Controlling respiratory infections in long-term care facilities: A systematic review.

BACKGROUND: Residents of long-term care facilities are vulnerable to respiratory infections, yet infection prevention and control strategies for these settings remain limited. While extensive infection control guidelines for hospitals are well established, few address long-term care facilities, where prevention efforts have largely prioritized pharmacological over non-pharmacological measures. Non-pharmacological strategies are therefore essential to prevent respiratory infection transmission, particularly during early outbreak stages or in settings where pathogen-specific treatments are limited, such as long-term care facilities. OBJECTIVE: To systematically review and synthesize non-pharmacological interventions used to prevent and control respiratory infections in long-term care facilities. INFORMATION SOURCES: Experimental and quasi-experimental studies sourced from PubMed, CINAHL, EMBASE, and Cochrane databases. METHODS: Systematic search for studies published in English between January 2008 and October 2025 was conducted. Eligible studies included those that implemented non-pharmacological interventions to prevent and control respiratory infections in long-term care facilities. The quality of included studies was assessed using the Cochrane Risk-of-Bias tool for Randomized control trials and the Risk of Bias in Non-randomized Studies of Interventions tool. Study characteristics and findings were extracted, and the World Health Organization's Infection Prevention and Control Assessment Framework was applied for analysis to classify interventions and identify evidence gaps across its core components. For data synthesis, a narrative synthesis with vote counting was performed across each component of the framework. RESULTS: Of the 12,203 retrieved studies, 18 met the inclusion criteria. Nine studies broadly examined respiratory tract infections overall, whereas five focused exclusively on coronavirus disease. Based on the framework, interventions related to provision of materials and equipment necessary for infection control, built environments, education, and multimodal strategies were most frequently studied, whereas those addressing guidelines, surveillance methods, and workload, staffing, and bed occupancy received limited attention. Multimodal strategies combining environmental cleaning and education showed the most positive impact, while monitoring and feedback showed promising effectiveness in reducing the incidence of infection. Notably, no studies have addressed all eight components of the framework or fully accounted for the unique characteristics and needs of long-term care facilities. CONCLUSIONS: The included studies had limited methodological quality and varied widely in study design, interventions, and outcome measures. However, by employing a globally recognized framework, this study provides a foundation for strengthening infection prevention and control measures in long-term care facilities and outlines key areas for future research. These findings emphasize the need for integrated, system-level multimodal strategies tailored to long-term care facilities to effectively control respiratory infections in vulnerable populations. REGISTRATION: International Prospective Register of Systematic Reviews CRD42024544560, registered 08/05/2024.