Nursing interventions to prevent healthcare-associated infections in Latin American Hospitals: A mixed-methods Systematic Review protocol with emphasis on Ecuador

Authors

DOI:

https://doi.org/10.71112/sdx5g689

Keywords:

Halthcare-associated infections, Nursing care, Infection control, Systematic review, Mixed methods

Abstract

Healthcare-associated infections (HAIs) compromise patient safety and require context-sensitive hospital interventions. This protocol aims to guide a mixed-methods systematic review of interventions with explicit nursing involvement to prevent and control HAIs in Latin American hospitals, with emphasis on Ecuador. The protocol follows PRISMA-P, and the final review will follow PRISMA 2020 and PRISMA-S. Original studies published since 2016 will be searched in seven bibliographic sources. Quantitative evidence will be synthesized narratively using SWiM, without meta-analysis; qualitative evidence will undergo thematic synthesis and will be integrated with quantitative findings through a convergent segregated approach. Methodological quality will be assessed using MMAT and design-specific JBI tools. As this is a protocol, no empirical results are reported.

Downloads

Download data is not yet available.

References

Allegranzi, B., Bagheri Nejad, S., Combescure, C., Graafmans, W., Attar, H., Donaldson, L., & Pittet, D. (2011). Burden of endemic health-care-associated infection in developing countries: Systematic review and meta-analysis. The Lancet, 377(9761), 228–241. https://doi.org/10.1016/S0140-6736(10)61458-4

Allegranzi, B., Gayet-Ageron, A., Damani, N., Bengaly, L., McLaws, M.-L., Moro, M.-L., Memish, Z., Urroz, O., Richet, H., Storr, J., Donaldson, L., & Pittet, D. (2013). Global implementation of WHO’s multimodal strategy for improvement of hand hygiene: A quasi-experimental study. The Lancet Infectious Diseases, 13(10), 843–851. https://doi.org/10.1016/S1473-3099(13)70163-4

Booth, A., Noyes, J., Flemming, K. A., Moore, G., Tunçalp, Ö., & Shakibazadeh, E. (2019). Formulating questions to explore complex interventions within qualitative evidence synthesis. BMJ Global Health, 4(Suppl. 1), e001107. https://doi.org/10.1136/bmjgh-2018-001107

Buetti, N., Marschall, J., Drees, M., Fakih, M. G., Hadaway, L., Maragakis, L. L., Monsees, E., Novosel, T., O’Grady, N. P., Rupp, M. E., Wolf, J., & Yokoe, D. S. (2022). Strategies to prevent central-line-associated bloodstream infections in acute-care hospitals: 2022 update. Infection Control & Hospital Epidemiology, 43(5), 553–569. https://doi.org/10.1017/ice.2022.87

Calderwood, M. S., Anderson, D. J., Bratzler, D. W., Dellinger, E. P., Garcia-Houchins, S., Maragakis, L. L., Nyquist, A.-C., Perkins, K. M., Preas, M. A., Saiman, L., Schaffzin, J. K., Schweizer, M., Yokoe, D. S., & Kaye, K. S. (2023). Strategies to prevent surgical site infections in acute-care hospitals: 2022 update. Infection Control & Hospital Epidemiology, 44(5), 695–720. https://doi.org/10.1017/ice.2023.67

Campbell, M., McKenzie, J. E., Sowden, A., Katikireddi, S. V., Brennan, S. E., Ellis, S., Hartmann-Boyce, J., Ryan, R., Shepperd, S., Thomas, J., Welch, V., & Thomson, H. (2020). Synthesis without meta-analysis (SWiM) in systematic reviews: Reporting guideline. BMJ, 368, l6890. https://doi.org/10.1136/bmj.l6890

Centers for Disease Control and Prevention. (2026). National Healthcare Safety Network (NHSN) patient safety component manual. https://www.cdc.gov/nhsn/psc/index.html

Fabre, V., Secaira, C., Herzig, C., Bancroft, E., Bernachea, M. P., Anchiraico Galarza, L., Aquiles, B., Arauz, A. B., Bangher, M. D. C., Bernan, M. L., Burokas, S., Canton, A., Cazali, I. L., Colque, A., Comas, M., Contreras, R. V., Cornistein, W., Cordoba, M. G., Correa, S. M., … Quiros, R. E. (2024). Contextual barriers to infection prevention and control program implementation in hospitals in Latin America: A mixed methods evaluation. Antimicrobial Resistance & Infection Control, 13, Article 132. https://doi.org/10.1186/s13756-024-01484-4

Flemming, K., Booth, A., Garside, R., Tunçalp, Ö., & Noyes, J. (2019). Qualitative evidence synthesis for complex interventions and guideline development: Clarification of the purpose, designs and relevant methods. BMJ Global Health, 4(Suppl. 1), e000882. https://doi.org/10.1136/bmjgh-2018-000882

