NURSING-LED INTERVENTIONS TO PREVENT NON-DEVICE-ASSOCIATED HOSPITAL-ACQUIRED INFECTIONS

Abstract

DOI: https://doi.org/10.46296/yc.v10i19.0986

Abstract

Introduction. Non-device-associated healthcare-associated infections (HAIs) represent a significant burden, yet they are less standardized than CAUTI, CLABSI, or ventilator-associated pneumonia. Various preventive measures rely on fundamental nursing care, particularly oral hygiene, dysphagia screening, patient mobilization, and monitoring of prevention practices. Objective. To synthesize evidence regarding the effectiveness of interventions led, driven, or primarily implemented by nursing staff to prevent non-device-associated HAIs in hospitalized patients. Methods. A systematic review was conducted following PRISMA 2020 guidelines. Studies were searched from the inception of each database through April 30, 2026, in PubMed/MEDLINE, Scopus, Google Scholar, and SciELO. Inclusion criteria comprised hospital-based studies with verifiable full text, interventions involving substantial nursing leadership or implementation, and clinical infection outcomes. Studies on VAP, CAUTI, CLABSI, and other primarily device-associated HAIs were excluded. Due to the heterogeneity of interventions, definitions, and study designs, a structured narrative synthesis was performed. Results. Fourteen studies were included. The evidence focused on preventing non-ventilator hospital-acquired pneumonia (NV-HAP) through oral hygiene and oral care programs; preventing stroke-associated pneumonia via dysphagia screening and oral hygiene; using nurse-liaison programs or prevention rounds for MRSA; and implementing a nursing-led bundle for surgical site infections. Most studies demonstrated a reduction in infection rates, although the evidence was predominantly quasi-experimental or derived from quality improvement initiatives. One cluster trial showed a significant reduction in NV-HAP in medical units, whereas a non-randomized trial on tooth brushing showed no benefit. Sustained implementation depended on clinical nursing leadership, the availability of supplies, training, documentation, auditing, and feedback. Conclusions. Nursing-led interventions can reduce non-device-associated HAIs, with the most consistent evidence supporting protocolized oral hygiene and early dysphagia screening. The certainty of evidence is moderate for the prevention of NV-HAP/post-stroke pneumonia and low to moderate for MRSA and surgical site infections, primarily due to the risk of bias and heterogeneity. Multicenter trials with standardized definitions and measurement of implementation fidelity are required..

Keywords: nursing; healthcare-associated infections; hospital-acquired infection; hospital-acquired pneumonia; oral hygiene; dysphagia; MRSA; surgical site infection; PRISMA 2020.