Patient satisfaction with infection prevention control interventions in the acute hospital setting: a systematic review and meta-analysis protocol

Patient satisfaction, infection prevention and control, systematic review, protocol ALL Metrics - Views Downloads How to cite this article Skally M, Kearney A, Rajesh S et al. Patient satisfaction with infection prevention control interventions in the acute hospital setting: a systematic review and meta-analysis protocol [version 2; peer review: 1 approved, 1 approved with reservations]. HRB Open Res 2025, 7:60 (https://doi.org/10.12688/hrbopenres.13924.2) NOTE: If applicable, it is important to ensure the information in square brackets after the title is included in all citations of this article. Export Citation Sciwheel EndNote Ref. Manager Bibtex ProCite Sente Select a format first ▬ ✚ Study Protocol Revised Patient satisfaction with infection prevention control interventions in the acute hospital setting: a systematic review and meta-analysis protocol [version 2; peer review: 1 approved, 1 approved with reservations] Mairead Skally https://orcid.org/0000-0003-3876-8229 1,2, Aoife Kearney2, Sahana Rajesh3, [...] Judith Strawbridge3, Kathleen Bennett https://orcid.org/0000-0002-2861-7665 4, Hilary Humphreys2, Fidelma Fitzpatrick https://orcid.org/0000-0002-3204-5962 1,2Mairead Skally https://orcid.org/0000-0003-3876-8229 1,2, Aoife Kearney2, [...] Sahana Rajesh3, Judith Strawbridge3, Kathleen Bennett https://orcid.org/0000-0002-2861-7665 4, Hilary Humphreys2, Fidelma Fitzpatrick https://orcid.org/0000-0002-3204-5962 1,2 PUBLISHED 23 Sep 2025 Author details Author details 1 Department of Microbiology, Beaumont Hospital, Dublin, Leinster, Ireland 2 Royal College of Surgeons in Ireland Department of Clinical Microbiology, Dublin, Leinster, Ireland 3 Royal College of Surgeons in Ireland School of Pharmacy, Dublin, Leinster, Ireland 4 Data Sciences Centre, School of Population Health, Royal College of Surgeons in Ireland, Dublin, Leinster, Ireland 2 Royal College of Surgeons in Ireland Department of Clinical Microbiology, Dublin, Leinster, Ireland 3 Royal College of Surgeons in Ireland School of Pharmacy, Dublin, Leinster, Ireland 4 Data Sciences Centre, School of Population Health, Royal College of Surgeons in Ireland, Dublin, Leinster, Ireland Mairead Skally Roles: Conceptualization, Methodology, Validation, Visualization, Writing – Review & Editing Roles: Conceptualization, Methodology, Validation, Visualization, Writing – Review & Editing Aoife Kearney Roles: Investigation, Methodology, Writing – Review & Editing Roles: Investigation, Methodology, Writing – Review & Editing Sahana Rajesh Roles: Formal Analysis, Investigation Roles: Formal Analysis, Investigation Judith Strawbridge Roles: Conceptualization, Methodology, Supervision, Writing – Review & Editing Roles: Conceptualization, Methodology, Supervision, Writing – Review & Editing Kathleen Bennett Roles: Conceptualization, Formal Analysis, Methodology, Supervision, Writing – Review & Editing Roles: Conceptualization, Formal Analysis, Methodology, Supervision, Writing – Review & Editing Hilary Humphreys Roles: Conceptualization, Methodology, Supervision, Writing – Review & Editing Roles: Conceptualization, Methodology, Supervision, Writing – Review & Editing Fidelma Fitzpatrick Roles: Conceptualization, Investigation, Methodology, Supervision, Writing – Review & Editing Roles: Conceptualization, Investigation, Methodology, Supervision, Writing – Review & Editing OPEN PEER REVIEW REVIEWER STATUS Infection prevention and control (IPC) interventions are used to prevent or minimise the risk to patients and staff of acquiring healthcare-associated infections (HAI), including those caused by antimicrobial resistance (AMR) pathogens. These interventions are continually changing. However, patient views and enabling patient and public involvement (PPI) in their development has been minimal. Previous systematic reviews have focused or either overall patient satisfaction or specific IPC interventions, however none have addressed patient satisfaction in the context of IPC interventions. The aim of this systematic review and meta-analysis is to assess patient satisfaction in the context of IPC interventions in the acute hospital setting. This systematic review will be conducted in accordance with the Joanna Briggs Institute (JBI) methodology for systematic reviews of aetiology and risk across multiple electronic databases. The population, exposure, outcomes (PEO) tool for systematic reviewing in patients having undergone IPC interventions will be used. Observational studies in peer-reviewed journals meeting the search criteria will be reviewed for inclusion. Rayyan Systematic Review software will be used and two reviewers from the research team will conduct the title and abstract screening. One team member will read identified articles in depth and extract relevant data with guidance by the JBI-recommended approach. Data will be extracted in duplicate, by another member of the research team, for 20% of the identified papers. The PRISMA statement will be referred. A descriptive summary of all included papers will be written. A random effects meta-analysis will be conducted where possible. IPC interventions are not limited to one intervention and a patient may experience numerous IPC interventions during their inpatient stay. However their association on patient satisfaction is unknown. Patient satisfaction, infection prevention and control, systematic review, protocol Corresponding Author(s) Mairead Skally ([email protected]) Grant information: Health Research Board [HRCI-HRB-2022-021]. This work was also supported by the Irish Research Council as part of the Employment-Based Postgraduate Programme (EBPPG/2022/196). Copyright: © 2025 Skally M et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. How to cite: Skally M, Kearney A, Rajesh S et al. Patient satisfaction with infection prevention control interventions in the acute hospital setting: a systematic review and meta-analysis protocol [version 2; peer review: 1 approved, 1 approved with reservations]. HRB Open Res 2025, 7:60 (https://doi.org/10.12688/hrbopenres.13924.2) First published: 26 Sep 2024, 7:60 (https://doi.org/10.12688/hrbopenres.13924.1) Latest published: 23 Sep 2025, 7:60 (https://doi.org/10.12688/hrbopenres.13924.2) In this revised version, we have made several updates in response to peer reviewer feedback and to strengthen the clarity and rigor of the protocol. The Title and Abstract have been refined to more clearly emphasize the focus on patient satisfaction in the context of infection prevention and control (IPC) interventions. The Introduction and Rationale sections were restructured for improved flow, with clearer differentiation between patient satisfaction and patient experience, and expanded discussion of the evidence gap this review seeks to address. The objectives were revised to explicitly highlight the study aims and research questions. The Methods section was updated to more clearly describe the use of the Joanna Briggs Institute (JBI) methodology for systematic reviews of etiology and risk, with justification provided for its selection. The eligibility criteria were revised to use a PEO framework, with a clearer description of population, exposures, and outcomes. Details were added on exclusion criteria, study types. In the study selection and data extraction processes, we clarified that title/abstract screening will be performed in duplicate, while 20% of full-text extractions and risk-of-bias assessments will be conducted in duplicate as a quality assurance measure, with discrepancies resolved through discussion or third-reviewer arbitration. Clarifications were also made on the statistical approach, including handling of small numbers of studies. Potential limitations were also discussed. In this revised version, we have made several updates in response to peer reviewer feedback and to strengthen the clarity and rigor of the protocol. The Title and Abstract have been refined to more clearly emphasize the focus on patient satisfaction in the context of infection prevention and control (IPC) interventions. The Introduction and Rationale sections were restructured for improved flow, with clearer differentiation between patient satisfaction and patient experience, and expanded discussion of the evidence gap this review seeks to address. The objectives were revised to explicitly highlight the study aims and research questions. The Methods section was updated to more clearly describe the use of the Joanna Briggs Institute (JBI) methodology for systematic reviews of etiology and risk, with justification provided for its selection. The eligibility criteria were revised to use a PEO framework, with a clearer description of population, exposures, and outcomes. Details were added on exclusion criteria, study types. In the study selection and data extraction processes, we clarified that title/abstract screening will be performed in duplicate, while 20% of full-text extractions and risk-of-bias assessments will be conducted in duplicate as a quality assurance measure, with discrepancies resolved through discussion or third-reviewer arbitration. Clarifications were also made on the statistical approach, including handling of small numbers of studies. Potential limitations were also discussed. The Methods section was updated to more clearly describe the use of the Joanna Briggs Institute (JBI) methodology for systematic reviews of etiology and risk, with justification provided for its selection. The eligibility criteria were revised to use a PEO framework, with a clearer description of population, exposures, and outcomes. Details were added on exclusion criteria, study types. In the study selection and data extraction processes, we clarified that title/abstract screening will be performed in duplicate, while 20% of full-text extractions and risk-of-bias assessments will be conducted in duplicate as a quality assurance measure, with discrepancies resolved through discussion or third-reviewer arbitration. Clarifications were also made on the statistical approach, including handling of small numbers of studies. Potential limitations were also discussed. See the authors' detailed response to the review by Susan FitzGerald See the authors' detailed response to the review by Shariful Amin Sumon Infection prevention and control (IPC) interventions, such as antimicrobial stewardship and hand hygiene principles, are used in healthcare facilities (HCF) to prevent or minimise the risk to patients and staff of developing healthcare-associated infections (HAI) or acquiring antimicrobial resistance (AMR) pathogens1. Targeted IPC practice occurs when a patient with an infection or with carriage of a multi-drug resistant organism (MDRO) poses a risk to other patients and/or staff, in an effort to reduce onward spread. These measures often include isolation precautions, cohorting of patients with similar infections/exposure (i.e. contact patients) and applying standard precautions in the form of using personal protective equipment (PPE) such as gloves gowns and/or masks by healthcare workers when interacting with affected patients. These measures are the cornerstone of IPC and widely recommended by national and international bodies2. IPC interventions in HCFs are continually changing3. The evidence for IPC practice continues to evolve, new antimicrobial resistant organisms are emerging as technologies and governance structures develop. Integration of IPC programmes with antimicrobial stewardship have had a positive effect on patient safety and quality improvement programmes4. Patient-centred healthcare should incorporate the patient journey and help improve IPC services. Evaluating patients’ expectations and experiences are central to understanding the patient voice. Two frequently used approaches are patient experience and patient satisfaction. While often treated as interchangeable, they capture different aspects of care. Patient experience is a qualitative approach used to describes how a patient perceived the care that received, offering deeper insights from the patient perspective. Patient satisfaction however measures how they rated their experience and provides a quantitative outcome to capture if their expectations were met. Patient satisfaction can therefore provide a standardised and systematic comparison across settings when methods and tools are aligned. Distinguishing overall from service-specific satisfaction is key for healthcare quality. A systematic review conducted in 2017 into the determinants of patient satisfaction found that patient satisfaction is mainly underpinned by perceptions of health service quality characteristics however, results varied greatly5. We are not aware of any systematic review of patient satisfaction in the context of IPC interventions Systematic reviews to determine aetiology and risk are helpful to assess the association between particular exposure and outcome6. Such reviews are important for informing healthcare planning, resource allocation, and are core to defining reliable evidence for practice7. This is particularly valuable for decision makers when deciding health policy and the prevention of adverse health outcomes. As different services are offered within healthcare facilities, overall patient satisfaction and transaction-specific satisfaction (i.e. with IPC services) should be differentiated. So how satisfied are patients with IPC services? Previous systematic reviews have focused or either overall patient satisfaction, finding that the potential determinants of patient satisfaction varied across studies and was determined by perceptions of health service quality, or specific IPC interventions. None have addressed the association of IPC with patient satisfaction5,8–10. To date, it remains unclear whether patients’ expectations of IPC measures are being met. Conducting a systematic review of the association of patient satisfaction with IPC practice will help IPC teams and policy decision-makers better understand HAI from the patient perspective i.e. those directly impacted by them. The aim is to identify peer-reviewed publications reporting on patient satisfaction outcomes in the context of implemented IPC interventions, whether satisfaction was the primary focus or one of several factors examined, document the methods used to quantify patient satisfaction and to conduct a meta-analysis of reported satisfaction levels associated with specific IPC interventions where feasible. This systematic review will be conducted in accordance with the Joanna Briggs Institute (JBI) methodology for systematic reviews of aetiology and risk as it provides established, peer-reviewed guidance specifically for systematic reviews of etiology and risk and aligns with the study objectives7. Systematic review of studies to answer questions of aetiology still follows the same basic principles of systematic review of other types of data and includes a critical appraisal process of identified studies. The registration number of this study protocol in PROSPERO IS 2024 CRD42024558385. The Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement will be used when screening papers11. The population, exposure, outcomes (PEO) tool for systematic reviewing in patients having undergone IPC interventions are outlined in Table 1. The population will include hospitalised patients in acute care hospitals. Exposures will encompass IPC interventions, either broadly or as specific strategies (e.g., isolation, cohorting, MDRO screening/flagging, hand hygiene, antimicrobial stewardship, personal protective equipment use, visitor restrictions, IPC education/communication, and delays in transfer, discharge, or procedures). The outcome of interest will be patient satisfaction with IPC interventions, assessed via surveys or interviews. Comparator data (usual care or alternative IPC strategies) will be recorded when available but will not be required. No language or timeframe filters will be applied to ensure a comprehensive search when executing search strings. Reference lists of identified systematic reviews will also be screened. Identified studies will be reviewed for the following inclusion criteria: i. Admitted patients in acute hospital facilities ii. Patients aged over 18 years iii. Quantifiable patient feedback on IPC practice Where studies are identified in which the population and outcomes of interest are reported as part of a broader study, the relevant subset of data will be extracted and included in this review. If it is unclear from the title and abstract whether the paper involves a specific assessment tool(s), reviewers will assess the full text against the study inclusion criteria (included here in Table 1). Observational studies in peer-reviewed journals meeting the search criteria will be reviewed for inclusion. Articles categorised as case reports, case series, letters, editorials, meta-analyses, commentaries, review