were used with the base strategies (organisational change and/or provider education) for quality improvement. Low strength of evidence was found for the improvement of rates when provider reminders systems alone were used with the base strategies (nine studies). Insufficient evidence was found for the improvement of rates with the base strategies only (organisational change plus provider education or provider education alone) (two studies).
All studies that reported on adherence rates, infection rates or both (71 studies) were included in the key findings for each infection. Reduced rates of central line-associated bloodstream infections were found with use of base strategies alone and in combination with audit and feedback plus provider reminder systems. For ventilator-associated pneumonia, infection rates and various types of adherence rates were improved with base strategies and audit and feedback (both with and without provider reminder systems). Similarly, adherence to antibiotic timing in surgical site infections was increased with use of the same strategies. Adherence to urinary catheterisation was improved in catheter-associated urinary tract infections using provider reminder systems with or without base strategies. All of this evidence was rated as being of moderate strength.
The full results were provided in the report.