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Table 3 Table of evidence

From: Implementation strategies for infection prevention and control promotion for nurses in Sub-Saharan Africa: a systematic review

No. Author/Year Purpose Country Study design Participants Disease EVB IPC intervention Quality
1 Allegranzi et al. [32] To assess the feasibility and effectiveness of WHO hand hygiene improvement strategy in low-income country Mali Pre/Post Design 224 Healthcare workers (# of nurses not specified) NA Hand hygiene/washing MAStARI 5
2 Brown et al. [50] To evaluate the impact, acceptability, and feasibility of a novel toolkit to prevent HIV Kenya Mixed methods 10 HCWs (2 nurses) 40 HIV Patients (20 HIV+ women; 10 discordant couples) HIV HIV prevention/safe conception practices associated with HIV prevention MMAT 50%
3 Brown et al. [51] To assess the impact of an immunization training on knowledge and practice of HCWs Nigeria Pre-Post experimental design/RCT study 69 HCWs (17 were nurses/midwives/CNO) NA Immunization MAStARI 9
4 Courtenay-Quirk et al. [52] To identify key factors in bloodborne Pathogen Exposure (BPE) incidence, report, and Post-exposure prophylaxis (PEP) uptake to inform the development of a multi-component intervention strategy Botswana Zambia Tanzania Mixed methods HCWs (2851 for all 3 countries; # of nurses not specified) Any blood- borne pathogen Post-exposure prophylaxis (PEP) MMAT 50%
5 Dahinten et al. [53] To describe the implementation and feasibility of the “Pratt Pouch,” a pre-packaged ARV medicated foil package for infants born to HIV+ mothers in non-healthcare facilities Zambia Pre/Post Design 41 HCWs (16 nurse, 18 community health-care workers, and 7 pharmacists) 150 HIV+ pregnant women HIV ART (HIV therapy) MAStARI 7
6 Durrheim et al. [54] To study a novel surveillance system to address deficiencies in identifying infectious disease syndromes South Africa Prospective cohort study 32 Nurses Multiple (Polio, Cholera, Measles, Plague, Meningococcal disease, Yellow fever, Dysentery, Viral hemorrhagic fevers) Surveillance/screening MAStARI 8
7 Elnour et al. [39] To assess nursing and sanitation staff knowledge and practice regarding health care waste management Sudan Pre/Post Design 200 HCWs (# of nurses not specified) 100 HCWs received training intervention; 100 HCWs were controls NA Waste management and proper disposal MAStARI 9
8 Farley et al. [55] To develop and evaluate a nurse case management model and intervention using the tenants of the Chronic Care Model (CCM) to manage MDR-TB treatment for patients South Africa Pre/Post Design 1 nurse case manager 40 MDR-TB patients MDR-TB HIV MDR-TB treatment/monitoring MAStARI 5
9 Fatti, G [56]. To evaluate the effectiveness of a Quality Nurse Mentor (QNM) health systems strengthening intervention to improve PMTCT processes and outcomes South Africa Pre/Post Design Number of nurses not directly stated All pregnant women attending material health facilities were eligible to enroll in intervention (specific #s of samples not specified) HIV PMTCT (HIV therapy) MAStARI 5
10 Gous et al. [57] To assess the feasibility and accuracy of the implementation of a nurse-operated multiple POCT in 2 ART clinics South Africa Cross-sectional study 3 Senior level nurses 793 HIV+ patients from 2 clinical sites HIV Point-of-care testing (POCT) MAStARI 7
11 Holmen et al. [58] To improve hand hygiene (HH) compliance among physicians and nurses using the WHO’s guidelines Rwanda Pre/Post Design HCWs (54 nurses; 12 physicians) N/A Hand hygiene (hand washing) MAStARI 5
12 Holmen et al. [33] To assess the impact of hand hygiene (HH) programs aimed at improving compliance AND to identify unique challenges to HH sustainability Rwanda Pre/Post Design HCWs(56 nurses; 11 physicians) N/A Hand hygiene (hand washing) MAStaARI 5
