Table 2.
Characteristics of included controlled before and after studies
| Study | Participants | Interventions | Outcomes | Risk of bias |
|---|---|---|---|---|
| Simon 2006w13 | Paediatric inpatients with diagnosis of respiratory syncytical virus admitted for at least 24 hours in Germany | Enhanced surveillance and feedback, rapid diagnosis, barriers and isolation, disinfection of surfaces | Nosocomial infection with respiratory syncytical virus decreased from 1.7 (year 1) to 0.2 per 1000 patient days (Year 3) | Low (reasonably reported study with incidence data presented by sex, age group, and birth weight to minimise bias) |
| Leclair 1987w14 | 695 children aged 5 days to 4 years and 11 months | Infection control intervention to increase use of gloves and gowns | Nosocomial infection with respiratory syncytical virus reduced by relative risk of 3 (95% CI 1.5 to 5.7) | Low (although prone to selection bias, study was better designed than some of its peers as attempt was made at adjusting for different levels of respiratory syncytical virus circulation by subanalysis of virus shedding days in infected participants) |
| Macartney 2000w15 | 1604 children in four seasons before and 2065 children after intervention seasons (aged about 1 year) with community acquired respiratory syncytical virus infection: inpatient children exposed to infected children, Philadelphia, USA | Education, high index of suspicion for case finding, barriers (not goggles or masks), and handwashing for patients and staff in contact with infected patients; two weeks’ isolation when possible: cohorting patients (assigning them to wards) and staff according to risk or symptoms, with enhanced surveillance and restriction of visits, and discouraging staff with acute respiratory infections from working unprotected | Infection with respiratory syncytical virus reduced (relative risk 0.61, 95% CI 0.53 to 0.69) | Medium (study well reported and conclusions reasonable, but no information given on background rate of infection and impact of intervention on morbidity in healthcare workers not analysed) |
| Gala 1986w16 | 74 children and 40 staff in before phase; 77 children and 41 staff in after phase | Use of disposable plastic eye-nose goggle and procedures for control of respiratory infections v procedures for control of respiratory infections alone (cohorting, isolation, and handwashing) | Infection with respiratory syncytical virus reduced from 42% (before) to 6% (after) | High (heavy play of confounders, missed opportunity for randomisation) |
| Hall 1981w17 | 31 volunteers caring for children with respiratory syncytical virus in hospital | Exposure to infants admitted with acute respiratory infection during community outbreak of respiratory syncytical virus | Rates of respiratory syncytical virus infection: 5/7 children cuddled, 4/10 children touched, and 0/14 kept away from their carers | Low (results are of low generalisability) |
| Hall 1981w18 | 162 inpatients with suspected respiratory syncytical virus infections from infants | Additional use of gowns and masks v standard infection control procedures (handwashing, isolation of affected cohorts) | Rates of respiratory syncytical virus infection increased from 32% to 41% | High (poor reporting) |
| Heymann 2004w19 | 186 094 children aged 6-12 years in Israel | Effect of school closure coinciding with “influenza” outbreak | Decreases in acute respiratory infections (42%), visits to doctor and emergency room (28%), and purchase of drugs (35%) | High (observed effect may result from school closure or possibly lower circulation of viruses) |
| Snydman 1988w20 | Healthcare workers and patients in special care baby unit | Active surveillance: gown, mask, and gloves used on contact; restricted visiting policy; and isolation of cohorts of cases, suspected cases, and staff | Rate of respiratory syncytical virus infection decreased from 8 (confirmed) cases to 0 cases per 1000 patient days | High (no denominators provided and exposure generically quantified by aggregate patient days of exposure. Unclear how circulation of respiratory syncytical virus outside related to claimed success of measures, as no information provided) |
| Krasinski 1990w21 | All in-hospital paediatric patients regarded as potentially infected with respiratory syncytical virus | Isolation of screening cohort for respiratory syncytical virus and service education programme v normal care | Respiratory syncytical virus infections to other children reduced from 5 to 3 infections per 1000 patient days | Medium (attempt at correlation between admissions with respiratory syncytical virus and circulation of virus in community) |
| Krilov 1996w22 | 33 children with Down’s syndrome (ages 6 weeks to 5 years) in special needs day care centre with staff-child ratio >5:1 | Training (reinforced by intensive monitoring of classroom behaviour), handwashing programme, and disinfectants on school buses, appliances, and toys | Decreased mean episodes per child per month: acute respiratory infection 0.7 to 0.4 (P<0.07), visits to doctor 0.5 to 0.3 (P<0.05), antibiotic courses 0.33 to 0.28 (P<0.05), days missed from school per study period from infection 0.8 to 0.4 (P<0.05) | High (disinfectants provided, and study sponsored, by manufacturer) |
| Pang 2003w23 | 2521 probable cases of SARS, mostly people admitted to hospital in Beijing, China | Management training and provision of gowns, gloves, and masks; and screening of port of entry | SARS public health measures (barriers, quarantine, screening, contact tracing); only 12 cases identified out of 13 000 000 screened | Low (efforts made to minimise impact of confounding) |
| Pelke 1994w24 | 230 infants, aged 22-42 weeks, of birth weight 464-6195 g | Additional use of gowns plus standard procedures (handwashing) v handwashing alone | No decrease in rates of respiratory syncytical virus infection, other infections, or death (1.2 v 1.4 deaths/100 patient days) | Medium (17% loss to follow-up) |
| Ryan 2001w25 | 136 225 naval recruits (mainly men, aged 19-20 years) undergoing training over three years compared with about 30 000 recruits for phase II of study | Structured ‘‘top-down’’, military ordered programme of handwashing (>4 times daily) v no programme of handwashing (that is, standard practice) | Three stratified samples of recruits: decreased self reported episodes of acute respiratory infections (4.7 v 3.2 per recruit, odds ratio 1.5, 95% CI 1.2 to 1.8) and fewer admissions to hospital (odds ratio 0.09, 95% CI 0.63 to 0.006) | Low (attempt at correlating effects in intervention cohort with viral circulation in non-intervention population on same military base) |