Impact of infection prevention and control quality improvements in haemodialysis facilities: a scoping review

Abstract

Background

Healthcare-associated infections (HAIs) pose significant risks to patients undergoing haemodialysis, necessitating effective infection prevention and control (IPC) strategies. This scoping review aims to summarise and analyse the existing literature on quality improvement (QI) interventions that enhance adherence to infection prevention and control measures in dialysis settings.

Methods

A comprehensive literature search was conducted across PubMed, Cochrane Library, MEDLINE, EMBASE and Google Scholar databases, identifying 10 relevant studies published between January 2013 and October 2024. The review was conducted according to an established methodology for scoping studies and followed guidelines. Data extraction and analysis were performed to evaluate the effectiveness and applicability of various quality improvement interventions.

Results

31 267 records with 10 studies eligible for final review. Post-intervention evaluation varied considerably across studies. The analysis revealed that diverse QI strategies significantly improved adherence to infection prevention protocols, including staff education, protocol standardisation, and multimodal interventions. However, the evaluation of outcomes differed across different contexts. Common patterns identified included the effectiveness of training programs in enhancing staff knowledge and the importance of leadership support in sustaining IPC practices. Additionally, some studies revealed a significant decrease in infection rates following the interventions, highlighting the effectiveness of structured educational efforts in enhancing patient safety and infection control in clinical settings.

Conclusion

This review provides valuable insights for healthcare professionals and policymakers to reduce HAIs in dialysis environments, thereby improving patient outcomes and promoting safety within healthcare systems. Future research should focus on implementing and evaluating integrated QI models tailored to local contexts in diverse healthcare settings.

Clinical trial

Not applicable.

Introduction

Haemodialysis (HD) is the leading kidney replacement therapy (KRT) method worldwide [1]. Patients undergoing HD are at heightened risk for HAIs due to frequent vascular access, immunocompromised status, and repeated exposure to healthcare settings [2–4]. These patients typically require treatment three times weekly, with each HD session involving direct access to the bloodstream through arteriovenous fistulas, grafts, or central venous catheters⁵. This frequent breaching of skin barriers and numerous touchpoints in the healthcare environment creates multiple opportunities for pathogen transmission [6].

The burden of infection in this population is substantial. Bloodstream infections in HD patients are estimated to be higher than in the general population, with central venous catheters carrying the highest risk [7, 8]. These infections contribute significantly to morbidity, mortality, hospitalisation rates, and healthcare costs [9, 10]. Furthermore, the rising prevalence of multidrug-resistant organisms poses additional challenges to infection control, given the altered pharmacokinetics and polypharmacy in patients requiring chronic HD [11].

Dialysis staff, including nurses, clinical techs and doctors, serve as frontline providers in HD units, primarily responsible for maintaining aseptic technique during vascular access creation, cannulation, connection, disconnection, and catheter site care [12, 13]. Their adherence to infection prevention and control (IPC) protocols and measures directly impacts patient outcomes [14, 15]. Practices of healthcare staff involved in HD encompass multiple critical domains, including hand hygiene, personal protective equipment use, environmental disinfection, and patient education, all which function as modifiable factors in infection transmission pathways [16, 17].

Despite established guidelines and recommendations from organisations such as the World Health Organisation [18, 19], the Centres for Disease Control and Prevention (CDC) [20], and the Kidney Disease Outcomes Quality Initiative (KDOQI) [21], compliance with IPC practices in HD settings remains suboptimal [22]. Studies have documented variable adherence rates to recommended protocols, with reported hand hygiene compliance ranging from 22 to 88% and significant inconsistencies in vascular access management techniques [5, 23].