13 Howard et al. [59] To evaluate the effectiveness and acceptability of a combination intervention package designed to improve isoniazid preventative therapy (IPT) initiation, adherence, and completion among PLHIV Ethiopia Mixed methods randomized cluster trial (RCT) (randomization occurred at the clinic level, not individual) HCWs (10 nurses; 2 health officers; 9 peer educators) # of patients not specified; 10 out of 11 sites were selected for participation (patients pulled from these sites) TB IPT (TB therapy) MAStARI 9
14 Imani et al. [60] To evaluate the effectiveness and cost-effectiveness of 2 interventions: on-site support (OSS) and integrative management of infectious disease (IMID) for HCWs Uganda Mixed methods randomized cluster trial (RCT) (randomization occurred at the clinic level, not individual) Mid-level professionals (including 20 nurses, 48 clinical officers, registered midwives) 2 MLP per site = 72 MLPs 687 total patients Malaria, TB, HIV, and other childhood infectious diseases Screening, diagnosis, therapy MAStARI 8
15 Jere et al. [61] To assess the effects of a peer-to-peer intervention on rural HCWs universal precautions and client teaching Malawi Pre/Post Design HCWs (clinicians, including nurses, and technicians; clinical support workers; non-clinical workers (no specific # of nurses) HIV Universal precautions AND HIV prevention associated with universal precautions MAStARI 8
16 Jones et al. [62] To describe the educational and transcultural strategies employed to bridge the gap between IPC policy and clinical practice of HCWs Tanzania Qualitative study HCWs (# nurses not specified) NA Standard Precautions/UP QARI 8
17 Jones-Konneh et al. [63] To reveal the importance and effect of intensive education of HCWs during an Ebola (EVD) outbreak Sierra Leone Cross-sectional study HCWs (# nurses not specified) Ebola Standard precautions and transmission- based precautions for EVD prevention MAStARI 5
18 Kaponda et al. [64] To evaluate the impact of a peer group intervention on work-related knowledge and behavior on universal precautions among HCWs Malawi Pre/Post Design Roughly 561 HCWs (clinicians, including nurses, and technicians; clinical support workers; non-clinical workers (no specific # of nurses) 678 Patients HIV Universal precautions AND HIV prevention associated with universal precautions MAStARI 5
19 Karari et al. [65] To evaluate the uptake, acceptability, and effectiveness of Uliza: a telephone consultation service for HCWs Kenya Prospective cohort study 296 HCWs (188 physicians, 66 nurses, 23 medical officers. 2 pharmacy technicians, and 17 other) HIV ART (HIV therapy) MAStART 7
20 Kerrigan et al. [66] To explore the feasibility and acceptability of three active case finding strategies for TB to inform their optimal implementation in a larger, randomized, cluster trail South Africa Qualitative study 25 participants (10 HCWs (# nurses not specified), 8 TB patients, and 7 family members of TB patients) TB TB screening/active case finding QARI 8
21 Kunzmann et al. [67] To develop and implement an evidence-based bundle of care (Best Care Always) to prevent pediatric VAP South Africa Prospective cohort study HCWs (doctors and nurses) (# of nurses not specified) VAP “Best Care Always:” an evidence- based HCAI prevention bundle MAStARI 6
22 Labhardt et al. [68] To assess the availability of equipment and staff knowledge of PMTCT Cameroon Pre/Post Design HCWs (no denominator provided; study states 42% were staff nurses; 40% were registered nurses; 18% care assistance among nurse-lead facilities (physicians were also included in this study) HIV PMTCT (HIV therapy) MAStARI 5
23 Levy et al. [69] To describe a successful partnership to implement a national IPC training and PPE supply program in all Primary Health Units (PHUs) Sierra Leone Cross-sectional study 4264 HCWs (# of cadres not specified) Ebola Standard precautions and transmission- based precautions for EVD prevention MAStARI 6