articles, and conference abstracts will be excluded, however, reference lists of identified systematic reviews will be searched for relevant papers. Due to insufficient data, reports from grey literature including conference abstracts will be excluded. Qualitative studies, which do not report a quantifiable measure of patient satisfaction, will be excluded. The search strategy will aim to locate both published studies and include all identified keywords and index terms. It will be adapted for each included information source (Appendix 1). To ensure all results are captured, search strings will focus on combining terms for ‘infection prevention and control’ and ‘patient satisfaction’. The term ‘acute hospital’ will not be used as a filter during the search process as some papers may not explicitly specify the facility type as a keyword or in the abstract. The search strings for each database have been developed in conjunction with an information specialist librarian. An electronic search will be performed through MEDLINE, Scopus, Web of Science, EMBASE, Cochrane Library, Cumulative Index to Nursing and Allied Health Literature (CINAHL) and PsycINFO databases. To identify appropriate key words, in addition to Medical Subject Headings (MeSH) terms, popular and commonly used phrases will be used in the search string. Reference lists of relevant articles will also be searched. Identified studies will be uploaded into Rayyan Systematic Review software, and any subsequent duplicates will be removed12. Two reviewers from the research team will conduct the title and abstract screening. Any potential discrepancies between reviewers will be decided by a third member of the research team who has expertise in the area of IPC. The Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA-P) will be used to display the findings of the screening process11. All studies identified for inclusion will then undergo data extraction and meta-analysis if sufficient homogeneity. One author (MS) will read identified articles in depth and will extract all relevant data with guidance by the JBI-recommended approach. Data will be extracted in duplicate, by another member of the research team, for 20% of the identified papers. Any discrepancies will be resolved through discussion, with arbitration by a third reviewer when required. No predefined discrepancy threshold was established, as this procedure served primarily as a quality check to ensure consistency before proceeding with single data extraction. Extracted data will be inserted into an excel data collection tool created for this purpose and approved by the research team. The initial version of this tool is included in Table 2. The usual demographic information (authors, year published, journal, etc.,) is included as well as the type of tool being utilised to measure patient satisfaction and what elements of IPC were assessed. We will also identify which papers were instigated as a result measures implemented during the COVID-19 pandemic. The number of participants, the mean and the standard deviation for each intervention group will be collected. If not available alternative statistics such as the standard error, confidence interval, or test statistic will be extracted. Subgroups of interests include hospital types, study groups conducting the research and patient demography such as sex, age and specialty. The study design of each study will be determined and a critical appraisal of the paper performed by MS using the appropriate JBI checklist according to their manual for evidence synthesis13. A second member of the study group will complete this process in duplicate for the 20% of included studies. All included studies, regardless of the results of their methodological quality, will undergo data extraction and synthesis (where possible). If possible, the results of critical appraisal will be incorporated into analysis on meta-analysis approach: type of IPC practice and association on patient satisfaction. The PRISMA statement will be referred to 7. A descriptive summary of all included papers will be written. Data extracted will be summarised where possible and at least five studies identified using similar patient satisfaction measures14. If fewer than five studies are identified, the appropriateness of conducting a meta-analysis will be considered and discussed by the study group. For each study, the number of satisfied patients were extracted according to authors specified definitions and thresholds, with no additional reclassification applied. If different measures of association are used (e.g. odds ratios, relative risks, standardised mean differences), these will only be pooled if there are sufficient numbers of studies. Methods similar to those provided in the Cochrane Handbook may be used to combine across different reported statistics15. A random effects meta-analysis will be conducted where possible to consider possible heterogeneity between studies. Where data has not been provided, we will attempt to contact the primary authors for the complete data set and analysis, if available by request11. Heterogeneity between studies will be assessed using the I2 statistic for quantifying inconsistency with an l2 of 50% or greater representing substantial heterogeneity. A contour-enhanced funnel plot will be used to investigate any possible publication bias. Subgroup analysis will be completed to investigate any heterogeneity in findings between studies published as a result of the COVID-19 pandemic compared with those not affected by the pandemic. Further subgroup analysis into possible heterogeneity due to the specific IPC practice will be conducted when there are five or more reports in each subgroup. This may not be possible if the number of identified reports is insufficient. As data extraction and risk of bias assessment will not be conducted in full duplicate for all studies, there is a small potential for error or bias. This will be highlighted in the results and discussion of the systematic review. IPC interventions are not limited to one intervention and as a result a patient may experience numerous IPC measures during their inpatient stay. However, their overall association on patient satisfaction is unknown. On completion of this systematic review, we hope to bridge this knowledge gap and quantify the association between IPC and patient satisfaction. Ethics approval is not required for this systematic review. This protocol is reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols (PRISMA-P) guidelines11. Findings will be disseminated through conference presentation and publication in a peer-reviewed journal. Findings will be reported in accordance with the PRISMA statement. Figshare: Supplementary files, https://doi.org/10.6084/m9.figshare.2639640716. This project contains the following extended data: Appendix 1: Search strategy Figshare: PRISMA-P Checklist for ‘Patient satisfaction with infection prevention control practices in the acute hospital setting: a systematic review and meta-analysis protocol’, https://doi.org/10.6084/m9.figshare.2639640417. Data are available under the terms of the Creative Commons Attribution 4.0 International license (CC-BY 4.0). The first draft of the manuscript was written by Mairead Skally. All authors contributed to the study conception and design and have read and approved the final manuscript. We are grateful for the assistance of John Heritage, patient representative on the European Study Group on Clostridioides difficile and Killian Walsh, Information Specialist, RCSI Library. Faculty Opinions recommendedReferences - 1. Allegranzi B, Pittet D: Role of hand hygiene in Healthcare-Associated Infection prevention. J Hosp Infect. 2009; 73(4): 305–15. PubMed Abstract | Publisher Full Text - 2. World Health Organisation: Guidelines on core components of infection prevention and control programmes at the national and acute health care facility level. Geneva: World Health Organization, 2016. Reference Source - 3. Dhar S, Sandhu AL, Valyko A, et al.: Strategies for effective infection prevention programs: structures, processes, and funding. Infect Dis Clin North Am. 2021; 35(3): 531–51. PubMed Abstract | Publisher Full Text - 4. Creedon M, Humphreys H, Connolly R, et al.: Multidisciplinary neurosurgical rounds incorporating antimicrobial stewardship. Are they of benefit? Brain Spine. 2022; 2: 100885. PubMed Abstract | Publisher Full Text | Free Full Text - 5. Batbaatar E, Dorjdagva J, Luvsannyam A, et al.: Determinants of patient satisfaction: a systematic review. Perspect Public Health. 2017; 137(2): 89–101. PubMed Abstract | Publisher Full Text - 6. Munn Z, Stern C, Aromataris E, et al.: What kind of systematic review should I conduct? A proposed typology and guidance for systematic reviewers in the medical and health sciences. BMC Med Res Methodol. 2018; 18(1): 5. PubMed Abstract | Publisher Full Text | Free Full Text - 7. Moola S, Munn Z, Sears K, et al.: Conducting systematic reviews of association (etiology): The Joanna Briggs Institute's approach. Int J Evid Based Healthc. 2015; 13(3): 163–9. PubMed Abstract | Publisher Full Text - 8. Berry D, Wakefield E, Street M, et al.: Clinical deterioration and hospital-acquired complications in adult patients with isolation precautions for infection control: a systematic review. J Adv Nurs. 2020; 76(9): 2235–52. PubMed Abstract | Publisher Full Text - 9. Abbas M, Tartari E, Allegranzi B, et al.: The effect of participating in a Surgical Site Infection (SSI) surveillance network on the time trend of SSI Rates: a systematic review. Infect Control Hosp Epidemiol. 2017; 38(11): 1364–6. PubMed Abstract | Publisher Full Text - 10. Peter D, Meng M, Kugler C, et al.: Strategies to promote infection prevention and control in acute care hospitals with the help of infection control link nurses: a systematic literature review. Am J Infect Control. 2018; 46(2): 207–16. PubMed Abstract | Publisher Full Text - 11. Moher D, Shamseer L, Clarke M, et al.: Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P) 2015 statement. Syst Rev. 2015; 4(1): 1. PubMed Abstract | Publisher Full Text | Free Full Text - 12. Ouzzani M, Hammady H, Fedorowicz Z, et al.: Rayyan-a web and mobile app for systematic reviews. Syst Rev. 2016; 5(1): 210. PubMed Abstract | Publisher Full Text | Free Full Text - 13. Johanna Briggs Institute (JBI): Manual for evidence synthesis. Johanna Briggs Institute (JBI), 2024. Reference Source - 14. Schriger DL, Altman DG, Vetter JA, et al.: Forest plots in reports of systematic reviews: a cross-sectional study reviewing current practice. Int J Epidemiol. 2010; 39(2): 421–9. PubMed Abstract | Publisher Full Text - 15. Deeks JJ, Higgins JPT, Altman DG, et al.: Analysing data and undertaking meta-analyses. Cochrane Handbook for Systematic Reviews of Interventions. version 64. Reference Source - 16. Skally M, Kearney A, Rajesh S, et al.: Search strategy. figshare. Dataset, 2024. http://www.doi.org/10.6084/m9.figshare.26396407.v1 - 17. Skally M, Kearney A, Rajesh S, et al.: PRISMA-P-checklist systematic review protocol - patient satisfaction and infection prevention and control measures. figshare. Dataset, 2024. http://www.doi.org/10.6084/m9.figshare.26396404.v1 Author details Author details 1 Department of Microbiology, Beaumont Hospital, Dublin, Leinster, Ireland 2 Royal College of Surgeons in Ireland Department of Clinical Microbiology, Dublin, Leinster, Ireland 3 Royal College of Surgeons in Ireland School of Pharmacy, Dublin, Leinster, Ireland 4 Data Sciences Centre, School of Population Health, Royal College of Surgeons in Ireland, Dublin, Leinster, Ireland 2 Royal College of Surgeons in Ireland Department of Clinical Microbiology, Dublin, Leinster, Ireland 3 Royal College of Surgeons in Ireland School of Pharmacy, Dublin, Leinster, Ireland 4 Data Sciences Centre, School of Population Health, Royal College of Surgeons in Ireland, Dublin, Leinster, Ireland Mairead Skally Roles: Conceptualization, Methodology, Validation, Visualization, Writing – Review & Editing Roles: Conceptualization, Methodology, Validation, Visualization, Writing – Review & Editing Aoife Kearney Roles: Investigation, Methodology, Writing – Review & Editing Roles: Investigation, Methodology, Writing – Review & Editing Sahana Rajesh Roles: Formal Analysis, Investigation Roles: Formal Analysis, Investigation Judith Strawbridge Roles: Conceptualization, Methodology, Supervision, Writing – Review & Editing Roles: Conceptualization, Methodology, Supervision, Writing – Review & Editing Kathleen Bennett Roles: Conceptualization, Formal Analysis, Methodology, Supervision, Writing – Review & Editing Roles: Conceptualization, Formal Analysis, Methodology, Supervision, Writing – Review & Editing Hilary Humphreys Roles: Conceptualization, Methodology, Supervision, Writing – Review & Editing Roles: Conceptualization, Methodology, Supervision, Writing – Review & Editing Fidelma Fitzpatrick Roles: Conceptualization, Investigation, Methodology, Supervision, Writing – Review & Editing Roles: Conceptualization, Investigation, Methodology, Supervision, Writing – Review & Editing Competing interests HH has received research grants from Pfizer and Astellas and has been a recipient of a consultancy fee from Pfizer FF has received research grant support and been a recipient of a consultancy fee from Tillots Pharma Grant information Health Research Board [HRCI-HRB-2022-021]. This work was also supported by the Irish Research Council as part of the Employment-Based Postgraduate Programme (EBPPG/2022/196). Article Versions (2) Copyright © 2025 Skally M et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. metrics VIEWS $counts.viewCount downloads Citations CITE how to cite this article Skally M, Kearney A, Rajesh S et al. Patient satisfaction with infection prevention control interventions in the acute hospital setting: a systematic review and meta-analysis protocol [version 2; peer review: 1 approved, 1 approved with reservations]. HRB Open Res 2025, 7:60 (https://doi.org/10.12688/hrbopenres.13924.2) NOTE: If applicable, it is important to ensure the information in square brackets after the title is included in all citations of this article. track receive updates on this article Track an article to receive email alerts on any updates to this article. Current Reviewer Status: ? Key to Reviewer Statuses VIEW HIDE ApprovedThe paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approvedFundamental flaws in the paper seriously undermine the findings and conclusions Version 2 VERSION 2 PUBLISHED 23 Sep 2025 Revised Views 0 How to cite this report: FitzGerald S. Reviewer Report For: Patient satisfaction with infection prevention control interventions in the acute hospital setting: a systematic review and meta-analysis protocol [version 2; peer review: 1 approved, 1 approved with reservations]. HRB Open Res 2025, 7:60 (https://doi.org/10.21956/hrbopenres.15682.r50201) The direct URL for this report is: https://hrbopenresearch.org/articles/7-60/v2#referee-response-50201 https://hrbopenresearch.org/articles/7-60/v2#referee-response-50201 NOTE: it is important to ensure the information in square brackets after the title is included in this citation. Reviewer Report 10 Oct 2025 Susan FitzGerald, St Vincent's University Hospital, Dublin, Leinster, Ireland Approved VIEWS 0 Approved. No ... Continue reading I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard. Close Approved. No further comments. Competing Interests: No competing interests were disclosed. Reviewer Expertise: IPC, AMR CITE HOW TO CITE THIS REPORT FitzGerald S. Reviewer Report For: Patient satisfaction with infection prevention control interventions in the acute hospital setting: a systematic review and meta-analysis protocol [version 2; peer review: 1 approved, 1 approved with reservations]. HRB Open Res 2025, 7:60 (https://doi.org/10.21956/hrbopenres.15682.r50201) The direct URL for this report is: https://hrbopenresearch.org/articles/7-60/v2#referee-response-50201 https://hrbopenresearch.org/articles/7-60/v2#referee-response-50201 NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article. Version 1 VERSION 1 PUBLISHED 26 Sep 2024 Views 0 How to cite this report: FitzGerald S. Reviewer Report For: Patient satisfaction with infection prevention control interventions in the acute hospital setting: a systematic review and meta-analysis protocol [version 2; peer review: 1 approved, 1 approved with reservations]. HRB Open Res 2025, 7:60 (https://doi.org/10.21956/hrbopenres.15274.r48530) The direct URL for this report is: https://hrbopenresearch.org/articles/7-60/v1#referee-response-48530 https://hrbopenresearch.org/articles/7-60/v1#referee-response-48530 NOTE: it is important to ensure the information in square brackets after the title is included in this citation. Reviewer Report 03 Sep 2025 Susan FitzGerald, St Vincent's University Hospital, Dublin, Leinster, Ireland Approved with Reservations VIEWS 0