Various barriers to optimal nursing practice have been identified, including time constraints during high patient turnover, staffing limitations, knowledge deficits, and organisational culture factors [24, 25]. Given these challenges, targeted interventions to enhance practice represent a crucial strategy for reducing infection rates [26]. For dialysis facilities to be high-reliability organisations, a collaborative effort is necessary to educate and engage the medical staff, support staff, and patients to foster a safety culture [12]. To prevent HAIs, IPC staff and healthcare professionals must identify and evaluate factors such as individuals (patients and providers), medical devices, personal protective equipment, the physical environment, and IPC guidelines [27].

This scoping review aims to map the available evidence on interventions targeting HD staff to improve IPC knowledge, practices, attitudes and outcomes. A scoping review was considered the most appropriate method due to its nature. It allows for capturing the extent of the existing literature and summarising the evidence to identify gaps and inform further research, primarily given the diverse nature of interventions and limited previous synthesis efforts [28]. By synthesising the types of interventions implemented, strategies used, and outcomes measured, this review seeks to identify promising approaches, implementation considerations, and knowledge gaps to guide future research and practice initiatives. Understanding which HD staff-targeted interventions demonstrate effectiveness in this specialised clinical context will provide valuable insights for dialysis facility leaders, IPC leaders, nursing educators, and policymakers seeking to enhance patient safety in HD settings.

This review addresses the following research questions:

• What are the most implemented infection prevention strategies in haemodialysis settings to reduce HAIs among healthcare workers (HCWs)?

• How do different methodologies employed in the research impact the outcomes of IPC approaches in HD?

• To what extent is existing literature on IPC interventions specific to HD, and what gaps can be identified?

The objectives of this review were to

• Map the research magnitude of studies focusing on implementing infection prevention approaches in HD, regarding their focus of interest and the methodologies used.

• Provide evidence on the extent, range, and nature of the existing literature on IPC interventions for preventing HAIs among healthcare workers (HCWs) in the context of HD.

Methods

We comprehensively searched for primary studies across PubMed, Cochrane Library, MEDLINE, EMBASE and Google Scholar databases. We identified 10 relevant studies based on the criteria for studies published from January 2013 to October 2024. This helped ensure a range of interventions were considered. To ensure extensiveness, the researchers adjusted the search strategies to meet the specific conditions of each database. We conducted this review according to an established methodology for scoping studies [29, 30]. Rayyan, an automation tool, was used to screen records for eligibility, and discrepancies were resolved through consensus [30]. Initially, we drew up the review questions, objectives, eligibility criteria, search strategy, evidence screening and selection, data extraction and charting, and evidence analysis. Results presentation and summary of evidence were done using the PRISMA method [30] as shown in Fig. 1.

Fig. 1.

PRISMA-ScR Flow Diagram of the selection process, modified according to the methodology guidelines [30]

This scoping review does not require ethical approval. The results of the scoping review will comprise peer-reviewed publications. The following key search terms for the review: “Haemodialysis”, “Infection prevention and control”, “Quality improvement (QI)”, “Quality Assessment”, “Healthcare-associated infections (HAIs)”, “Multimodal strategies”, “Antimicrobial resistance”, kidney diseases Nurses”, “Nephrologists”, “Dialysis Clinical Technologists” “Doctors” ”Dialysis techs” “Vascular access infection” “Infection control measures” “Healthcare quality improvement “Patient safety”, “Dialysis staff compliance” “Aseptic technique “Bloodstream infections”, “Effects of education”, “Impact of training” “Educational interventions” “Staff training programs” “Protocol adherence” “Environmental disinfection” “Patient outcomes” “Chronic kidney disease”.

Selection criteria

The review selection criteria were completed in 2 phases. In the first phase, one reviewer independently screened the titles and abstracts of retrieved records against the eligibility criteria agreed upon for review. In the second phase, articles that appeared relevant and those with insufficient evidence in the title and abstract were retrieved for full-text review by three independent reviewers. In both phases, differences were resolved through discussion until all three reviewers reached a consensus and confirmed the final decisions for studies to be included and excluded. Ethical approval was deemed unnecessary for this review, as it is predicated upon existing published literature. Nonetheless, the researchers verified that all included studies had obtained the requisite ethical clearance before execution. Eligibility criteria Inclusion and exclusion criteria were developed to provide pertinent data from the literature extracted from the databases.

