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Design, implementation, and analysis considerations for cluster-randomized trials in infection control and hospital epidemiology: A systematic review.


ABSTRACT:

Background

In cluster-randomized trials (CRT), groups rather than individuals are randomized to interventions. The aim of this study was to present critical design, implementation, and analysis issues to consider when planning a CRT in the healthcare setting and to synthesize characteristics of published CRT in the field of healthcare epidemiology.

Methods

A systematic review was conducted to identify CRT with infection control outcomes.

Results

We identified the following 7 epidemiological principles: (1) identify design type and justify the use of CRT; (2) account for clustering when estimating sample size and report intraclass correlation coefficient (ICC)/coefficient of variation (CV); (3) obtain consent; (4) define level of inference; (5) consider matching and/or stratification; (6) minimize bias and/or contamination; and (7) account for clustering in the analysis. Among 44 included studies, the most common design was CRT with crossover (n = 15, 34%), followed by parallel CRT (n = 11, 25%) and stratified CRT (n = 7, 16%). Moreover, 22 studies (50%) offered justification for their use of CRT, and 20 studies (45%) demonstrated that they accounted for clustering at the design phase. Only 15 studies (34%) reported the ICC, CV, or design effect. Also, 15 studies (34%) obtained waivers of consent, and 7 (16%) sought consent at the cluster level. Only 17 studies (39%) matched or stratified at randomization, and 10 studies (23%) did not report efforts to mitigate bias and/or contamination. Finally, 29 studies (88%) accounted for clustering in their analyses.

Conclusions

We must continue to improve the design and reporting of CRT to better evaluate the effectiveness of infection control interventions in the healthcare setting.

SUBMITTER: O'Hara LM 

PROVIDER: S-EPMC6897299 | biostudies-literature | 2019 Jun

REPOSITORIES: biostudies-literature

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Publications

Design, implementation, and analysis considerations for cluster-randomized trials in infection control and hospital epidemiology: A systematic review.

O'Hara Lyndsay M LM   Blanco Natalia N   Leekha Surbhi S   Stafford Kristen A KA   Slobogean Gerard P GP   Ludeman Emilie E   Harris Anthony D AD  

Infection control and hospital epidemiology 20190502 6


<h4>Background</h4>In cluster-randomized trials (CRT), groups rather than individuals are randomized to interventions. The aim of this study was to present critical design, implementation, and analysis issues to consider when planning a CRT in the healthcare setting and to synthesize characteristics of published CRT in the field of healthcare epidemiology.<h4>Methods</h4>A systematic review was conducted to identify CRT with infection control outcomes.<h4>Results</h4>We identified the following  ...[more]

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