Give more detail on the systematic review of patient satisfaction. Expand on why patient satisfaction with IPC practices is important and how the results of the systematic review could impact delivery of healthcare. Clarify if the ... Continue reading I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above. Close Give more detail on the systematic review of patient satisfaction. Expand on why patient satisfaction with IPC practices is important and how the results of the systematic review could impact delivery of healthcare. Clarify if the ... Continue reading

Give more detail on the systematic review of patient satisfaction. Expand on why patient satisfaction with IPC practices is important and how the results of the systematic review could impact delivery of healthcare. Clarify if the scope of the review will include overall patient satisfaction in patients in whom IPC practices were implemented, or patient satisfaction specifically with the implementation of IPC practices, or both.

Detail why the JBI methodology was chosen; were there other options? Research question 1 implies causality; the systematic review is looking at association. Inclusion criteria - detail the IPC practices here Table 1 PEO tool - explore whether the patient knows that the IPC practices are in place e.g., AMS, flag for MDRO Exclusion criteria - v. certain studies - state other than observational studies here Data collection and analysis: Not clear what is planned if there are less than five studies - clarify Detail how risk of bias will be reported. Give more detail on the systematic review of patient satisfaction. Expand on why patient satisfaction with IPC practices is important and how the results of the systematic review could impact delivery of healthcare. Clarify if the scope of the review will include overall patient satisfaction in patients in whom IPC practices were implemented, or patient satisfaction specifically with the implementation of IPC practices, or both.

Detail why the JBI methodology was chosen; were there other options? Research question 1 implies causality; the systematic review is looking at association. Inclusion criteria - detail the IPC practices here Table 1 PEO tool - explore whether the patient knows that the IPC practices are in place e.g., AMS, flag for MDRO Exclusion criteria - v. certain studies - state other than observational studies here Data collection and analysis: Not clear what is planned if there are less than five studies - clarify Detail how risk of bias will be reported. - Is the rationale for, and objectives of, the study clearly described? Partly - Is the study design appropriate for the research question? Yes - Are sufficient details of the methods provided to allow replication by others? Yes - Are the datasets clearly presented in a useable and accessible format? Partly Competing Interests: No competing interests were disclosed. Reviewer Expertise: IPC, AMR CITE HOW TO CITE THIS REPORT FitzGerald S. Reviewer Report For: Patient satisfaction with infection prevention control interventions in the acute hospital setting: a systematic review and meta-analysis protocol [version 2; peer review: 1 approved, 1 approved with reservations]. HRB Open Res 2025, 7:60 (https://doi.org/10.21956/hrbopenres.15274.r48530) The direct URL for this report is: https://hrbopenresearch.org/articles/7-60/v1#referee-response-48530 https://hrbopenresearch.org/articles/7-60/v1#referee-response-48530 NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article. - Author Response 23 Sep 2025Mairead Skally, Department of Microbiology, Beaumont Hospital, Dublin, Ireland23 Sep 2025Author ResponseIntroduction: 1. Give more detail on the systematic review of patient satisfaction. Response: Thank you to reviewer 2 for this feedback. To provide more detail on this paper we have ... Continue reading Introduction: 1. Give more detail on the systematic review of patient satisfaction. Response: Thank you to reviewer 2 for this feedback. To provide more detail on this paper we have added the following text to the Introduction on page 3, lines 38 to 41: “Previous systematic reviews have focused or either overall patient satisfaction, finding that the potential determinants of patient satisfaction varied across studies and was determined by perceptions of health service quality, or specific IPC interventions. None have addressed the association of IPC with patient satisfaction” 2. Expand on why patient satisfaction with IPC practices is important and how the results of the systematic review could impact delivery of healthcare. Response: Thank you to reviewer 2 for this feedback. To expand on why patient satisfaction with IPC interventions is important and how they could impact delivery of healthcare we have added the following text to “Rationale for this study” on page 3, lines 32 to 46: “Systematic reviews to determine aetiology and risk are helpful to assess the association between particular exposure and outcome. Such reviews are important for informing healthcare planning, resource allocation, and are core to defining reliable evidence for practice. This is particularly valuable for decision makers when deciding health policy and the prevention of adverse health outcomes. As different services are offered within healthcare facilities, overall patient satisfaction and transaction-specific satisfaction (i.e. with IPC services) should be differentiated. So how satisfied are patients with IPC services? Previous systematic reviews have focused or either overall patient satisfaction, which found that the potential determinants of patient satisfaction varied across studies and was determined by perceptions of health service quality, or specific IPC interventions. None have addressed the association of IPC with patient satisfaction .To date, it remains unclear whether patients’ expectations of IPC measures are being met. Conducting a systematic review of the association of patient satisfaction with IPC practice will help IPC teams and policy decision-makers better understand HAI from the patient perspective i.e. those directly impacted by them.” 3. Clarify if the scope of the review will include overall patient satisfaction in patients in whom IPC practices were implemented, or patient satisfaction specifically with the implementation of IPC practices, or both. Response: Thanks to Reviewer 2 for this helpful comment. This was also raised by Reviewer 1 under point 2. To address this issue, we have we have replaced the term ‘IPC practices’ with ‘IPC interventions’ throughout the manuscript. We have also updated the Introduction on page 4, lines 38 to 43: “Previous systematic reviews have focused or either overall patient satisfaction, which found that the potential determinants of patient satisfaction varied across studies and was determined by perceptions of health service quality, or specific IPC interventions. None have addressed the association of IPC with patient satisfaction . To date, it remains unclear whether patients’ expectations of IPC measures are being met. We have also added more detail the Objective on page 4, lines 48 to 52: “The aim is to identify peer-reviewed publications reporting on patient satisfaction outcomes in the context of implemented IPC interventions, whether satisfaction was the primary focus or one of several factors examined, document the methods used to quantify patient satisfaction and to conduct a meta-analysis of reported satisfaction levels associated with specific IPC interventions where feasible. We have also added further to the Inclusion criteria section on page 5, lines 76 to 86: “The population, exposure, outcomes (PEO) tool for systematic reviewing in patients having undergone IPC interventions are outlined in Table 1. The population will include hospitalised patients in acute care hospitals. Exposures will encompass IPC interventions, either broadly or as specific strategies (e.g., isolation, cohorting, multidrug resistant organism screening/flagging, hand hygiene, antimicrobial stewardship, personal protective equipment use, visitor restrictions, IPC education/communication, and delays in transfer, discharge, or procedures). The outcome of interest will be patient satisfaction with IPC interventions, assessed via surveys or interviews. Comparator data (usual care or alternative IPC strategies) will be recorded when available but will not be required. No language or timeframe filters will be applied to ensure a comprehensive search when executing search strings. Reference lists of identified systematic reviews will also be screened.”