24 Lewin et al. [70] To assess whether adding a training intervention for clinic staff to usual DOTS strategy for TB would affect TB treatment outcomes South Africa Clustered RCT (randomization occurred at the clinic level; total number of clincis-24 (with 50 patients per clinic) HCWs (doctors, nurses, educators, clerical staff, CHWs) # of nurses not specified Roughly 1200 patients TB TB therapy MAStARI 11
25 Liautaud et al. [71] To examine the effectiveness of a 1-year certificate program in IPC and occupational health (OH) aimed at empowering HCWs to act as change agents for improving workplace-based HIV and TB prevention South Africa Mixed methods 32 HCWs (56% were nurses) HIV TB HIV/TB IPC MMAT 75%
26 Liu et al. [72] To describe the Chinese response to the Ebola epidemic in Liberia Liberia Cross-sectional study HCWs (nurses, social workers, cleaners, and technicians) # nurses not specified Ebola Ebola ETU safe design/layout for patient isolation and infection reduction; standard precautions; transmission-based precautions MAStARI 7
27 Mahomed et al. [73] To evaluate infection control in intensive care units (ICUs) using the Infection Control Assessment Tool (ICAT) South Africa Cross-sectional study Nurses (# not specified) NA IPC Practices (including standard precautions and transmission-based precautions) MAStARI 6
28 Miceli et al. [74] To describe the Integrated Infectious Disease Capacity Building Evaluation approach to integrating advances in health professional educational theory in the context of primary healthcare system Uganda Pre/Post Design 72 HCWs (clinical officers, nursing officers) # of nurses not specified (36 sites total) Infectious Diseases (emphasis on HIV, TB, and malaria) HIV prevention/ART, TB screening/therapy, malaria screening/therapy MAStARI 7
29 Mbombo & Bimerew [75] To evaluate students’ clinical performance on PMTCT competencies integrated into the standard nursing curriculum and to determine the effectiveness and relevance PMTCT training program South Africa Pre/Post Design 154 student nurses HIV PMTCT (HIV therapy) MAStARI 5
30 Ogoina et al. [76] To describe the experiences of a tertiary teaching hospital in preparing and responding to the 2014 EVD outbreak Nigeria Multi-modal HCWs (70 doctors, 61 nurses, and 59 other medical staff) Ebola Standard precautions and transmission-based precautions for EVD prevention MAStARI 7 QARI 7
31 Otu et al. [77] To assess the effect of using a tablet computer application to deliver an educational intervention to change HCWs EVD-related knowledge and attitudes Nigeria Pre/Post Design 203 HCWs (94 CHWs, 26 nurses, 8 lab staff, and 75 other Ebola Standard precautions and transmission-based precautions for EVD prevention MAStARI 5
32 Parker et al. [78] To describe the results of an evaluation of the impact of a low-cost, brief nursing intervention on the utilization of Safe Water System (SWS) and knowledge of proper hand-washing Kenya Pre/Post Design 11 Nurses NA Safe Water System (Hand hygiene) MAStARI 5
33 Richards et al. [79] To describe the implementation and impact of a bundle to reduce CLASI in the Netcare group of private hospitals South Africa Prospective cohort study HCWs (# nurses not specified) NA “Best Care Always:” an evidence- based HCAI prevention bundle MAStARI 7
34 Samuel et al. [80] To examine the feasibility of adherence to quality standards once established, with reference to hand washing practice as a measure of infection prevention Eritrea Qualitative study HCWs (10 physicians, 10 nurses, 14 health assistants and support staff) 30 patients NA Hand hygiene (hand washing) QARI 8
35 Schmitz et al. [81] To define baseline rates of HCW hand hygiene adherence and assess the impact of implementing the WHO Multi-modal Hand Hygiene Strategy at an academic hospital Ethiopia Pre/Post Design 1000 HCWs (505 physicians, 291 medical students, 144 nurses, and 60 other) NA Hand hygiene/washing MAStARI 5
36 Shumbusho et al. [82] To evaluate the results of a pilot program of nurse-centered ART Rwanda Retrospective cohort study 3 Nurses (at 3 health centers) HIV ART (HIV therapy) MAStART 7