The inclusion criteria were:

• Original research articles published in peer-reviewed journals.

• Studies included were those focused on Dialysis Practitioners (DPs), such as dialysis nurses, clinical technologists or technicians, nephrologists and doctors.

• Studies focusing on IPC in the nephrology space.

• Articles addressing quality improvement approaches conducted in the HD contexts.

• Articles published in English exclusively.

The exclusion criteria consisted of:

• Case reports, editorials and review articles.

• Studies focusing on HD patient populations.

• Studies that missed nurses and patients.

• Dissertations and theses.

• Articles that did not provide transparent methodologies or results.

• Abstracts.

Results

The articles were retrieved from five databases and represented 31 267 records. After removing 2800 duplicates with the assistance of the information librarian, 3702 studies were screened through their abstracts for eligibility. 32 full-text articles were included for eligibility. Finally, 10 articles were included in the final review. Table 1 below presents the description of the eligible studies for review. Extracted data included the first author and year of publication, tools used in the study, the country where the study was conducted, study aim, study population and sample size, study population and aim or objective of each study, and the key findings.

Table 1.

Data of eligible studies in the final review

Names of first authors and year of publication	Tools	Population and sample size	Country where study was conducted	Design and methods	Aim or objective of the study	Key findings
1. Shrestha 2013 [33]	A structured, self-administered questionnaire was used for pre-intervention data collection. After two weeks of educational intervention, a post-intervention test was taken.	40 nurses	Nepal	This is a pre-experimental study design (pre-intervention intervention post-intervention)	A structured, self-administered questionnaire was used for pre-intervention data collection After two weeks of educational intervention, a post-intervention test was taken.	There was a significant difference between the pre-intervention and post-intervention knowledge scores (p-value = 0.039). When assessing the participants’ overall knowledge level, most had a moderate knowledge level (50–75%). However, after the intervention, their knowledge level significantly increased (p-value = 0.001). An educational intervention programme considerably improved the nurses’ knowledge about caring for patients with central lines. The overall mean knowledge score between pre-intervention and post-intervention was significant.
2. Baghaei et al., 2016 [35]	A six-part validated, and reliable questionnaire was used.	70 dialysis nurses	Iran	Controlled quasi-experimental study	This to determine the effectiveness of BASNEF (Behavior, Attitude, Subjective Norms, and Enabling Factors) model on hand hygiene adherence education.	Post-intervention, the attitude, subjective norms, enabling factors, and intention improved significantly in the intervention group (P,0.001), but hand hygiene behaviour did not show any significant change in the intervention group (P = 0.16)
3. Millson et al. 2019 [37]	Evidence-based checklists and audit tools were used to track staff adherence to protocols.	6 outpatient dialysis clinics Healthcare staff in dialysis and moments of IPC	United States of America.	A comprehensive unit-based Safety Program was instituted to enhance infection prevention practices.	To reduce the risk of infection among HD patients in an outpatient dialysis clinic in upstate New York by developing an enhanced patient safety culture.	Adherence to infection control standards improved when the End Stage Renal Disease Safety Program was implemented, with audits improving from 27%-82% of procedures performed correctly. Bloodstream infection rates decreased from 2.33–1.07 events per 100 patient months, and the standardised infection ratios decreased from 1.960–0.985 in the 12 months after implementation.
4. Ahmed et al. 2019 [31]	Effect of Educational Program about Infection Control Precautions for Nurses in Pediatric Hemodialysis Units	Nurses (36) in paediatric units	Egypt.	Pre/post-quasi-experimental design	To evaluate the effect of the educational program on the nurse’s knowledge and their practices about infection control measures in HD units.	The findings revealed that there were statistically significant differences between nurses’ knowledge and practices in pre- and post-program. There were significant correlations between nurses’ knowledge, residence and occupation, respectively at pre-program