4. Detail why the JBI methodology was chosen; were there other options? Response: Thank you to Reviewer 2 for this question. This was also raised by Reviewer 1 under point 5. We selected the JBI systematic review methodology for etiology and risk because our aim is to examine the association between IPC interventions (exposure) and patient satisfaction (outcome). This approach is recommended when synthesising evidence on how an intervention or practice influences outcomes across different settings, which aligns with the focus of our review. The JBI methodology was selected as it provides established, peer-reviewed guidance specifically for systematic reviews of etiology and risk. We have added this supporting text to the Methods on page 5, lines 58 to 61: “This systematic review will be conducted in accordance with the Joanna Briggs Institute (JBI) methodology for systematic reviews of aetiology and risk as it provides established, peer-reviewed guidance specifically for systematic reviews of etiology and risk and aligns with the study objectives” 5. Research question 1 implies causality; the systematic review is looking at association. Response: Thank you to Reviewer 2 for bringing this to our attention. We agree with their view that research question I implies causality. We have removed this question and instead have focused on two main Research questions, on page 5, lines 68 to 72: “I. What approaches have been used to understand the association between IPC interventions and patient satisfaction? II. What determinants of IPC practice are most likely to be associated with affecting patient satisfaction?” 6. Inclusion criteria - detail the IPC practices here Response: Thanks to the reviewer for this point. We have addressed this under point 3 above where we detailed the addition of Inclusion criteria section on page 5, lines 76 to 86: “The population, exposure, outcomes (PEO) tool for systematic reviewing in patients having undergone IPC interventions are outlined in Table 1. The population will include hospitalised patients in acute care hospitals. Exposures will encompass IPC interventions, either broadly or as specific strategies (e.g., isolation, cohorting, multidrug resistant organism screening/flagging, hand hygiene, antimicrobial stewardship, personal protective equipment use, visitor restrictions, IPC education/communication, and delays in transfer, discharge, or procedures). The outcome of interest will be patient satisfaction with IPC interventions, assessed via surveys or interviews. Comparator data (usual care or alternative IPC strategies) will be recorded when available but will not be required. No language or timeframe filters will be applied to ensure a comprehensive search when executing search strings. Reference lists of identified systematic reviews will also be screened.” 7. Table 1 PEO tool - explore whether the patient knows that the IPC practices are in place e.g., AMS, flag for MDRO Response: We thank the reviewer for this suggestion. While we agree that this is an important area for further exploration it falls outside the objectives and scope of the present systematic review. Therefore, we have not added this criterion to Table 1. 8. Exclusion criteria - v. certain studies - state other than observational studies here Response: Thank you to Reviewer 2 for this comment. We have updated the Exclusion criteria to include non-observational studies on page 6, line 104: “vi. Non observational studies” Data collection and analysis: 9. Not clear what is planned if there are less than five studies – clarify Response: Thank you to the reviewer for raising this point of clarification. We have stated in our Methods that “Data extracted will be summarised where possible and at least five studies identified using similar patient satisfaction measures”. The lack of supporting reference was raised by Reviewer 1, point 11. The supporting reference (14) which discusses the suitable number of studies for inclusion in a meta-analysis has been added on page10, line 168: Data extracted will be summarised where possible and at least five studies identified using similar patient satisfaction measures. 14” New reference 14: Schriger DL, Altman DG, Vetter JA, et al. Forest plots in reports of systematic reviews: a cross-sectional study reviewing current practice. Int J Epidemiol. 2010;39(2):421-9. In response to this query, we have now added the following text to the Methodology on page 10, lines 168 to 171: “If fewer than five studies are identified, the appropriateness of conducting a meta-analysis will be considered and discussed by the study group.” 10. Detail how risk of bias will be reported. Response: Thank you to Reviewer 2 for raising this point of clarification. This was also raised by Reviewer 1 under point 10. We have addressed the topic of bias assessment in the section “Risk of bias in individual studies”. Since we first published this protocol we have identified that the Manual for Evidence Synthesis by the JBI a more suitable quality appraisal tool for a diverse research topic. As such we have updated this methodology and supporting reference (13) on page 10, lines 154 to 159: “The study design of each study will be determined and a critical appraisal of the paper performed by MS using the appropriate JBI checklist according to their manual for evidence synthesis. (13). A second member of the study group will complete this process in duplicate for the 20% of included studies.”Introduction:Competing Interests: No competing interests were disclosed. Close 1. Give more detail on the systematic review of patient satisfaction. Response: Thank you to reviewer 2 for this feedback. To provide more detail on this paper we have added the following text to the Introduction on page 3, lines 38 to 41: “Previous systematic reviews have focused or either overall patient satisfaction, finding that the potential determinants of patient satisfaction varied across studies and was determined by perceptions of health service quality, or specific IPC interventions. None have addressed the association of IPC with patient satisfaction” 2. Expand on why patient satisfaction with IPC practices is important and how the results of the systematic review could impact delivery of healthcare. Response: Thank you to reviewer 2 for this feedback. To expand on why patient satisfaction with IPC interventions is important and how they could impact delivery of healthcare we have added the following text to “Rationale for this study” on page 3, lines 32 to 46: “Systematic reviews to determine aetiology and risk are helpful to assess the association between particular exposure and outcome. Such reviews are important for informing healthcare planning, resource allocation, and are core to defining reliable evidence for practice. This is particularly valuable for decision makers when deciding health policy and the prevention of adverse health outcomes. As different services are offered within healthcare facilities, overall patient satisfaction and transaction-specific satisfaction (i.e. with IPC services) should be differentiated. So how satisfied are patients with IPC services? Previous systematic reviews have focused or either overall patient satisfaction, which found that the potential determinants of patient satisfaction varied across studies and was determined by perceptions of health service quality, or specific IPC interventions. None have addressed the association of IPC with patient satisfaction .To date, it remains unclear whether patients’ expectations of IPC measures are being met. Conducting a systematic review of the association of patient satisfaction with IPC practice will help IPC teams and policy decision-makers better understand HAI from the patient perspective i.e. those directly impacted by them.” 3. Clarify if the scope of the review will include overall patient satisfaction in patients in whom IPC practices were implemented, or patient satisfaction specifically with the implementation of IPC practices, or both. Response: Thanks to Reviewer 2 for this helpful comment. This was also raised by Reviewer 1 under point 2. To address this issue, we have we have replaced the term ‘IPC practices’ with ‘IPC interventions’ throughout the manuscript. We have also updated the Introduction on page 4, lines 38 to 43: “Previous systematic reviews have focused or either overall patient satisfaction, which found that the potential determinants of patient satisfaction varied across studies and was determined by perceptions of health service quality, or specific IPC interventions. None have addressed the association of IPC with patient satisfaction . To date, it remains unclear whether patients’ expectations of IPC measures are being met. We have also added more detail the Objective on page 4, lines 48 to 52: “The aim is to identify peer-reviewed publications reporting on patient satisfaction outcomes in the context of implemented IPC interventions, whether satisfaction was the primary focus or one of several factors examined, document the methods used to quantify patient satisfaction and to conduct a meta-analysis of reported satisfaction levels associated with specific IPC interventions where feasible. We have also added further to the Inclusion criteria section on page 5, lines 76 to 86: “The population, exposure, outcomes (PEO) tool for systematic reviewing in patients having undergone IPC interventions are outlined in Table 1. The population will include hospitalised patients in acute care hospitals. Exposures will encompass IPC interventions, either broadly or as specific strategies (e.g., isolation, cohorting, multidrug resistant organism screening/flagging, hand hygiene, antimicrobial stewardship, personal protective equipment use, visitor restrictions, IPC education/communication, and delays in transfer, discharge, or procedures). The outcome of interest will be patient satisfaction with IPC interventions, assessed via surveys or interviews. Comparator data (usual care or alternative IPC strategies) will be recorded when available but will not be required. No language or timeframe filters will be applied to ensure a comprehensive search when executing search strings. Reference lists of identified systematic reviews will also be screened.”

4. Detail why the JBI methodology was chosen; were there other options? Response: Thank you to Reviewer 2 for this question. This was also raised by Reviewer 1 under point 5. We selected the JBI systematic review methodology for etiology and risk because our aim is to examine the association between IPC interventions (exposure) and patient satisfaction (outcome). This approach is recommended when synthesising evidence on how an intervention or practice influences outcomes across different settings, which aligns with the focus of our review. The JBI methodology was selected as it provides established, peer-reviewed guidance specifically for systematic reviews of etiology and risk. We have added this supporting text to the Methods on page 5, lines 58 to 61: “This systematic review will be conducted in accordance with the Joanna Briggs Institute (JBI) methodology for systematic reviews of aetiology and risk as it provides established, peer-reviewed guidance specifically for systematic reviews of etiology and risk and aligns with the study objectives” 5. Research question 1 implies causality; the systematic review is looking at association. Response: Thank you to Reviewer 2 for bringing this to our attention. We agree with their view that research question I implies causality. We have removed this question and instead have focused on two main Research questions, on page 5, lines 68 to 72: “I. What approaches have been used to understand the association between IPC interventions and patient satisfaction? II. What determinants of IPC practice are most likely to be associated with affecting patient satisfaction?” 6. Inclusion criteria - detail the IPC practices here Response: Thanks to the reviewer for this point. We have addressed this under point 3 above where we detailed the addition of Inclusion criteria section on page 5, lines 76 to 86: “The population, exposure, outcomes (PEO) tool for systematic reviewing in patients having undergone IPC interventions are outlined in Table 1. The population will include hospitalised patients in acute care hospitals. Exposures will encompass IPC interventions, either broadly or as specific strategies (e.g., isolation, cohorting, multidrug resistant organism screening/flagging, hand hygiene, antimicrobial stewardship, personal protective equipment use, visitor restrictions, IPC education/communication, and delays in transfer, discharge, or procedures). The outcome of interest will be patient satisfaction with IPC interventions, assessed via surveys or interviews. Comparator data (usual care or alternative IPC strategies) will be recorded when available but will not be required. No language or timeframe filters will be applied to ensure a comprehensive search when executing search strings. Reference lists of identified systematic reviews will also be screened.” 7. Table 1 PEO tool - explore whether the patient knows that the IPC practices are in place e.g., AMS, flag for MDRO Response: We thank the reviewer for this suggestion. While we agree that this is an important area for further exploration it falls outside the objectives and scope of the present systematic review. Therefore, we have not added this criterion to Table 1. 8. Exclusion criteria - v. certain studies - state other than observational studies here Response: Thank you to Reviewer 2 for this comment. We have updated the Exclusion criteria to include non-observational studies on page 6, line 104: “vi. Non observational studies” Data collection and analysis: 9. Not clear what is planned if there are less than five studies – clarify Response: Thank you to the reviewer for raising this point of clarification. We have stated in our Methods that “Data extracted will be summarised where possible and at least five studies identified using similar patient satisfaction measures”. The lack of supporting reference was raised by Reviewer 1, point 11. The supporting reference (14) which discusses the suitable number of studies for inclusion in a meta-analysis has been added on page10, line 168: Data extracted will be summarised where possible and at least five studies identified using similar patient satisfaction measures. 14” New reference 14: Schriger DL, Altman DG, Vetter JA, et al. Forest plots in reports of systematic reviews: a cross-sectional study reviewing current practice. Int J Epidemiol. 2010;39(2):421-9. In response to this query, we have now added the following text to the Methodology on page 10, lines 168 to 171: “If fewer than five studies are identified, the appropriateness of conducting a meta-analysis will be considered and discussed by the study group.” 10. Detail how risk of bias will be reported. Response: Thank you to Reviewer 2 for raising this point of clarification. This was also raised by Reviewer 1 under point 10. We have addressed the topic of bias assessment in the section “Risk of bias in individual studies”. Since we first published this protocol we have identified that the Manual for Evidence Synthesis by the JBI a more suitable quality appraisal tool for a diverse research topic. As such we have updated this methodology and supporting reference (13) on page 10, lines 154 to 159: “The study design of each study will be determined and a critical appraisal of the paper performed by MS using the appropriate JBI checklist according to their manual for evidence synthesis. (13). A second member of the study group will complete this process in duplicate for the 20% of included studies.” COMMENTS ON THIS REPORT - Author Response 23 Sep 2025Mairead Skally, Department of Microbiology, Beaumont Hospital, Dublin, Ireland23 Sep 2025Author ResponseIntroduction: 1. Give more detail on the systematic review of patient satisfaction. Response: Thank you to reviewer 2 for this feedback. To provide more detail on this paper we have ... Continue reading Introduction: 1. Give more detail on the systematic review of patient satisfaction. Response: Thank you to reviewer 2 for this feedback. To provide more detail on this paper we have added the following text to the Introduction on page 3, lines 38 to 41: “Previous systematic reviews have focused or either overall patient satisfaction, finding that the potential determinants of patient satisfaction varied across studies and was determined by perceptions of health service quality, or specific IPC interventions. None have addressed the association of IPC with patient satisfaction” 2. Expand on why patient satisfaction with IPC practices is important and how the results of the systematic review could impact delivery of healthcare. Response: Thank you to reviewer 2 for this feedback. To expand on why patient satisfaction with IPC interventions is important and how they could impact delivery of healthcare we have added the following text to “Rationale for this study” on page 3, lines 32 to 46: “Systematic reviews to determine aetiology and risk are helpful to assess the association between particular exposure and outcome. Such reviews are important for informing healthcare planning, resource allocation, and are core to defining reliable evidence for practice. This is particularly valuable for decision makers when deciding health policy and the prevention of adverse health outcomes. As different services are offered within healthcare facilities, overall patient satisfaction and transaction-specific satisfaction (i.e. with IPC services) should be differentiated. So how satisfied are patients with IPC services? Previous systematic reviews have focused or either overall patient satisfaction, which found that the potential determinants of patient satisfaction varied across studies and was determined by perceptions of health service quality, or specific IPC interventions. None have addressed the association of IPC with patient satisfaction .To date, it remains unclear whether patients’ expectations of IPC measures are being met. Conducting a systematic review of the association of patient satisfaction with IPC practice will help IPC teams and policy decision-makers better understand HAI from the patient perspective i.e. those directly impacted by them.” 3. Clarify if the scope of the review will include overall patient satisfaction in patients in whom IPC practices were implemented, or patient satisfaction specifically with the implementation of IPC practices, or both. Response: Thanks to Reviewer 2 for this helpful comment. This was also raised by Reviewer 1 under point 2. To address this issue, we have we have replaced the term ‘IPC practices’ with ‘IPC interventions’ throughout the manuscript. We have also updated the Introduction on page 4, lines 38 to 43: “Previous systematic reviews have focused or either overall patient satisfaction, which found that the potential determinants of patient satisfaction varied across studies and was determined by perceptions of health service quality, or specific IPC interventions. None have addressed the association of IPC with patient satisfaction . To date, it remains unclear whether patients’ expectations of IPC measures are being met. We have also added more detail the Objective on page 4, lines 48 to 52: “The aim is to identify peer-reviewed publications reporting on patient satisfaction outcomes in the context of implemented IPC interventions, whether satisfaction was the primary focus or one of several factors examined, document the methods used to quantify patient satisfaction and to conduct a meta-analysis of reported satisfaction levels associated with specific IPC interventions where feasible. We have also added further to the Inclusion criteria section on page 5, lines 76 to 86: “The population, exposure, outcomes (PEO) tool for systematic reviewing in patients having undergone IPC interventions are outlined in Table 1. The population will include hospitalised patients in acute care hospitals. Exposures will encompass IPC interventions, either broadly or as specific strategies (e.g., isolation, cohorting, multidrug resistant organism screening/flagging, hand hygiene, antimicrobial stewardship, personal protective equipment use, visitor restrictions, IPC education/communication, and delays in transfer, discharge, or procedures). The outcome of interest will be patient satisfaction with IPC interventions, assessed via surveys or interviews. Comparator data (usual care or alternative IPC strategies) will be recorded when available but will not be required. No language or timeframe filters will be applied to ensure a comprehensive search when executing search strings. Reference lists of identified systematic reviews will also be screened.”