Higgins, J. P. T., Thomas, J., Chandler, J., Cumpston, M., Li, T., Page, M. J., & Welch, V. A. (Eds.). (2024). Cochrane handbook for systematic reviews of interventions (Version 6.5). Cochrane. https://training.cochrane.org/handbook/current

Hong, Q. N., Pluye, P., Fàbregues, S., Bartlett, G., Boardman, F., Cargo, M., Dagenais, P., Gagnon, M.-P., Griffiths, F., Nicolau, B., O’Cathain, A., Rousseau, M.-C., & Vedel, I. (2018). Mixed Methods Appraisal Tool (MMAT), version 2018: User guide. McGill University. http://mixedmethodsappraisaltoolpublic.pbworks.com/

Hong, Q. N., Pluye, P., Fàbregues, S., Bartlett, G., Boardman, F., Cargo, M., Dagenais, P., Gagnon, M.-P., Griffiths, F., Nicolau, B., O’Cathain, A., Rousseau, M.-C., & Vedel, I. (2019). Improving the content validity of the Mixed Methods Appraisal Tool (MMAT): A modified e-Delphi study. Journal of Clinical Epidemiology, 111, 49–59. https://doi.org/10.1016/j.jclinepi.2019.03.008

Joanna Briggs Institute. (s. f.). Critical appraisal tools. Recuperado el 24 de mayo de 2026, de https://jbi.global/critical-appraisal-tools

Klompas, M., Branson, R., Cawcutt, K., Crist, M., Eichenwald, E. C., Greene, L. R., Lee, G., Maragakis, L. L., Powell, K., Priebe, G. P., Speck, K., Yokoe, D. S., & Berenholtz, S. M. (2022). Strategies to prevent ventilator-associated pneumonia, ventilator-associated events, and nonventilator hospital-acquired pneumonia in acute-care hospitals: 2022 update. Infection Control & Hospital Epidemiology, 43(6), 687–713. https://doi.org/10.1017/ice.2022.88

Lewin, S., Booth, A., Glenton, C., Munthe-Kaas, H., Rashidian, A., Wainwright, M., Bohren, M. A., Tunçalp, Ö., Colvin, C. J., Garside, R., Carlsen, B., Langlois, E. V., Noyes, J., & GRADE-CERQual Coordinating Team. (2018). Applying GRADE-CERQual to qualitative evidence synthesis findings: Introduction to the series. Implementation Science, 13(Suppl. 1), Article 2. https://doi.org/10.1186/s13012-017-0688-3

McGowan, J., Sampson, M., Salzwedel, D. M., Cogo, E., Foerster, V., & Lefebvre, C. (2016). PRESS peer review of electronic search strategies: 2015 guideline statement. Journal of Clinical Epidemiology, 75, 40–46. https://doi.org/10.1016/j.jclinepi.2016.01.021

Ministerio de Salud Pública del Ecuador. (2025a). Boletín epidemiológico: Infecciones asociadas a la atención en salud, período 2022–2023. https://www.salud.gob.ec/wp-content/uploads/2025/01/boletin_iaas_2022-2023_final.pdf

Ministerio de Salud Pública del Ecuador. (2025b). Norma Técnica de Prevención y Control de Infecciones Asociadas a la Atención en Salud (PCIAAS) (Acuerdo Ministerial No. 00028-2025). https://www.salud.gob.ec/documentos-normativos-iass-y-ram/

Moher, D., Shamseer, L., Clarke, M., Ghersi, D., Liberati, A., Petticrew, M., Shekelle, P., & Stewart, L. A. (2015). Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015 statement. Systematic Reviews, 4, Article 1. https://doi.org/10.1186/2046-4053-4-1

Noyes, J., Booth, A., Moore, G., Flemming, K., Tunçalp, Ö., & Shakibazadeh, E. (2019). Synthesising quantitative and qualitative evidence to inform guidelines on complex interventions: Clarifying the purposes, designs and outlining some methods. BMJ Global Health, 4(Suppl. 1), e000893. https://doi.org/10.1136/bmjgh-2018-000893

Page, M. J., McKenzie, J. E., Bossuyt, P. M., Boutron, I., Hoffmann, T. C., Mulrow, C. D., Shamseer, L., Tetzlaff, J. M., Akl, E. A., Brennan, S. E., Chou, R., Glanville, J., Grimshaw, J. M., Hróbjartsson, A., Lalu, M. M., Li, T., Loder, E. W., Mayo-Wilson, E., McDonald, S., … Moher, D. (2021a). The PRISMA 2020 statement: An updated guideline for reporting systematic reviews. BMJ, 372, n71. https://doi.org/10.1136/bmj.n71