5. Kersten et al. 2019 [38]	The dialysis nurses in the intervention group were surveyed at three points in time using validated scales.	The survey responses of 33 dialysis nurses could be matched over time.	Germany	A quasi-experimental study	This study aimed to evaluate the intervention of a developed health-promoting intervention for dialysis nurses.	In the intervention group, small to medium effect were found in sizes for all measures. However, only a sense of community and burnout improved significantly between the pre- and post-tests. Compared to the control group, the sense of community increased significantly only in the intervention group. This strengthens the result that the intervention had a particular effect on enhancing the sense of community.
6. Yousef et al. 2019 [40]	Tool 1: Structured questionnaire sheet Tool 2: An observational checklist sheet for the nurses Tool 3: Educational nursing program	32 nurses working in the paediatric renal dialysis unit	Egypt	Quasi-experimental research design	To evaluate how training and educational intervention can improve healthcare providers’ understanding of hospital infection control measures in HD services.	There was a highly significant improvement in the nurses’ practice scores regarding general precautions, handwashing, wearing gloves, wearing masks, catheter insertion, skin preparation technique, taking care of patients’ equipment, dealing with sharp objects, dealing with blood, body secretions, and fluids, and maintaining a clean environment and safe injection practices in addition to the total practice score.
7. Abdo et al., 2020 [39]	Questionnaire and observation checklists in the pre-and post-intervention phases.	69 nurses	Kuwait	An educational intervention pre-test/post-test study. Done over 7 months	To assess knowledge and practice of nurses of Farwaniya hospital HD unit regarding care, maintenance and prevention of CRBSIs of CVCs before and after application of an educational program.	Demonstrated that (43.5%) of participants had a satisfactory level of knowledge regarding maintenance and care of CVCs and prevention of CRBSIs at the pre-intervention stage increased to (73.9%) post interventional. Participants correct knowledge items ranged from (31–100%) in the pre-intervention phase and raised at the post-intervention to range from (58–100%). The implemented educational intervention program improved nurses’ knowledge and practice about CVC maintenance. The overall participant nurses’ practices concerning maintenance, care of CVCs and prevention of CRBSIs showed a significant increase from 46% in the pre-intervention phase to 72% in the post-intervention phase. The correct practice elements ranged from 0–100% at the preintervention phase and increased after the intervention to range from 32–100%.
8. Osman et al., 2021 [34]	Interviews and checklist	30 nurses in haemodialysis	Egypt	Quasi-experimental research design (pretest-post-test)	To evaluate the effects of educational interventions on nurses’ knowledge and practices in the HD Unit regarding infection control practices.	Educational nursing interventions had significant positive effects on the overall percent improvement of nurses’ knowledge and practice related to infection control in HD Unit Fever Hospital.
9. Singh et al. 2023 [32]	A pretested questionnaire consisting of 29 statements,	208 nurses	India	Pre-and post-single-group interventions	To assess the impact of training on nursing professionals’ practices of hospital infection control measures in HD services.	The training program or educational intervention proved very useful for enhancing nursing professionals’ knowledge about hospital infection control measures related to HD services. The post-test group had a significantly higher knowledge score than the pretest group in all age groups (P- value < 0.001) This study is notable for its focus on HD services. The findings show that the participants’ knowledge scores improved significantly after the educational intervention. The study resulted in useful findings and guidance for the HCPs including primary care physicians to improve infection control measures and reduce the occurrence of catheter-associated bloodstream infections (CRBSIs) in patients undergoing HD.
10. Harsvardhan et al. 2023 [36]	An evidence-based questionnaire in both English and Hindi languages for knowledge and attitude. Structured observation checklist for practice.	Nursing staff (57) and dialysis technicians (23)	India	An interventional, longitudinal study	To assess the impact of appropriate interventions on key infection control parameters subsequent to baseline assessment in the dialysis unit with objectives to ascertain the current status of knowledge, attitude, and practice for key hospital infection control (HIC) parameters	The overall improvement in knowledge was from 55–70%. Improvement in practice was also observed. Attitudes towards hand hygiene, beneficence, and firm adherence to hand hygiene. On evaluating the data statistically, for all the domains, there was a significant improvement in compliance scores (P < 0.005).