4. Detail why the JBI methodology was chosen; were there other options? Response: Thank you to Reviewer 2 for this question. This was also raised by Reviewer 1 under point 5. We selected the JBI systematic review methodology for etiology and risk because our aim is to examine the association between IPC interventions (exposure) and patient satisfaction (outcome). This approach is recommended when synthesising evidence on how an intervention or practice influences outcomes across different settings, which aligns with the focus of our review. The JBI methodology was selected as it provides established, peer-reviewed guidance specifically for systematic reviews of etiology and risk. We have added this supporting text to the Methods on page 5, lines 58 to 61: “This systematic review will be conducted in accordance with the Joanna Briggs Institute (JBI) methodology for systematic reviews of aetiology and risk as it provides established, peer-reviewed guidance specifically for systematic reviews of etiology and risk and aligns with the study objectives” 5. Research question 1 implies causality; the systematic review is looking at association. Response: Thank you to Reviewer 2 for bringing this to our attention. We agree with their view that research question I implies causality. We have removed this question and instead have focused on two main Research questions, on page 5, lines 68 to 72: “I. What approaches have been used to understand the association between IPC interventions and patient satisfaction? II. What determinants of IPC practice are most likely to be associated with affecting patient satisfaction?” 6. Inclusion criteria - detail the IPC practices here Response: Thanks to the reviewer for this point. We have addressed this under point 3 above where we detailed the addition of Inclusion criteria section on page 5, lines 76 to 86: “The population, exposure, outcomes (PEO) tool for systematic reviewing in patients having undergone IPC interventions are outlined in Table 1. The population will include hospitalised patients in acute care hospitals. Exposures will encompass IPC interventions, either broadly or as specific strategies (e.g., isolation, cohorting, multidrug resistant organism screening/flagging, hand hygiene, antimicrobial stewardship, personal protective equipment use, visitor restrictions, IPC education/communication, and delays in transfer, discharge, or procedures). The outcome of interest will be patient satisfaction with IPC interventions, assessed via surveys or interviews. Comparator data (usual care or alternative IPC strategies) will be recorded when available but will not be required. No language or timeframe filters will be applied to ensure a comprehensive search when executing search strings. Reference lists of identified systematic reviews will also be screened.” 7. Table 1 PEO tool - explore whether the patient knows that the IPC practices are in place e.g., AMS, flag for MDRO Response: We thank the reviewer for this suggestion. While we agree that this is an important area for further exploration it falls outside the objectives and scope of the present systematic review. Therefore, we have not added this criterion to Table 1. 8. Exclusion criteria - v. certain studies - state other than observational studies here Response: Thank you to Reviewer 2 for this comment. We have updated the Exclusion criteria to include non-observational studies on page 6, line 104: “vi. Non observational studies” Data collection and analysis: 9. Not clear what is planned if there are less than five studies – clarify Response: Thank you to the reviewer for raising this point of clarification. We have stated in our Methods that “Data extracted will be summarised where possible and at least five studies identified using similar patient satisfaction measures”. The lack of supporting reference was raised by Reviewer 1, point 11. The supporting reference (14) which discusses the suitable number of studies for inclusion in a meta-analysis has been added on page10, line 168: Data extracted will be summarised where possible and at least five studies identified using similar patient satisfaction measures. 14” New reference 14: Schriger DL, Altman DG, Vetter JA, et al. Forest plots in reports of systematic reviews: a cross-sectional study reviewing current practice. Int J Epidemiol. 2010;39(2):421-9. In response to this query, we have now added the following text to the Methodology on page 10, lines 168 to 171: “If fewer than five studies are identified, the appropriateness of conducting a meta-analysis will be considered and discussed by the study group.” 10. Detail how risk of bias will be reported. Response: Thank you to Reviewer 2 for raising this point of clarification. This was also raised by Reviewer 1 under point 10. We have addressed the topic of bias assessment in the section “Risk of bias in individual studies”. Since we first published this protocol we have identified that the Manual for Evidence Synthesis by the JBI a more suitable quality appraisal tool for a diverse research topic. As such we have updated this methodology and supporting reference (13) on page 10, lines 154 to 159: “The study design of each study will be determined and a critical appraisal of the paper performed by MS using the appropriate JBI checklist according to their manual for evidence synthesis. (13). A second member of the study group will complete this process in duplicate for the 20% of included studies.”Introduction:Competing Interests: No competing interests were disclosed. Close 1. Give more detail on the systematic review of patient satisfaction. Response: Thank you to reviewer 2 for this feedback. To provide more detail on this paper we have added the following text to the Introduction on page 3, lines 38 to 41: “Previous systematic reviews have focused or either overall patient satisfaction, finding that the potential determinants of patient satisfaction varied across studies and was determined by perceptions of health service quality, or specific IPC interventions. None have addressed the association of IPC with patient satisfaction” 2. Expand on why patient satisfaction with IPC practices is important and how the results of the systematic review could impact delivery of healthcare. Response: Thank you to reviewer 2 for this feedback. To expand on why patient satisfaction with IPC interventions is important and how they could impact delivery of healthcare we have added the following text to “Rationale for this study” on page 3, lines 32 to 46: “Systematic reviews to determine aetiology and risk are helpful to assess the association between particular exposure and outcome. Such reviews are important for informing healthcare planning, resource allocation, and are core to defining reliable evidence for practice. This is particularly valuable for decision makers when deciding health policy and the prevention of adverse health outcomes. As different services are offered within healthcare facilities, overall patient satisfaction and transaction-specific satisfaction (i.e. with IPC services) should be differentiated. So how satisfied are patients with IPC services? Previous systematic reviews have focused or either overall patient satisfaction, which found that the potential determinants of patient satisfaction varied across studies and was determined by perceptions of health service quality, or specific IPC interventions. None have addressed the association of IPC with patient satisfaction .To date, it remains unclear whether patients’ expectations of IPC measures are being met. Conducting a systematic review of the association of patient satisfaction with IPC practice will help IPC teams and policy decision-makers better understand HAI from the patient perspective i.e. those directly impacted by them.” 3. Clarify if the scope of the review will include overall patient satisfaction in patients in whom IPC practices were implemented, or patient satisfaction specifically with the implementation of IPC practices, or both. Response: Thanks to Reviewer 2 for this helpful comment. This was also raised by Reviewer 1 under point 2. To address this issue, we have we have replaced the term ‘IPC practices’ with ‘IPC interventions’ throughout the manuscript. We have also updated the Introduction on page 4, lines 38 to 43: “Previous systematic reviews have focused or either overall patient satisfaction, which found that the potential determinants of patient satisfaction varied across studies and was determined by perceptions of health service quality, or specific IPC interventions. None have addressed the association of IPC with patient satisfaction . To date, it remains unclear whether patients’ expectations of IPC measures are being met. We have also added more detail the Objective on page 4, lines 48 to 52: “The aim is to identify peer-reviewed publications reporting on patient satisfaction outcomes in the context of implemented IPC interventions, whether satisfaction was the primary focus or one of several factors examined, document the methods used to quantify patient satisfaction and to conduct a meta-analysis of reported satisfaction levels associated with specific IPC interventions where feasible. We have also added further to the Inclusion criteria section on page 5, lines 76 to 86: “The population, exposure, outcomes (PEO) tool for systematic reviewing in patients having undergone IPC interventions are outlined in Table 1. The population will include hospitalised patients in acute care hospitals. Exposures will encompass IPC interventions, either broadly or as specific strategies (e.g., isolation, cohorting, multidrug resistant organism screening/flagging, hand hygiene, antimicrobial stewardship, personal protective equipment use, visitor restrictions, IPC education/communication, and delays in transfer, discharge, or procedures). The outcome of interest will be patient satisfaction with IPC interventions, assessed via surveys or interviews. Comparator data (usual care or alternative IPC strategies) will be recorded when available but will not be required. No language or timeframe filters will be applied to ensure a comprehensive search when executing search strings. Reference lists of identified systematic reviews will also be screened.”

4. Detail why the JBI methodology was chosen; were there other options? Response: Thank you to Reviewer 2 for this question. This was also raised by Reviewer 1 under point 5. We selected the JBI systematic review methodology for etiology and risk because our aim is to examine the association between IPC interventions (exposure) and patient satisfaction (outcome). This approach is recommended when synthesising evidence on how an intervention or practice influences outcomes across different settings, which aligns with the focus of our review. The JBI methodology was selected as it provides established, peer-reviewed guidance specifically for systematic reviews of etiology and risk. We have added this supporting text to the Methods on page 5, lines 58 to 61: “This systematic review will be conducted in accordance with the Joanna Briggs Institute (JBI) methodology for systematic reviews of aetiology and risk as it provides established, peer-reviewed guidance specifically for systematic reviews of etiology and risk and aligns with the study objectives” 5. Research question 1 implies causality; the systematic review is looking at association. Response: Thank you to Reviewer 2 for bringing this to our attention. We agree with their view that research question I implies causality. We have removed this question and instead have focused on two main Research questions, on page 5, lines 68 to 72: “I. What approaches have been used to understand the association between IPC interventions and patient satisfaction? II. What determinants of IPC practice are most likely to be associated with affecting patient satisfaction?” 6. Inclusion criteria - detail the IPC practices here Response: Thanks to the reviewer for this point. We have addressed this under point 3 above where we detailed the addition of Inclusion criteria section on page 5, lines 76 to 86: “The population, exposure, outcomes (PEO) tool for systematic reviewing in patients having undergone IPC interventions are outlined in Table 1. The population will include hospitalised patients in acute care hospitals. Exposures will encompass IPC interventions, either broadly or as specific strategies (e.g., isolation, cohorting, multidrug resistant organism screening/flagging, hand hygiene, antimicrobial stewardship, personal protective equipment use, visitor restrictions, IPC education/communication, and delays in transfer, discharge, or procedures). The outcome of interest will be patient satisfaction with IPC interventions, assessed via surveys or interviews. Comparator data (usual care or alternative IPC strategies) will be recorded when available but will not be required. No language or timeframe filters will be applied to ensure a comprehensive search when executing search strings. Reference lists of identified systematic reviews will also be screened.” 7. Table 1 PEO tool - explore whether the patient knows that the IPC practices are in place e.g., AMS, flag for MDRO Response: We thank the reviewer for this suggestion. While we agree that this is an important area for further exploration it falls outside the objectives and scope of the present systematic review. Therefore, we have not added this criterion to Table 1. 8. Exclusion criteria - v. certain studies - state other than observational studies here Response: Thank you to Reviewer 2 for this comment. We have updated the Exclusion criteria to include non-observational studies on page 6, line 104: “vi. Non observational studies” Data collection and analysis: 9. Not clear what is planned if there are less than five studies – clarify Response: Thank you to the reviewer for raising this point of clarification. We have stated in our Methods that “Data extracted will be summarised where possible and at least five studies identified using similar patient satisfaction measures”. The lack of supporting reference was raised by Reviewer 1, point 11. The supporting reference (14) which discusses the suitable number of studies for inclusion in a meta-analysis has been added on page10, line 168: Data extracted will be summarised where possible and at least five studies identified using similar patient satisfaction measures. 14” New reference 14: Schriger DL, Altman DG, Vetter JA, et al. Forest plots in reports of systematic reviews: a cross-sectional study reviewing current practice. Int J Epidemiol. 2010;39(2):421-9. In response to this query, we have now added the following text to the Methodology on page 10, lines 168 to 171: “If fewer than five studies are identified, the appropriateness of conducting a meta-analysis will be considered and discussed by the study group.” 10. Detail how risk of bias will be reported. Response: Thank you to Reviewer 2 for raising this point of clarification. This was also raised by Reviewer 1 under point 10. We have addressed the topic of bias assessment in the section “Risk of bias in individual studies”. Since we first published this protocol we have identified that the Manual for Evidence Synthesis by the JBI a more suitable quality appraisal tool for a diverse research topic. As such we have updated this methodology and supporting reference (13) on page 10, lines 154 to 159: “The study design of each study will be determined and a critical appraisal of the paper performed by MS using the appropriate JBI checklist according to their manual for evidence synthesis. (13). A second member of the study group will complete this process in duplicate for the 20% of included studies.” Views 0 How to cite this report: Sumon SA. Reviewer Report For: Patient satisfaction with infection prevention control interventions in the acute hospital setting: a systematic review and meta-analysis protocol [version 2; peer review: 1 approved, 1 approved with reservations]. HRB Open Res 2025, 7:60 (https://doi.org/10.21956/hrbopenres.15274.r42981) The direct URL for this report is: https://hrbopenresearch.org/articles/7-60/v1#referee-response-42981 https://hrbopenresearch.org/articles/7-60/v1#referee-response-42981 NOTE: it is important to ensure the information in square brackets after the title is included in this citation. Reviewer Report 21 Nov 2024 Approved with Reservations VIEWS 0

I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above. Close - Adding a rationale for linking infection prevention and control (IPC) practices to patient satisfaction would be more comprehensive. - Need to mention the explore area: Patient satisfaction with infection prevention control practices – of

Introduction: - Adding a rationale for linking infection prevention and control (IPC) practices to patient satisfaction would be more comprehensive. - Need to mention the explore area: Patient satisfaction with infection prevention control practices – of whom – self, healthcare worker, HCF?