Page, M. J., Moher, D., Bossuyt, P. M., Boutron, I., Hoffmann, T. C., Mulrow, C. D., Shamseer, L., Tetzlaff, J. M., Akl, E. A., Brennan, S. E., Chou, R., Glanville, J., Grimshaw, J. M., Hróbjartsson, A., Lalu, M. M., Li, T., Loder, E. W., Mayo-Wilson, E., McDonald, S., … McKenzie, J. E. (2021b). PRISMA 2020 explanation and elaboration: Updated guidance and exemplars for reporting systematic reviews. BMJ, 372, n160. https://doi.org/10.1136/bmj.n160

Patel, P. K., Advani, S. D., Kofman, A. D., Lo, E., Maragakis, L. L., Pegues, D. A., Pettis, A. M., Saint, S., Trautner, B., Yokoe, D. S., & Meddings, J. (2023). Strategies to prevent catheter-associated urinary tract infections in acute-care hospitals: 2022 update. Infection Control & Hospital Epidemiology, 44(8), 1209–1231. https://doi.org/10.1017/ice.2023.137

Rethlefsen, M. L., Kirtley, S., Waffenschmidt, S., Ayala, A. P., Moher, D., Page, M. J., Koffel, J. B., & PRISMA-S Group. (2021). PRISMA-S: An extension to the PRISMA statement for reporting literature searches in systematic reviews. Systematic Reviews, 10, Article 39. https://doi.org/10.1186/s13643-020-01542-z

Schreiber, P. W., Sax, H., Wolfensberger, A., Clack, L., & Kuster, S. P. (2018). The preventable proportion of healthcare-associated infections 2005–2016: Systematic review and meta-analysis. Infection Control & Hospital Epidemiology, 39(11), 1277–1295. https://doi.org/10.1017/ice.2018.183

Shamseer, L., Moher, D., Clarke, M., Ghersi, D., Liberati, A., Petticrew, M., Shekelle, P., & Stewart, L. A. (2015). Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015: Elaboration and explanation. BMJ, 349, g7647. https://doi.org/10.1136/bmj.g7647

Stern, C., Lizarondo, L., Carrier, J., Godfrey, C., Rieger, K., Salmond, S., Apostolo, J., Kirkpatrick, P., & Loveday, H. (2020). Methodological guidance for the conduct of mixed methods systematic reviews. JBI Evidence Synthesis, 18(10), 2108–2118. https://doi.org/10.11124/JBISRIR-D-19-00169

Storr, J., Twyman, A., Zingg, W., Damani, N., Kilpatrick, C., Reilly, J., Price, L., Egger, M. M., Grayson, M. L., Kelley, E., Allegranzi, B., & WHO Guidelines Development Group. (2017). Core components for effective infection prevention and control programmes: New WHO evidence-based recommendations. Antimicrobial Resistance & Infection Control, 6, Article 6. https://doi.org/10.1186/s13756-016-0149-9

Thomas, J., & Harden, A. (2008). Methods for the thematic synthesis of qualitative research in systematic reviews. BMC Medical Research Methodology, 8, Article 45. https://doi.org/10.1186/1471-2288-8-45

Verdezoto, M. J., & González Naranjo, D. E. (2025). Intervenciones de enfermería en la prevención de las infecciones asociadas a la atención sanitaria en las unidades de cuidados intensivos: Una revisión sistemática. Reincisol, 4(7), 3891–3904. https://doi.org/10.59282/reincisol.V4(7)3891-3904

Vázquez-Espinoza, J. A., Alcaraz-Moreno, N., & Godínez Gómez, R. (2021). Conocimiento y cumplimiento del cuidado de catéteres centrales en un hospital mexicano. Revista Cuidarte, 12(1), e1076. https://doi.org/10.15649/cuidarte.1076

World Health Organization. (2016). Guidelines on core components of infection prevention and control programmes at the national and acute health care facility level. https://www.who.int/publications/i/item/9789241549929

World Health Organization. (2019). Minimum requirements for infection prevention and control programmes. https://www.who.int/publications/i/item/9789241516945

World Health Organization. (2024). Global report on infection prevention and control 2024. https://www.who.int/publications/i/item/9789240103986

Zingg, W., Holmes, A., Dettenkofer, M., Goetting, T., Secci, F., Clack, L., Allegranzi, B., Magiorakos, A. P., & Pittet, D. (2015). Hospital organisation, management, and structure for prevention of health-care-associated infection: A systematic review and expert consensus. The Lancet Infectious Diseases, 15(2), 212–224. https://doi.org/10.1016/S1473-3099(14)70854-0

Published

2026-06-11

Issue

Section

Health Sciences

How to Cite

Galárraga Almeida, M. Y., Reza Orbea, S. T., Paredes Veloz, C. M. ., & Guerra Gómez, W. C. . (2026). Nursing interventions to prevent healthcare-associated infections in Latin American Hospitals: A mixed-methods Systematic Review protocol with emphasis on Ecuador. Multidisciplinary Journal Epistemology of the Sciences, 3(2), 2735-2759. https://doi.org/10.71112/sdx5g689