37 Speare et al. [83] To describe the results of a training strategy for communicable disease control nurses South Africa Cross-sectional study 20 Nurses NA Surveillance/screening MAStARI 6
38 Tillerkeratne et al. [84] To determine whether a multi-faceted intervention targeting health care personnel would reduce CAUTI rate in a public hospital Kenya Pre/Post Design Roughly 44 HCWs (nurses and clinical officers) # nurses not specified NA CAUTI Infection Prevention and Control MARtARI 5
39 Uneke et al. [34] To promote the adoption of the WHO HH guidelines to enhance compliance among doctors and nurses and improve patient safety in a teaching hospital Nigeria Cross-sectional study 202 HCWs (39 physicians and 163 nurses) NA Hand hygiene/washing MAStARI 6
40 Uneke et al. [85] To assess the impact of a stethoscope disinfection campaign among doctors and nurses Nigeria Pre/Post Design HCWs (39 physicians and 163 nurses) NA Disinfection (of medical equipment) MAStARI 5
41 Van Rie et al. [86] To evaluate the implementation of three models of provider-initiated HIV counseling and testing for TB patients Democratic Republic of the Congo Cross-sectional study 10 HCWs (6 research nurses, 2 VCT staff, 1 counselor/nurse, 1 TB nurse (1238 patients at 3 TB clinics) HIV TB HIV Counseling/Testing AND TB Prophylaxis MAStARI 7
42 Wanyu et al. [87] To describe the introduction, successes, and challenges implementing a PMTCT program using trained birth attendants Cameroon Cross-sectional study 30 Trained Birth Attendants (42 mother-newborn dyads) HIV PMTCT (HIV therapy) MAStARI 7
43 Welty et al. [88] To describe how the Cameroon Baptist Convention Health Board (CBHHB) successfully integrated PMTCT into routine antenatal care Cameroon Cross-sectional study 690 Nurse, midwives, nurse aids, and trained birth attendants HIV PMTCT (HIV therapy) MAStARI 7
44 White et al. [89] To evaluate three different methods of checklist training by assessing change in behavior at 3–6 months post training on the WHO Surgical safety checklist Guinea Cross-sectional study HCWs (4 surgeons, 7 anesthetists, and 2 ward nurses) NA IPC Practices during surgeries (disinfection of equipment, decontamination of equipment, disinfection of environment) MAStARI 6
45 Xi et al. [90] To investigate the importance of supervision through video surveillance in improving the quality of personal protection in preparing health care workers working in Ebola treatment units Liberia Cross sectional study HCWs (23 physicians; 8 nurses) Ebola PPE use MAStARI 7
46 Zaeh et al. [91] To evaluate the impact of a cost-effective quality improvement intervention targeting active TB cases and provision of IPT among those without active TB disease Ethiopia Pre/Post Design 4 HCWs (2 physicians; 2 nurses) 751 HIV+ patients HIV TB TB screening/IPT Prophylaxis MAStARI 5
47 *Bedelu et al. [92] To describe how the integration of HIV care and treatment into primary health care in Lusikisiki overcome some of the challenges of working in a resource-limited rural area, to achieve good treatment outcomes and clinical outcomes South Africa Prospective cohort study HCWs (nurses and community health workers) (# of nurses not specified) 2200 patients HIV ART (HIV therapy) MAStARI 7
48 Elden et al. [38] To implement and evaluate a program of intensive case finding for TB into a high HIV prevalence, low resource, rural setting Swaziland Prospective cohort study HCWs (nurses and HIV counselors) (# of nurses not specified) 1467 HIV patients TB TB screening/intensive case finding MAStARI 6
49 Charalambous et al. [93] To evaluate the feasibility and acceptability of a specialist clinical service for HIV-infected mineworkers South Africa Prospective cohort study HCWs (physicians, nurses) (3 nurses) 1773 patients HIV TB ART (HIV therapy) TB screening/INH therapy MAStARI 6
