Introduction and background of a systematic review

Introduction and background of a systematic review Order Description Review question Does antimicrobial resistance occur following prolonged use of antibacterial hand washing products, and, if so, in what magnitude? Searches Literature searches will be undertaken to identify articles on all observational and interventional studies that reported antimicrobial resistance development following the use of any type of hand washing product in the prevention of respiratory and gastrointestinal infections in all settings such as community, health care, travel and mass gathering settings. It is planned to search the following key databases from inception: OVID MEDLINE, OVID Embase, The Cochrane Library, Cumulated Index to Nursing and Allied Health Literature (CINAHL), Scopus and Web of Science. Relevant database and textword terms pertaining to the research question will be used. To minimise bias, no language or date restrictions will be applied. Types of study to be included All observational and interventional studies that reported antimicrobial resistance development following the use of any type of hand hygiene in household, work, community and healthcare settings. Particular emphasis will be given on studies involving travellers and attendees of mass gathering events. Condition or domain being studied Resistance to antibacterial, antiviral, antifungal and antiparasitic agents following long-term (defined as 6 months or more) use of hand washing products. Participants/population The participants of interest will be any individual who use hand washing products (medicated or antiseptic) for long time. These include community dwellers, household members, health care workers, travellers and pilgrims. Intervention(s), exposure(s) Hand hygiene products: including medicated soap, alcoholic hand rub, antiseptic solution, hand sanitiser with antibacterial, antiviral, antifungal or anti-parasitic agents. Comparator(s)/control Could be anything other than the intervention or nothing. Context A rigorous systematic review will be conducted to explore the findings of previous studies and their methodologies related to hand hygiene and antimicrobial resistance. It will seek to investigate different hand hygiene products including antibacterial and non-antibacterial, alcoholic and non-alcoholic substances, their frequency of use, duration and discomfort reported by the consumers. The frequency of antimicrobial resistance will be recorded including the profile of resistant organisms. Inclusion criteria will be all observational and interventional studies that reported antimicrobial resistance development following the use of any type of hand hygiene in the prevention of respiratory and gastrointestinal infections in community, mass gathering or travel settings. No language restriction and duplicate entries will be identified and removed. The titles and the abstracts will be screened against the selection criteria, the full texts of the potentially included articles will be gone through to create the final list of studies that fully meet the inclusion criteria. The preferred reporting items for systematic reviews and meta-analyses (PRISMA) statement will be used to represent the search methodology. Subsequently, the data from each included paper will be extracted into an excel spread sheet, specially designed for the purpose of this study. The following data will be extracted: the aim of the study, country of origin, age, gender and health status of the participants, study design, sample size, type of hand hygiene used, diagnostic method used, uptake rate, factors affecting the uptake, and the burden of antimicrobial resistant organisms. Primary outcome(s) Exploring the association between the prolonged use of medicated hand hygiene products and development of antimicrobial resistance. Secondary outcome(s) Exploring the association between the prolonged use of medicated hand hygiene products and development of adverse events other than antimicrobial resistance such as allergic reactions, skin desquamation, etc. Data extraction (selection and coding) Reviewers will independently select eligible studies from the titles and abstracts searched. Two independent researchers will design an Excel spreadsheet based on existing literature into which data from studies eligible for full text review will be abstracted. Then they will go through the full texts of the potentially included articles to create the final list of studies that fully meet the inclusion criteria. The preferred reporting items for systematic reviews and meta-analyses (PRISMA) statement will be used to represent the search methodology. The following data will be extracted: the aim of the study, country of origin, age, gender and health status of the participants, study design, settings (e.g., mass gathering, hospital, community clinic), sample size, type of hand hygiene used, methods used to establish microbial diagnosis, uptake rate, factors affecting the uptake, and the burden of antimicrobial resistant organisms. Any discrepancies will be resolved in consultation with senior authors.