Overview of included studies

Our scoping review included 10 studies that evaluated educational interventions to improve infection control knowledge, practices, and attitudes among healthcare providers in HD settings. The studies were conducted between 2013 and 2023 in various countries, including Iran, the United States of America (USA), Kuwait, Iran, Egypt, Nepal, Germany, and India. Sample sizes ranged from 30 to 208 participants, with most studies focusing on nursing professionals working in HD units. Most interventions targeted knowledge and practices related to infection control, while few addressed organisational culture or systemic issues. Nine studies [31–38, 40] in this review focused on nurse populations, while one study focused on nurses and clinical technicians [39].

Methodological characteristics

The scoping review included a total of ten studies [31–40], of which eight employed quasi-experimental designs to evaluate the effectiveness of educational interventions aimed at improving infection control knowledge, practices, and attitudes among healthcare providers in HD settings. The ten studies were published between 2013 and 2023, revealing a significant scarcity of QI studies in HD environments. Two studies were published between 2013 and 2016 [33, 35]. A notable surge in research activity occurred in 2019, with four studies [31, 37, 38, 40] published. Followed by a sustained output of four studies from 2020 to 2023 [32, 34, 36, 39]. This decade-long investigation highlights the evolution of research methodologies and findings.

Several studies highlighted the importance of education and training programs in enhancing infection control practices among healthcare professionals, particularly nurses working in HD units. One notable initiative was a two-week educational intervention program focusing on central line care for nurses [30], while another study in Egypt developed a Beliefs, Attitudes, Subjective Norms, and Enabling Factors (BASNEF) model-based education program aimed at improving hand hygiene adherence, emphasising Behaviour, Attitude, Subjective Norms, and Enabling Factors [31]. A comprehensive unit-based safety program was implemented in India, utilising evidence-based checklists and audit tools to bolster infection prevention practices [32]. This approach was complemented by an educational program designed specifically for nurses in paediatric HD units, addressing critical infection control precautions in Nepal [33], along with a health-promoting intervention tailored for dialysis nurses that focused on preventive strategies within their work environment in Egypt [34]. Additionally, an educational nursing program concentrated on hospital infection control measures in HD services [35], along with a targeted intervention on the care and maintenance of central venous catheters to prevent catheter-related bloodstream infections (CRBSIs) [36]. Another educational intervention focused on infection control practices in HD units [37], while a recent training program was introduced to enhance hospital infection control measures within these services [38]. In Kuwait, the outcomes of an educational program on nurses’ knowledge and practices for infection prevention and control precautions in the paediatric HD unit were assessed two months after its implementation [40]. Lastly, an evidence-based intervention addressed key infection control parameters, including knowledge, attitude, and practice among dialysis unit staff [39]. Overall, these initiatives have primarily focused on providing education and training to enhance infection prevention practices, with one notable exception being a comprehensive safety program implementation.

Post-intervention evaluation time frames

The timeframe for post-intervention evaluation varied considerably across studies, which can be categorised as follows:

Immediate post-intervention assessment

Two studies conducted assessments immediately or shortly after the educational intervention: A study in Egypt assessed paediatric HD nurses’ knowledge and practices immediately after completing their educational program [31]. An Indian study evaluated nursing professionals’ knowledge of hospital infection control measures directly after their training program [32].