- State an argument for why the association between IPC practices and patient satisfaction is worth investigating. - Introduction: mentioned the key points that refer to the systematic review 2017 for conducting this review. - Is the use of JBI methodology appropriate for systematic reviews of etiology and risk? Can be added as a justification. - Mention the clarification for excluding certain study types (e.g. qualitative) and their potential selection bias. - The absence of MeSH term, language, or timeframe restrictions needs to be justified. - A plan for a standard definition/ measure process of patient satisfaction needs to be included. - Checking duplicate data extraction for 20% of studies and its potential impact on data quality needs to be justified. - Mention how the results of bias assessments will influence the overall analysis and how to address - Mention the reason for ‘at least five studies identified using similar patient satisfaction measures’ and reporting plan for less than five studies. - Acknowledgment of potential limitations needs to be mentioned, e.g. varying definitions of IPC practices across studies/ subjectivity of patient satisfaction measures. - Is the rationale for, and objectives of, the study clearly described? Partly - Is the study design appropriate for the research question? Yes - Are sufficient details of the methods provided to allow replication by others? Yes - Are the datasets clearly presented in a useable and accessible format? Partly Competing Interests: No competing interests were disclosed. Reviewer Expertise: AMR, IPC, Hygiene CITE HOW TO CITE THIS REPORT Sumon SA. Reviewer Report For: Patient satisfaction with infection prevention control interventions in the acute hospital setting: a systematic review and meta-analysis protocol [version 2; peer review: 1 approved, 1 approved with reservations]. HRB Open Res 2025, 7:60 (https://doi.org/10.21956/hrbopenres.15274.r42981) The direct URL for this report is: https://hrbopenresearch.org/articles/7-60/v1#referee-response-42981 https://hrbopenresearch.org/articles/7-60/v1#referee-response-42981 NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article. - Author Response 23 Sep 2025Mairead Skally, Department of Microbiology, Beaumont Hospital, Dublin, Ireland23 Sep 2025Author ResponseAbstract comments: 1. Adding a rationale for linking infection prevention and control (IPC) practices to patient satisfaction would be more comprehensive. Response: We thank Reviewer 1 for this feedback. We ... Continue reading Abstract comments: 1. Adding a rationale for linking infection prevention and control (IPC) practices to patient satisfaction would be more comprehensive. Response: We thank Reviewer 1 for this feedback. We have added our rationale to the Abstract as follows: “However, patient views and enabling patient and public involvement (PPI) in their development has been minimal.” We have added further to the Introduction to strengthen the rationale for this systematic review on page 3, lines 17 to 26: “Patient-centred healthcare should incorporate the patient journey and help improve IPC services. Evaluating patients expectations and experiences are central to understanding the patient voice. Two frequently used approaches are patient experience and patient satisfaction. While often treated as interchangeable, they capture different aspects of care. Patient experience is a qualitative approached used to describes how a patient perceives the care that they received, offering deeper insights from the patient perspective. Patient satisfaction however measures how they rated their experience and provides a quantitative outcome to capture if their expectations were met. Patient satisfaction can therefore provide a standardised and systematic comparison across settings when methods and tools are aligned. Distinguishing overall from service-specific satisfaction is key for healthcare quality.” 2. Need to mention the explore area: Patient satisfaction with infection prevention control practices – of whom – self, healthcare worker, HCF? Response: Thank you to the reviewer for this feedback. To address this question and avoid uncertainty, we have replaced the term ‘IPC practices’ to that of ‘IPC interventions’ throughout the manuscript. To address the specific point here we have updated the Abstract:’ “Previous systematic reviews have focused or either overall patient satisfaction or specific IPC interventions , however none have addressed patient satisfaction in the context of IPC interventions.” And to the Introduction on page 4, lines 38 to 43: “Previous systematic reviews have focused or either overall patient satisfaction, which found that the potential determinants of patient satisfaction varied across studies and was determined by perceptions of health service quality, or specific IPC interventions. None have addressed the association of IPC with patient satisfaction . To date, it remains unclear whether patients’ expectations of IPC measures are being met. We have also added more detail the Objective on page 4, lines 48 to 52: “The aim is to identify peer-reviewed publications reporting on patient satisfaction outcomes in the context of implemented IPC interventions, whether satisfaction was the primary focus or one of several factors examined, document the methods used to quantify patient satisfaction and to conduct a meta-analysis of reported satisfaction levels associated with specific IPC interventions where feasible. We have also added further to the Inclusion criteria section on page 5, lines 76 to 86: “The population, exposure, outcomes (PEO) tool for systematic reviewing in patients having undergone IPC interventions are outlined in Table 1. The population will include hospitalised patients in acute care hospitals. Exposures will encompass IPC interventions, either broadly or as specific strategies (e.g., isolation, cohorting, multidrug resistant organism screening/flagging, hand hygiene, antimicrobial stewardship, personal protective equipment use, visitor restrictions, IPC education/communication, and delays in transfer, discharge, or procedures). The outcome of interest will be patient satisfaction with IPC interventions, assessed via surveys or interviews. Comparator data (usual care or alternative IPC strategies) will be recorded when available but will not be required. No language or timeframe filters will be applied to ensure a comprehensive search when executing search strings. Reference lists of identified systematic reviews will also be screened.”

3. State an argument for why the association between IPC practices and patient satisfaction is worth investigating. Response: Thank you for this comment which we have addressed under point 1 . Specifically we have added further to the Introduction to strengthen the rationale for this systematic review on page 4, lines 17 to 26 “Patient-centred healthcare should incorporate the patient journey and help improve IPC services. Evaluating patients expectations and experiences are central to understanding the patient voice. Two frequently used approaches are patient experience and patient satisfaction. While often treated as interchangeable, they capture different aspects of care. Patient experience is a qualitative approached used to describes how patients perceived care received, offering deeper insights from the patient perspective. Patient satisfaction however measures how they rated their experience and provides a quantitative outcome to capture if their expectations were met offering a standardised and systematic comparison across settings when methods and tools are aligned. Distinguishing overall from service-specific satisfaction is key for healthcare quality.” 4. Introduction: mentioned the key points that refer to the systematic review 2017 for conducting this review. Response: Thank you for the helpful feedback. We have added further to the Introduction context specific to this 2017 systematic review on page 4, lines 26 to 30: “A systematic review conducted in 2017 into the determinants of patient satisfaction found that patient satisfaction is mainly underpinned by perceptions of health service quality characteristics however, results varied greatly. We are not aware of any systematic review of patient satisfaction in the context of IPC interventions “.

5. Is the use of JBI methodology appropriate for systematic reviews of etiology and risk? Can be added as a justification. Response: Thank you for this comment which was also raised by Reviewer 2 under point 4. We selected the JBI systematic review methodology for etiology and risk because our aim is to examine the association between IPC interventions (exposure) and patient satisfaction (outcome). This approach is recommended when synthesising evidence on how an intervention or practice influences outcomes across different settings, which aligns with the focus of our review. The JBI methodology was selected as it provides established, peer-reviewed guidance specifically for systematic reviews of etiology and risk. We have added this supporting text to the Methods on page 5, lines 58 to 61: “This systematic review will be conducted in accordance with the Joanna Briggs Institute (JBI) methodology for systematic reviews of aetiology and risk as it provides established, peer-reviewed guidance specifically for systematic reviews of etiology and risk and aligns with the study objectives” 6. Mention the clarification for excluding certain study types (e.g. qualitative) and their potential selection bias. Response: Qualitative studies offer valuable insights into patients’ perspectives on IPC. However, our review aimed to synthesise quantitative outcomes of patient satisfaction with IPC interventions, document measurement methods, and, where possible, conduct meta-analyses. This focus addresses a gap in the literature, as prior reviews examined satisfaction either generally or with single IPC measures, but not across interventions. We believe we have addressed this under points 1 and 3 above. Specifically, we have added further to the Introduction to strengthen the rationale for this systematic review on page 4, lines 17 to 26:: “Patient-centred healthcare should incorporate the patient journey and help improve IPC services. Evaluating patients expectations and experiences are central to understanding the patient voice. Two frequently used approaches are patient experience and patient satisfaction. While often treated as interchangeable, they capture different aspects of care. Patient experience is a qualitative approach used to describes how patients perceived care received, offering deeper insights from the patient perspective. Patient satisfaction however measures how they rated their experience and provides a quantitative outcome to capture if their expectations were met offering a standardised and systematic comparison across settings when methods and tools are aligned. Distinguishing overall from service-specific satisfaction is key for healthcare quality.” 7. The absence of MeSH term, language, or timeframe restrictions needs to be justified. Response: Thank you for this comment. All search terms, including the MeSH terms used are given in Appendix 1. We have added a justification to our methods about not filtering by language and timeframe on page 5, lines 84 to 86: “No language or timeframe filters will be applied to ensure a comprehensive search when executing…” Data collection and analysis 8. A plan for a standard definition/ measure process of patient satisfaction needs to be included. Response: Thank you to the reviewer for this helpful comment and agree that we should be clearer on the data extraction process. To do this we have added the following to the Data analysis of the Methods section on page 10, lines 170 to 171: “For each study, the number of satisfied patients were extracted according to authors specified definitions and thresholds, with no additional reclassification applied” 9. Checking duplicate data extraction for 20% of studies and its potential impact on data quality needs to be justified. Response: Thank you for highlighting this helpful point of clarification. Titles/abstracts and full-text screening were conducted in duplicate. For 20% of full texts, data extraction and assessment were also performed in duplicate, with any discrepancies resolved through discussion and, when necessary, arbitration by a third reviewer. Although no predefined discrepancy threshold was established, this process functioned as a quality assurance step to ensure consistency prior to proceeding with single extraction. To clarify we have added the following to our Methods on page 7, lines 137 to 140: “Any discrepancies will be resolved through discussion, with arbitration by a third reviewer when required. No predefined discrepancy threshold was established, as this procedure served primarily as a quality check to ensure consistency before proceeding with single data extraction” 10. Mention how the results of bias assessments will influence the overall analysis and how to address Response: Thank you for this feedback, which was also raised by Reviewer 2, point 10. We have addressed the topic of bias assessment in the section “Risk of bias in individual studies”. Since we first published this protocol, we have identified that the Manual for Evidence Synthesis by the JBI a more suitable quality appraisal tool for a diverse research topic. As such we have updated the Methodology and supporting reference (13) on page 10, lines 154 to 159: “The study design of each study will be determined and a critical appraisal of the paper performed by MS using the appropriate JBI checklist according to their manual for evidence synthesis. (13). A second member of the study group will complete this process in duplicate for the 20% of included studies.” New reference 13: Johanna Briggs Institute (JBI). Manual for Evidence Synthesis. Johanna Briggs Institute (JBI). 2024. [Available from: https://synthesismanual.jbi.global 11. Mention the reason for ‘at least five studies identified using similar patient satisfaction measures’ and reporting plan for less than five studies. Response: Thank you to the reviewer for pointing out this omission. We have now added a supporting reference (14) which discusses the suitable number of studies for inclusion in a meta-analysis on page10, line 168: “Data extracted will be summarised where possible and at least five studies identified using similar patient satisfaction measures. 14” New reference 14: Schriger DL, Altman DG, Vetter JA, et al. Forest plots in reports of systematic reviews: a cross-sectional study reviewing current practice. Int J Epidemiol. 2010;39(2):421-9. 12.Acknowledgment of potential limitations needs to be mentioned, e.g. varying definitions of IPC practices across studies/ subjectivity of patient satisfaction measures. Response: Thanks to Reviewer 1 for this feedback. We have added a Potential limitations subsection on page 11, lines 187 to 190 with the following text: “Potential limitations As data extraction and risk of bias assessment will not be conducted in full duplicate for all studies, there is a small potential for error or bias. This will be highlighted in the results and discussion of the systematic review.”Abstract comments:Competing Interests: No competing interests were disclosed. Close 1. Adding a rationale for linking infection prevention and control (IPC) practices to patient satisfaction would be more comprehensive. Response: We thank Reviewer 1 for this feedback. We have added our rationale to the Abstract as follows: “However, patient views and enabling patient and public involvement (PPI) in their development has been minimal.” We have added further to the Introduction to strengthen the rationale for this systematic review on page 3, lines 17 to 26: “Patient-centred healthcare should incorporate the patient journey and help improve IPC services. Evaluating patients expectations and experiences are central to understanding the patient voice. Two frequently used approaches are patient experience and patient satisfaction. While often treated as interchangeable, they capture different aspects of care. Patient experience is a qualitative approached used to describes how a patient perceives the care that they received, offering deeper insights from the patient perspective. Patient satisfaction however measures how they rated their experience and provides a quantitative outcome to capture if their expectations were met. Patient satisfaction can therefore provide a standardised and systematic comparison across settings when methods and tools are aligned. Distinguishing overall from service-specific satisfaction is key for healthcare quality.” 2. Need to mention the explore area: Patient satisfaction with infection prevention control practices – of whom – self, healthcare worker, HCF? Response: Thank you to the reviewer for this feedback. To address this question and avoid uncertainty, we have replaced the term ‘IPC practices’ to that of ‘IPC interventions’ throughout the manuscript. To address the specific point here we have updated the Abstract:’ “Previous systematic reviews have focused or either overall patient satisfaction or specific IPC interventions , however none have addressed patient satisfaction in the context of IPC interventions.” And to the Introduction on page 4, lines 38 to 43: “Previous systematic reviews have focused or either overall patient satisfaction, which found that the potential determinants of patient satisfaction varied across studies and was determined by perceptions of health service quality, or specific IPC interventions. None have addressed the association of IPC with patient satisfaction . To date, it remains unclear whether patients’ expectations of IPC measures are being met. We have also added more detail the Objective on page 4, lines 48 to 52: “The aim is to identify peer-reviewed publications reporting on patient satisfaction outcomes in the context of implemented IPC interventions, whether satisfaction was the primary focus or one of several factors examined, document the methods used to quantify patient satisfaction and to conduct a meta-analysis of reported satisfaction levels associated with specific IPC interventions where feasible. We have also added further to the Inclusion criteria section on page 5, lines 76 to 86: “The population, exposure, outcomes (PEO) tool for systematic reviewing in patients having undergone IPC interventions are outlined in Table 1. The population will include hospitalised patients in acute care hospitals. Exposures will encompass IPC interventions, either broadly or as specific strategies (e.g., isolation, cohorting, multidrug resistant organism screening/flagging, hand hygiene, antimicrobial stewardship, personal protective equipment use, visitor restrictions, IPC education/communication, and delays in transfer, discharge, or procedures). The outcome of interest will be patient satisfaction with IPC interventions, assessed via surveys or interviews. Comparator data (usual care or alternative IPC strategies) will be recorded when available but will not be required. No language or timeframe filters will be applied to ensure a comprehensive search when executing search strings. Reference lists of identified systematic reviews will also be screened.”

