McConeghy 2017.

Study characteristics
Methods	Pilot study of comprehensive intervention (education, cleaning of surfaces, audit and feedback) to staff of nursing homes versus usual care. Pair‐matched cluster‐randomised design with only 5 clusters (nursing homes) in each group
Participants	10 nursing homes in Colorado, USA Intervention group = 481 long‐stay residents and control group = 380 'Long‐stay' defined as resident at least 90 days prior to baseline, or recently readmitted after previous long stay.
Interventions	A multifaceted hand‐washing/surface‐cleaning intervention comprised of 1) 1‐hour online educational module focused on how to prevent infections; 2) provided with an “essential bundle” of 7 products, ranging from hand sanitiser gel and foam to antiviral facial tissues, disinfecting spray, and hand and face wipe and recommendation to use 4 skin cream and wipe products; 3) audit and feedback system. See Table 4 for details.
Outcomes	Laboratory: surface cultures mentioned in Methods, but no results given Effectiveness: LRTI, all infections, hospitalisation, use of antibiotics (not relevant to this review) Safety: none mentioned in Methods and no results given
Notes	The authors conclude that “This multifaceted hand‐washing and surface cleaning intervention was designed to reduce infection rates among nursing homes residents. In our 10‐facility randomized, matched pair pilot study, we observed program compliance and satisfaction along with reductions in surface bacterial counts, but did not observe a statistically significant reduction in infection rates, antimicrobial use, or hospitalizations”. Very poorly reported study with results not explained, summarised in Table 3 as RDs. Denominators and attrition are unclear.
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Unclear risk	Method not described
Allocation concealment (selection bias)	Unclear risk	Method not described
Blinding of participants and personnel (performance bias) All outcomes	High risk	Unblinded
Blinding of outcome assessment (detection bias) All outcomes	High risk	Illness and absenteeism reported by treating staff.
Incomplete outcome data (attrition bias) All outcomes	Unclear risk	No attrition given. Data were collected from e‐medical record at baseline, but not clear whether illness data during the study were collected by the same method.
Selective reporting (reporting bias)	High risk	Upper respiratory tract infection was mentioned in the Methods (intervention presumably would target these), but only LRTI and overall infection reported.