Short-term follow-up (2–4 weeks)

Two studies implemented a short-term follow-up approach. A study in Nepal [33] conducted post-intervention testing two weeks after the educational intervention on nurses’ knowledge regarding caring for patients with central venous lines. In a study done in Egypt, nurses’ knowledge and practices were assessed approximately one month after educational interventions in the HD unit [34].

Medium-term follow-up (1–6 months)

Four studies were identified that evaluated outcomes over a medium-term period. A study conducted in Iran assessed hand hygiene adherence and related factors three months after implementing the BASNEF model intervention [35]. Another study in Kuwait conducted on nurses’ knowledge and practices for IPC precautions in the paediatric HD unit assessed the outcomes two months after implementing the educational program [40]. Another study conducted in India conducted follow-up assessments three months post-intervention to evaluate changes in knowledge and practice for hospital infection control parameters [36]. Lastly, a study on adherence to infection control measures included a three-month post-intervention assessment [32].

Long-term follow-up (> 6 months)

Three studies monitored outcomes over an extended period. A study in the USA tracked adherence to infection control standards and bloodstream infection rates for 12 months after implementing their End Stage Renal Disease Safety Program, providing valuable data on sustained effects [37]. Another study in Germany employed a longitudinal approach with three measurements over approximately one year to evaluate their health-promoting intervention for dialysis nurses [38].

These variations in evaluation timeframes contribute to the heterogeneity of evidence and influence how results should be interpreted. Studies with immediate post-intervention assessments demonstrate short-term knowledge acquisition but may not reflect retention or practice changes. In contrast, studies with more extended follow-up periods provide more robust evidence of sustained effects but are fewer in number. The most comprehensive evidence comes from the US study [37], which conducted a 12-month follow-up. Results demonstrated adherence among participants to infection control standards, and corresponding reductions in infection rates were noted.

Impact of interventions on knowledge

Eight studies reported significant improvements in healthcare providers’ knowledge following educational interventions. A study reported significant differences between pre-intervention and post-intervention knowledge scores (p = 0.039) among nurses caring for patients with central venous lines, with overall knowledge levels increasing significantly after the intervention (p = 0.001) [33]. A study conducted in Kuwait showed that (43.5%) of participants had a satisfactory level of knowledge regarding the maintenance and care of CVCs and the prevention of CRBSIs at the pre-intervention stage increased to (73.9%) post-intervention [39]. The participant’s correct knowledge items ranged from 31 to 100% in the pre-intervention phase and increased in the post-intervention phase from 58 to 100% [39].

A study demonstrated statistically significant differences in paediatric HD nurses’ knowledge before and after their educational program [31]. These findings were consistent with a study conducted in India [32], which reported that their training program significantly enhanced nursing professionals’ knowledge about hospital infection control measures related to HD services. In another study, educational interventions had significant positive effects on the overall improvement of nurses’ knowledge related to infection control in HD units [34]. Likewise, another investigation in India observed an overall improvement in knowledge from 55 to 70% following their intervention [36]. In another study that utilised the BASNEF model in India [35], significant improvements in attitude, subjective norms, enabling factors, and intention in the intervention group (p < 0.001) were revealed. However, it did not significantly change hand hygiene behaviour (p = 0.16) [35].

Impact of interventions on practices and adherence

All studies evaluated the impact of educational interventions on healthcare providers’ practices and adherence to infection control measures. A study in the US focused on enhancing a positive safety culture within outpatient dialysis units in New York to improve infection control practices and ultimately reduce bloodstream infections. It was reported that adherence to infection control standards improved from 27 to 82% of procedures performed correctly after implementing an End Stage Renal Disease Safety Program [37]. This improvement was associated with decreased bloodstream infection rates from 2.33 to 1.07 events per 100 patient months and reduced standardised infection ratios from 1.960 to 0.985 in the 12 months following implementation. A study in Kuwait showed an overall significant increase in nurses’ practice related to maintenance, care of CVCs and prevention of CRBSIs [39]. The increase switched from 46% in the pre-intervention phase to 72% in the post-intervention phase, overall participant nurses’ practices. The correct practice elements ranged from 0 to 100% at the preintervention phase and increased after the intervention to range from 32 to 100% [39].