3. State an argument for why the association between IPC practices and patient satisfaction is worth investigating. Response: Thank you for this comment which we have addressed under point 1 . Specifically we have added further to the Introduction to strengthen the rationale for this systematic review on page 4, lines 17 to 26 “Patient-centred healthcare should incorporate the patient journey and help improve IPC services. Evaluating patients expectations and experiences are central to understanding the patient voice. Two frequently used approaches are patient experience and patient satisfaction. While often treated as interchangeable, they capture different aspects of care. Patient experience is a qualitative approached used to describes how patients perceived care received, offering deeper insights from the patient perspective. Patient satisfaction however measures how they rated their experience and provides a quantitative outcome to capture if their expectations were met offering a standardised and systematic comparison across settings when methods and tools are aligned. Distinguishing overall from service-specific satisfaction is key for healthcare quality.” 4. Introduction: mentioned the key points that refer to the systematic review 2017 for conducting this review. Response: Thank you for the helpful feedback. We have added further to the Introduction context specific to this 2017 systematic review on page 4, lines 26 to 30: “A systematic review conducted in 2017 into the determinants of patient satisfaction found that patient satisfaction is mainly underpinned by perceptions of health service quality characteristics however, results varied greatly. We are not aware of any systematic review of patient satisfaction in the context of IPC interventions “.

5. Is the use of JBI methodology appropriate for systematic reviews of etiology and risk? Can be added as a justification. Response: Thank you for this comment which was also raised by Reviewer 2 under point 4. We selected the JBI systematic review methodology for etiology and risk because our aim is to examine the association between IPC interventions (exposure) and patient satisfaction (outcome). This approach is recommended when synthesising evidence on how an intervention or practice influences outcomes across different settings, which aligns with the focus of our review. The JBI methodology was selected as it provides established, peer-reviewed guidance specifically for systematic reviews of etiology and risk. We have added this supporting text to the Methods on page 5, lines 58 to 61: “This systematic review will be conducted in accordance with the Joanna Briggs Institute (JBI) methodology for systematic reviews of aetiology and risk as it provides established, peer-reviewed guidance specifically for systematic reviews of etiology and risk and aligns with the study objectives” 6. Mention the clarification for excluding certain study types (e.g. qualitative) and their potential selection bias. Response: Qualitative studies offer valuable insights into patients’ perspectives on IPC. However, our review aimed to synthesise quantitative outcomes of patient satisfaction with IPC interventions, document measurement methods, and, where possible, conduct meta-analyses. This focus addresses a gap in the literature, as prior reviews examined satisfaction either generally or with single IPC measures, but not across interventions. We believe we have addressed this under points 1 and 3 above. Specifically, we have added further to the Introduction to strengthen the rationale for this systematic review on page 4, lines 17 to 26:: “Patient-centred healthcare should incorporate the patient journey and help improve IPC services. Evaluating patients expectations and experiences are central to understanding the patient voice. Two frequently used approaches are patient experience and patient satisfaction. While often treated as interchangeable, they capture different aspects of care. Patient experience is a qualitative approach used to describes how patients perceived care received, offering deeper insights from the patient perspective. Patient satisfaction however measures how they rated their experience and provides a quantitative outcome to capture if their expectations were met offering a standardised and systematic comparison across settings when methods and tools are aligned. Distinguishing overall from service-specific satisfaction is key for healthcare quality.” 7. The absence of MeSH term, language, or timeframe restrictions needs to be justified. Response: Thank you for this comment. All search terms, including the MeSH terms used are given in Appendix 1. We have added a justification to our methods about not filtering by language and timeframe on page 5, lines 84 to 86: “No language or timeframe filters will be applied to ensure a comprehensive search when executing…” Data collection and analysis 8. A plan for a standard definition/ measure process of patient satisfaction needs to be included. Response: Thank you to the reviewer for this helpful comment and agree that we should be clearer on the data extraction process. To do this we have added the following to the Data analysis of the Methods section on page 10, lines 170 to 171: “For each study, the number of satisfied patients were extracted according to authors specified definitions and thresholds, with no additional reclassification applied” 9. Checking duplicate data extraction for 20% of studies and its potential impact on data quality needs to be justified. Response: Thank you for highlighting this helpful point of clarification. Titles/abstracts and full-text screening were conducted in duplicate. For 20% of full texts, data extraction and assessment were also performed in duplicate, with any discrepancies resolved through discussion and, when necessary, arbitration by a third reviewer. Although no predefined discrepancy threshold was established, this process functioned as a quality assurance step to ensure consistency prior to proceeding with single extraction. To clarify we have added the following to our Methods on page 7, lines 137 to 140: “Any discrepancies will be resolved through discussion, with arbitration by a third reviewer when required. No predefined discrepancy threshold was established, as this procedure served primarily as a quality check to ensure consistency before proceeding with single data extraction” 10. Mention how the results of bias assessments will influence the overall analysis and how to address Response: Thank you for this feedback, which was also raised by Reviewer 2, point 10. We have addressed the topic of bias assessment in the section “Risk of bias in individual studies”. Since we first published this protocol, we have identified that the Manual for Evidence Synthesis by the JBI a more suitable quality appraisal tool for a diverse research topic. As such we have updated the Methodology and supporting reference (13) on page 10, lines 154 to 159: “The study design of each study will be determined and a critical appraisal of the paper performed by MS using the appropriate JBI checklist according to their manual for evidence synthesis. (13). A second member of the study group will complete this process in duplicate for the 20% of included studies.” New reference 13: Johanna Briggs Institute (JBI). Manual for Evidence Synthesis. Johanna Briggs Institute (JBI). 2024. [Available from: https://synthesismanual.jbi.global 11. Mention the reason for ‘at least five studies identified using similar patient satisfaction measures’ and reporting plan for less than five studies. Response: Thank you to the reviewer for pointing out this omission. We have now added a supporting reference (14) which discusses the suitable number of studies for inclusion in a meta-analysis on page10, line 168: “Data extracted will be summarised where possible and at least five studies identified using similar patient satisfaction measures. 14” New reference 14: Schriger DL, Altman DG, Vetter JA, et al. Forest plots in reports of systematic reviews: a cross-sectional study reviewing current practice. Int J Epidemiol. 2010;39(2):421-9. 12.Acknowledgment of potential limitations needs to be mentioned, e.g. varying definitions of IPC practices across studies/ subjectivity of patient satisfaction measures. Response: Thanks to Reviewer 1 for this feedback. We have added a Potential limitations subsection on page 11, lines 187 to 190 with the following text: “Potential limitations As data extraction and risk of bias assessment will not be conducted in full duplicate for all studies, there is a small potential for error or bias. This will be highlighted in the results and discussion of the systematic review.” COMMENTS ON THIS REPORT - Author Response 23 Sep 2025Mairead Skally, Department of Microbiology, Beaumont Hospital, Dublin, Ireland23 Sep 2025Author ResponseAbstract comments: 1. Adding a rationale for linking infection prevention and control (IPC) practices to patient satisfaction would be more comprehensive. Response: We thank Reviewer 1 for this feedback. We ... Continue reading Abstract comments: 1. Adding a rationale for linking infection prevention and control (IPC) practices to patient satisfaction would be more comprehensive. Response: We thank Reviewer 1 for this feedback. We have added our rationale to the Abstract as follows: “However, patient views and enabling patient and public involvement (PPI) in their development has been minimal.” We have added further to the Introduction to strengthen the rationale for this systematic review on page 3, lines 17 to 26: “Patient-centred healthcare should incorporate the patient journey and help improve IPC services. Evaluating patients expectations and experiences are central to understanding the patient voice. Two frequently used approaches are patient experience and patient satisfaction. While often treated as interchangeable, they capture different aspects of care. Patient experience is a qualitative approached used to describes how a patient perceives the care that they received, offering deeper insights from the patient perspective. Patient satisfaction however measures how they rated their experience and provides a quantitative outcome to capture if their expectations were met. Patient satisfaction can therefore provide a standardised and systematic comparison across settings when methods and tools are aligned. Distinguishing overall from service-specific satisfaction is key for healthcare quality.” 2. Need to mention the explore area: Patient satisfaction with infection prevention control practices – of whom – self, healthcare worker, HCF? Response: Thank you to the reviewer for this feedback. To address this question and avoid uncertainty, we have replaced the term ‘IPC practices’ to that of ‘IPC interventions’ throughout the manuscript. To address the specific point here we have updated the Abstract:’ “Previous systematic reviews have focused or either overall patient satisfaction or specific IPC interventions , however none have addressed patient satisfaction in the context of IPC interventions.” And to the Introduction on page 4, lines 38 to 43: “Previous systematic reviews have focused or either overall patient satisfaction, which found that the potential determinants of patient satisfaction varied across studies and was determined by perceptions of health service quality, or specific IPC interventions. None have addressed the association of IPC with patient satisfaction . To date, it remains unclear whether patients’ expectations of IPC measures are being met. We have also added more detail the Objective on page 4, lines 48 to 52: “The aim is to identify peer-reviewed publications reporting on patient satisfaction outcomes in the context of implemented IPC interventions, whether satisfaction was the primary focus or one of several factors examined, document the methods used to quantify patient satisfaction and to conduct a meta-analysis of reported satisfaction levels associated with specific IPC interventions where feasible. We have also added further to the Inclusion criteria section on page 5, lines 76 to 86: “The population, exposure, outcomes (PEO) tool for systematic reviewing in patients having undergone IPC interventions are outlined in Table 1. The population will include hospitalised patients in acute care hospitals. Exposures will encompass IPC interventions, either broadly or as specific strategies (e.g., isolation, cohorting, multidrug resistant organism screening/flagging, hand hygiene, antimicrobial stewardship, personal protective equipment use, visitor restrictions, IPC education/communication, and delays in transfer, discharge, or procedures). The outcome of interest will be patient satisfaction with IPC interventions, assessed via surveys or interviews. Comparator data (usual care or alternative IPC strategies) will be recorded when available but will not be required. No language or timeframe filters will be applied to ensure a comprehensive search when executing search strings. Reference lists of identified systematic reviews will also be screened.”

3. State an argument for why the association between IPC practices and patient satisfaction is worth investigating. Response: Thank you for this comment which we have addressed under point 1 . Specifically we have added further to the Introduction to strengthen the rationale for this systematic review on page 4, lines 17 to 26 “Patient-centred healthcare should incorporate the patient journey and help improve IPC services. Evaluating patients expectations and experiences are central to understanding the patient voice. Two frequently used approaches are patient experience and patient satisfaction. While often treated as interchangeable, they capture different aspects of care. Patient experience is a qualitative approached used to describes how patients perceived care received, offering deeper insights from the patient perspective. Patient satisfaction however measures how they rated their experience and provides a quantitative outcome to capture if their expectations were met offering a standardised and systematic comparison across settings when methods and tools are aligned. Distinguishing overall from service-specific satisfaction is key for healthcare quality.” 4. Introduction: mentioned the key points that refer to the systematic review 2017 for conducting this review. Response: Thank you for the helpful feedback. We have added further to the Introduction context specific to this 2017 systematic review on page 4, lines 26 to 30: “A systematic review conducted in 2017 into the determinants of patient satisfaction found that patient satisfaction is mainly underpinned by perceptions of health service quality characteristics however, results varied greatly. We are not aware of any systematic review of patient satisfaction in the context of IPC interventions “.

