For the roughly 2.7 million people living in nursing homes and long-term care facilities across high-income countries alone, infection risk is not a side concern — it is one of the leading drivers of hospitalization and death. Yet the evidence base guiding infection prevention in these settings has lagged far behind that governing hospitals, leaving residents in a policy and practice gap. This systematic review, published in The Lancet Healthy Longevity and commissioned to inform forthcoming WHO global guidelines, attempts to close that gap by rigorously cataloguing what actually reduces healthcare-associated infections (HAIs) and antimicrobial resistance (AMR) in older adult care environments.
The review evaluated a broad spectrum of infection prevention and control (IPC) interventions — spanning hand hygiene programs, personal protective equipment protocols, environmental cleaning strategies, antimicrobial stewardship initiatives, and bundled care approaches — assessing their effectiveness specifically within long-term care facility (LTCF) populations. The distinction matters because LTCFs differ structurally from hospitals: residents live there long-term, communal socializing is integral to wellbeing, staffing ratios are lower, and rapid diagnostic infrastructure is often absent. The review synthesized evidence across these domains to produce a tiered picture of which interventions carry the strongest evidentiary support for this specific context.
The broader significance here extends well beyond institutional hygiene. AMR is a recognized global health emergency, and long-term care facilities are increasingly understood as reservoirs for resistant organisms — a role amplified by the COVID-19 pandemic's devastating toll on LTCF populations. This review's role in shaping WHO guidelines means its conclusions will carry direct policy weight across multiple health systems simultaneously. The primary limitation is inherent to the field: much of the available evidence from LTCFs remains lower quality — observational, single-site, or underpowered — compared to hospital-based IPC literature. The review's value therefore lies as much in mapping evidentiary gaps as in confirming effective practices, and health systems investing in LTCF infection control infrastructure now will likely be ahead of the regulatory curve when WHO guidelines formalize.