A quasi-experimental study in India [32] observed significant improvements in nursing professionals’ practices of hospital infection control measures in HD services following their educational intervention. Similarly, another study reported significant positive effects on nurses’ practices related to infection control in HD units [34]. Another study in Kuwait showed a substantial improvement in the nurses’ practice scores regarding general precautions, handwashing, wearing gloves, wearing masks, catheter insertion, and skin preparation technique [40].

A study conducted in paediatric HD in Egypt to evaluate the program’s impact. revealed statistically significant differences in paediatric HD nurses’ practices before and after their educational program, with significant correlations between nurses’ knowledge, residence, and occupation at pre-program assessment [31]. However, not all interventions were equally effective in changing practices. A study conducted in Iran [35] showed that while their BASNEF model improved attitudes and intentions, it did not show significant changes in hand hygiene behaviour (p = 0.16), suggesting that knowledge improvement alone may not always translate to practice changes [35].

Impact on organisational outcomes

Two studies assessed the impact of educational interventions on broader organisational outcomes. After their intervention, reductions in bloodstream infection rates and standardised infection ratios were reported [37]. However, another study in Germany took a different approach by focusing on the well-being of dialysis nurses [38]. They found small to medium effect sizes for all measures in their health-promoting intervention, with significant improvements in the sense of community and burnout between pre- and post-tests [38]. Lastly, compared to the control group, the sense of community increased significantly only in the intervention group, suggesting that educational interventions may have benefits beyond clinical outcomes [38].

Discussion

This scoping review systematically summarises data on the literature related to quality improvement studies focusing on IPC in the HD environments during the specified period and its implications for practice and policy in healthcare systems. Despite the importance of IPC in HD settings, few studies on IPC interventions were observed in this study. The review demonstrates consistent evidence that educational interventions can significantly improve healthcare providers’ knowledge and practices related to infection control in HD settings. Eight of the ten included studies reported significant improvements in knowledge outcomes following educational interventions [31–36, 39, 40]. Notably, the study by [33] showed significant improvements in nurses’ knowledge caring for patients with central venous lines (p = 0.001), while [39] demonstrated an increase in satisfactory knowledge levels from 43.5 to 73.9% post-intervention. These findings align with other evidence that structured educational programs can significantly enhance healthcare workers’ theoretical understanding of IPC principles. Specifically, similar results have been observed in various healthcare settings. For instance, a study conducted in the Intensive Care Units of Egypt demonstrated that IPC training programs not only improved healthcare workers’ knowledge but also led to meaningful compliance with essential IPC practices [41]. Another study conducted in multiple districts in Bangladesh demonstrated a significant improvement after implementing an integrated intervention package of IPC in multiple facilities [42]. This consistency across different studies underscores the positive impact of targeted educational initiatives on IPC within the healthcare sector.

The translation of knowledge into practice, however, presents a more complex picture. Nine studies evaluated practice outcomes, with most demonstrating significant improvements in adherence to IPC measures [31, 32, 34, 37, 39, 40]. The most compelling evidence comes from [37], which reported substantial improvements in adherence to infection control standards from 27 to 82% of procedures performed correctly. This improvement was associated with meaningful clinical outcomes, including reduced bloodstream infection rates from 2.33 to 1.07 events per 100 patient months and decreased standardised infection ratios from 1.960 to 0.985 over 12 months. However, the study by [35] highlighted a critical limitation, showing that while their BASNEF model improved attitudes and intentions, it did not significantly change hand hygiene behaviour (p = 0.16), suggesting that knowledge acquisition alone may not guarantee practice modification.