50 Fairall et al. [40] To assess the effects on mortality, viral suppression, and other health outcomes and quality indicators of the Streamlining Tasks and Roles to Expand Treatment and Care for HIV (STRETCH) program South Africa Clustered RCT (randomization occurred at the clinic level; total number of clincis-31 103 nurses (this number represents the number of nurses trained in the intervention group) HIV ART (HIV therapy) MAStARI 10
51 Harrison et al. [94] To evaluate the implementation of syndrome packets and healthcare worker training of sexually-transmitted diseases South Africa Clustered RCT (randomized at the clinic level; total of 10 clinics) 5 nurses (one from each intervention clinic) Sexually- transmitted diseases STD Syndromic case management MAStARI 11
52 Naidoo et al. [95] To measure knowledge changes among HCWs who participated in a TB training program and make recommendations for future TB trainings South Africa Pre/Post Design 267 HCWs (physicians, nurses, and other HCWs) (171 nurses, # of physicians or other HCWs not specified) TB TB diagnosis, treatment, and treatment monitoring MAStARI 5
53 Morris et al. [96] To describe experiences with task-shifting in Lusaka in a large public sector ART program Zambia Prospective cohort study HCWs (Clinical officers, which practice as NPs, nurses, and peer educators) 71,000 patients HIV ART (HIV therapy) MAStARI 6
54 Perez et al. [97] To report on activities and lessons learned during the first 18-months of a rural program of PMTCT of HIV Zimbabwe Prospective cohort study 20 nurses and midwives 2308 patients HIV PMTCT (HIV therapy) MAStARI 7
55 Sanne et al. [98] To assess the efficacy of “doctor-initiated-nurse-monitored” ART to doctor-initiated-doctor-monitored” ART using a composite endpoint reflecting both treatment outcomes and patient management South Africa RCT HCWs (2 physicians, 2 nurses) (812 patients) HIV ART (HIV therapy) MAStART 7
56 Ssekabira et al. [99] To evaluate the impact of a training on the quality case management in 8 health facilities roughly one-year after the implementation of artemether-lumefantrine as a recommended 1st-line treatment regimen Uganda Pre/Post Design 170 HCWs at 8 sites (each site had 1 MO, 2 CO, 5 nurses, 5 midwives, 4 nursing assistants, 1 dental officer, 1 lab tech, 1 lab assistant, 1 records officer, 1 educator, 1 health assistant) (Roughly 112 nurses) 76,705 patients Malaria Malaria screening, diagnosis, treatment MAStART 5
57 Sserwanga et al. [100] To describe the impact of a sentinel site malaria surveillance system promoting laboratory testing and rational antimalarial drug use Uganda Prospective cohort study HCWs AT 6 sites (each site had 1 MO, 2 CO, 5 nurses, 5 midwives, 4 nursing assistants, 1 dental officer, 1 lab tech, 1 lab assistant, 1 records officer, 1 educator, 1 health assistant) (Roughly 84 nurses) 424,701 patients Malaria Malaria screening/surveillance/ intensive case finding MAStARI 7
58 Stringer et al. [101] To report the feasibility and early outcomes of scaling up an ART program Zambia Prospective cohort study HCWs (# nurses not specified) 21,755 patients HIV ART (HIV therapy) MAStARI 8
59 Umulisa et al. [102] To describe a multi-strategy intervention with a focus on ensuring stable water supply to improve hand hygiene compliance in a district hospital Rwanda Pre/Post Design HCWs (physicians, nurses, student nurses) NA Hand hygiene/washing MAStARI 5
60 Driessche et al. [103] To develop and evaluate training materials for provider-initiated HIV counseling, testing, prevention involved in care of patients with TB at the primary health care clinic level Democratic Republic of the Congo Pre/Post Design 65 HCWs completed post-test assessment (7 physicians, 38 nurses; 16 lab techs, 4 district supervisors) HIV HIV Counseling/Testing AND TB testing/therapy MAStARI 5
61 Workneh et al. [104] To report on the effectiveness of a clinical mentoring program at decentralized ART sites dedicated to promoting the scale-up of quality pediatric HIV care and treatment Botswana Retrospective cohort study HCWs (physicians, nurses)
(# of nurses not specified)
374 patient charts
HIV ART (HIV therapy) MAStARI 6