The predominance of quasi-experimental designs in the eight included studies [31–36, 39, 40] reflects both the practical challenges of conducting randomised controlled trials in healthcare settings and potential limitations in evidence quality. While these designs provide valuable insights into intervention effectiveness, the absence of randomisation and control groups in most studies limits the strength of causal inferences. The heterogeneity in intervention designs, ranging from traditional didactic education [31, 32] to comprehensive safety programs [37] and theory-based behavioural interventions [35], makes direct comparisons challenging and limits the ability to identify optimal intervention components.

Despite the generally positive outcomes reported across studies, several limitations were evident. First, the heterogeneity in intervention designs, outcome measures, and evaluation timeframes makes direct comparisons challenging. Second, most studies employed quasi-experimental designs without randomisation or control groups, which may limit the strength of the evidence. Third, the long-term sustainability of improvements was rarely assessed, with most studies focusing on immediate or short-term outcomes. Lastly, most studies in this review focused on nursing populations, whilst the HD facilities comprise multidisciplinary members and approaches to combat infections and antimicrobial resistance. In addition, the exceptionally high duplicate removal rate in our search strategy, primarily driven by database overlap and automated deduplication without comprehensive manual verification, may have resulted in the inadvertent exclusion of some eligible studies.

Several evidence-based recommendations emerge from this review for immediate implementation. HD facilities should establish standardised educational programs delivered every 6–12 months to maintain knowledge retention, as studies have shown knowledge declines over time [35]. The most successful interventions incorporated evidence-based checklists and real-time audit tools [37], demonstrating that passive education alone is insufficient.

HD Facilities should prioritise multimodal educational approaches combining didactic learning with hands-on training, particularly for central venous catheter care and hand hygiene protocols. Implementation of immediate feedback mechanisms and regular assessment cycles at 3-month intervals can sustain improvements beyond initial interventions. The comprehensive safety culture programs similar to the End Stage Renal Disease Safety Program model [37] should be considered, as this approach demonstrated substantial improvements in both compliance (27–82%) and clinical outcomes (50% reduction in bloodstream infections).

To improve infection prevention and control (IPC) in HD environments, actionable recommendations include establishing baseline assessments of current knowledge and practices, as well as implementing multimodal educational interventions targeting central venous catheter care and hand hygiene. Additionally, deploying evidence-based checklists and audit tools for real-time monitoring, along with developing comprehensive safety culture programs supported by sustained leadership, is crucial.

Considering a scoping review that encompasses a broader range of outcomes would be beneficial. Alternatively, conducting systematic reviews focused on IPC interventions for preventing healthcare-associated infections (HAIs) in HD settings could provide valuable evidence. Further research is needed to evaluate the long-term effects of specific IPC interventions on HAI-related outcomes. Lastly, prioritising studies that explore the relationship between resources in HD facilities and the effectiveness of interventions is essential for optimising patient safety and care.

Conclusion

This scoping review highlights the importance of prioritising educational interventions to enhance infection prevention and control among healthcare workers in haemodialysis settings. By mitigating healthcare-associated infections (HAIs), patient outcomes and safety within healthcare systems can be improved. Healthcare administrators should implement regular staff education, standardised checklists for high-risk procedures, and robust monitoring systems to boost adherence to infection control practices. Future research should focus on the effectiveness of various intervention models, long-term sustainability beyond 12 months, and cost-effectiveness analyses. Additionally, creating context-specific implementation guidelines that account for different resources and staffing levels is essential for effective infection prevention strategies in these environments.

Author contributions

SA conceptualised the manuscript and served as the primary author of the scoping review, and TLA acted as a co-reviewer for the scoping review and provided supervision alongside TS. TS supervised the entire research process from beginning to end.

Funding

This scoping review received no specific grant from any funding agency.

Data availability

All data analysed during this review are included in this published article. [Table 1 and Addendum A]

Declarations

Ethics approval and consent to participate

Not applicable.

Consent for publication

Not Applicable.

Competing interests

The authors declare no competing interests.