5. Is the use of JBI methodology appropriate for systematic reviews of etiology and risk? Can be added as a justification. Response: Thank you for this comment which was also raised by Reviewer 2 under point 4. We selected the JBI systematic review methodology for etiology and risk because our aim is to examine the association between IPC interventions (exposure) and patient satisfaction (outcome). This approach is recommended when synthesising evidence on how an intervention or practice influences outcomes across different settings, which aligns with the focus of our review. The JBI methodology was selected as it provides established, peer-reviewed guidance specifically for systematic reviews of etiology and risk. We have added this supporting text to the Methods on page 5, lines 58 to 61: “This systematic review will be conducted in accordance with the Joanna Briggs Institute (JBI) methodology for systematic reviews of aetiology and risk as it provides established, peer-reviewed guidance specifically for systematic reviews of etiology and risk and aligns with the study objectives” 6. Mention the clarification for excluding certain study types (e.g. qualitative) and their potential selection bias. Response: Qualitative studies offer valuable insights into patients’ perspectives on IPC. However, our review aimed to synthesise quantitative outcomes of patient satisfaction with IPC interventions, document measurement methods, and, where possible, conduct meta-analyses. This focus addresses a gap in the literature, as prior reviews examined satisfaction either generally or with single IPC measures, but not across interventions. We believe we have addressed this under points 1 and 3 above. Specifically, we have added further to the Introduction to strengthen the rationale for this systematic review on page 4, lines 17 to 26:: “Patient-centred healthcare should incorporate the patient journey and help improve IPC services. Evaluating patients expectations and experiences are central to understanding the patient voice. Two frequently used approaches are patient experience and patient satisfaction. While often treated as interchangeable, they capture different aspects of care. Patient experience is a qualitative approach used to describes how patients perceived care received, offering deeper insights from the patient perspective. Patient satisfaction however measures how they rated their experience and provides a quantitative outcome to capture if their expectations were met offering a standardised and systematic comparison across settings when methods and tools are aligned. Distinguishing overall from service-specific satisfaction is key for healthcare quality.” 7. The absence of MeSH term, language, or timeframe restrictions needs to be justified. Response: Thank you for this comment. All search terms, including the MeSH terms used are given in Appendix 1. We have added a justification to our methods about not filtering by language and timeframe on page 5, lines 84 to 86: “No language or timeframe filters will be applied to ensure a comprehensive search when executing…” Data collection and analysis 8. A plan for a standard definition/ measure process of patient satisfaction needs to be included. Response: Thank you to the reviewer for this helpful comment and agree that we should be clearer on the data extraction process. To do this we have added the following to the Data analysis of the Methods section on page 10, lines 170 to 171: “For each study, the number of satisfied patients were extracted according to authors specified definitions and thresholds, with no additional reclassification applied” 9. Checking duplicate data extraction for 20% of studies and its potential impact on data quality needs to be justified. Response: Thank you for highlighting this helpful point of clarification. Titles/abstracts and full-text screening were conducted in duplicate. For 20% of full texts, data extraction and assessment were also performed in duplicate, with any discrepancies resolved through discussion and, when necessary, arbitration by a third reviewer. Although no predefined discrepancy threshold was established, this process functioned as a quality assurance step to ensure consistency prior to proceeding with single extraction. To clarify we have added the following to our Methods on page 7, lines 137 to 140: “Any discrepancies will be resolved through discussion, with arbitration by a third reviewer when required. No predefined discrepancy threshold was established, as this procedure served primarily as a quality check to ensure consistency before proceeding with single data extraction” 10. Mention how the results of bias assessments will influence the overall analysis and how to address Response: Thank you for this feedback, which was also raised by Reviewer 2, point 10. We have addressed the topic of bias assessment in the section “Risk of bias in individual studies”. Since we first published this protocol, we have identified that the Manual for Evidence Synthesis by the JBI a more suitable quality appraisal tool for a diverse research topic. As such we have updated the Methodology and supporting reference (13) on page 10, lines 154 to 159: “The study design of each study will be determined and a critical appraisal of the paper performed by MS using the appropriate JBI checklist according to their manual for evidence synthesis. (13). A second member of the study group will complete this process in duplicate for the 20% of included studies.” New reference 13: Johanna Briggs Institute (JBI). Manual for Evidence Synthesis. Johanna Briggs Institute (JBI). 2024. [Available from: https://synthesismanual.jbi.global 11. Mention the reason for ‘at least five studies identified using similar patient satisfaction measures’ and reporting plan for less than five studies. Response: Thank you to the reviewer for pointing out this omission. We have now added a supporting reference (14) which discusses the suitable number of studies for inclusion in a meta-analysis on page10, line 168: “Data extracted will be summarised where possible and at least five studies identified using similar patient satisfaction measures. 14” New reference 14: Schriger DL, Altman DG, Vetter JA, et al. Forest plots in reports of systematic reviews: a cross-sectional study reviewing current practice. Int J Epidemiol. 2010;39(2):421-9. 12.Acknowledgment of potential limitations needs to be mentioned, e.g. varying definitions of IPC practices across studies/ subjectivity of patient satisfaction measures. Response: Thanks to Reviewer 1 for this feedback. We have added a Potential limitations subsection on page 11, lines 187 to 190 with the following text: “Potential limitations As data extraction and risk of bias assessment will not be conducted in full duplicate for all studies, there is a small potential for error or bias. This will be highlighted in the results and discussion of the systematic review.”Abstract comments:Competing Interests: No competing interests were disclosed. Close 1. Adding a rationale for linking infection prevention and control (IPC) practices to patient satisfaction would be more comprehensive. Response: We thank Reviewer 1 for this feedback. We have added our rationale to the Abstract as follows: “However, patient views and enabling patient and public involvement (PPI) in their development has been minimal.” We have added further to the Introduction to strengthen the rationale for this systematic review on page 3, lines 17 to 26: “Patient-centred healthcare should incorporate the patient journey and help improve IPC services. Evaluating patients expectations and experiences are central to understanding the patient voice. Two frequently used approaches are patient experience and patient satisfaction. While often treated as interchangeable, they capture different aspects of care. Patient experience is a qualitative approached used to describes how a patient perceives the care that they received, offering deeper insights from the patient perspective. Patient satisfaction however measures how they rated their experience and provides a quantitative outcome to capture if their expectations were met. Patient satisfaction can therefore provide a standardised and systematic comparison across settings when methods and tools are aligned. Distinguishing overall from service-specific satisfaction is key for healthcare quality.” 2. Need to mention the explore area: Patient satisfaction with infection prevention control practices – of whom – self, healthcare worker, HCF? Response: Thank you to the reviewer for this feedback. To address this question and avoid uncertainty, we have replaced the term ‘IPC practices’ to that of ‘IPC interventions’ throughout the manuscript. To address the specific point here we have updated the Abstract:’ “Previous systematic reviews have focused or either overall patient satisfaction or specific IPC interventions , however none have addressed patient satisfaction in the context of IPC interventions.” And to the Introduction on page 4, lines 38 to 43: “Previous systematic reviews have focused or either overall patient satisfaction, which found that the potential determinants of patient satisfaction varied across studies and was determined by perceptions of health service quality, or specific IPC interventions. None have addressed the association of IPC with patient satisfaction . To date, it remains unclear whether patients’ expectations of IPC measures are being met. We have also added more detail the Objective on page 4, lines 48 to 52: “The aim is to identify peer-reviewed publications reporting on patient satisfaction outcomes in the context of implemented IPC interventions, whether satisfaction was the primary focus or one of several factors examined, document the methods used to quantify patient satisfaction and to conduct a meta-analysis of reported satisfaction levels associated with specific IPC interventions where feasible. We have also added further to the Inclusion criteria section on page 5, lines 76 to 86: “The population, exposure, outcomes (PEO) tool for systematic reviewing in patients having undergone IPC interventions are outlined in Table 1. The population will include hospitalised patients in acute care hospitals. Exposures will encompass IPC interventions, either broadly or as specific strategies (e.g., isolation, cohorting, multidrug resistant organism screening/flagging, hand hygiene, antimicrobial stewardship, personal protective equipment use, visitor restrictions, IPC education/communication, and delays in transfer, discharge, or procedures). The outcome of interest will be patient satisfaction with IPC interventions, assessed via surveys or interviews. Comparator data (usual care or alternative IPC strategies) will be recorded when available but will not be required. No language or timeframe filters will be applied to ensure a comprehensive search when executing search strings. Reference lists of identified systematic reviews will also be screened.”

3. State an argument for why the association between IPC practices and patient satisfaction is worth investigating. Response: Thank you for this comment which we have addressed under point 1 . Specifically we have added further to the Introduction to strengthen the rationale for this systematic review on page 4, lines 17 to 26 “Patient-centred healthcare should incorporate the patient journey and help improve IPC services. Evaluating patients expectations and experiences are central to understanding the patient voice. Two frequently used approaches are patient experience and patient satisfaction. While often treated as interchangeable, they capture different aspects of care. Patient experience is a qualitative approached used to describes how patients perceived care received, offering deeper insights from the patient perspective. Patient satisfaction however measures how they rated their experience and provides a quantitative outcome to capture if their expectations were met offering a standardised and systematic comparison across settings when methods and tools are aligned. Distinguishing overall from service-specific satisfaction is key for healthcare quality.” 4. Introduction: mentioned the key points that refer to the systematic review 2017 for conducting this review. Response: Thank you for the helpful feedback. We have added further to the Introduction context specific to this 2017 systematic review on page 4, lines 26 to 30: “A systematic review conducted in 2017 into the determinants of patient satisfaction found that patient satisfaction is mainly underpinned by perceptions of health service quality characteristics however, results varied greatly. We are not aware of any systematic review of patient satisfaction in the context of IPC interventions “.

5. Is the use of JBI methodology appropriate for systematic reviews of etiology and risk? Can be added as a justification. Response: Thank you for this comment which was also raised by Reviewer 2 under point 4. We selected the JBI systematic review methodology for etiology and risk because our aim is to examine the association between IPC interventions (exposure) and patient satisfaction (outcome). This approach is recommended when synthesising evidence on how an intervention or practice influences outcomes across different settings, which aligns with the focus of our review. The JBI methodology was selected as it provides established, peer-reviewed guidance specifically for systematic reviews of etiology and risk. We have added this supporting text to the Methods on page 5, lines 58 to 61: “This systematic review will be conducted in accordance with the Joanna Briggs Institute (JBI) methodology for systematic reviews of aetiology and risk as it provides established, peer-reviewed guidance specifically for systematic reviews of etiology and risk and aligns with the study objectives” 6. Mention the clarification for excluding certain study types (e.g. qualitative) and their potential selection bias. Response: Qualitative studies offer valuable insights into patients’ perspectives on IPC. However, our review aimed to synthesise quantitative outcomes of patient satisfaction with IPC interventions, document measurement methods, and, where possible, conduct meta-analyses. This focus addresses a gap in the literature, as prior reviews examined satisfaction either generally or with single IPC measures, but not across interventions. We believe we have addressed this under points 1 and 3 above. Specifically, we have added further to the Introduction to strengthen the rationale for this systematic review on page 4, lines 17 to 26:: “Patient-centred healthcare should incorporate the patient journey and help improve IPC services. Evaluating patients expectations and experiences are central to understanding the patient voice. Two frequently used approaches are patient experience and patient satisfaction. While often treated as interchangeable, they capture different aspects of care. Patient experience is a qualitative approach used to describes how patients perceived care received, offering deeper insights from the patient perspective. Patient satisfaction however measures how they rated their experience and provides a quantitative outcome to capture if their expectations were met offering a standardised and systematic comparison across settings when methods and tools are aligned. Distinguishing overall from service-specific satisfaction is key for healthcare quality.” 7. The absence of MeSH term, language, or timeframe restrictions needs to be justified. Response: Thank you for this comment. All search terms, including the MeSH terms used are given in Appendix 1. We have added a justification to our methods about not filtering by language and timeframe on page 5, lines 84 to 86: “No language or timeframe filters will be applied to ensure a comprehensive search when executing…” Data collection and analysis 8. A plan for a standard definition/ measure process of patient satisfaction needs to be included. Response: Thank you to the reviewer for this helpful comment and agree that we should be clearer on the data extraction process. To do this we have added the following to the Data analysis of the Methods section on page 10, lines 170 to 171: “For each study, the number of satisfied patients were extracted according to authors specified definitions and thresholds, with no additional reclassification applied” 9. Checking duplicate data extraction for 20% of studies and its potential impact on data quality needs to be justified. Response: Thank you for highlighting this helpful point of clarification. Titles/abstracts and full-text screening were conducted in duplicate. For 20% of full texts, data extraction and assessment were also performed in duplicate, with any discrepancies resolved through discussion and, when necessary, arbitration by a third reviewer. Although no predefined discrepancy threshold was established, this process functioned as a quality assurance step to ensure consistency prior to proceeding with single extraction. To clarify we have added the following to our Methods on page 7, lines 137 to 140: “Any discrepancies will be resolved through discussion, with arbitration by a third reviewer when required. No predefined discrepancy threshold was established, as this procedure served primarily as a quality check to ensure consistency before proceeding with single data extraction” 10. Mention how the results of bias assessments will influence the overall analysis and how to address Response: Thank you for this feedback, which was also raised by Reviewer 2, point 10. We have addressed the topic of bias assessment in the section “Risk of bias in individual studies”. Since we first published this protocol, we have identified that the Manual for Evidence Synthesis by the JBI a more suitable quality appraisal tool for a diverse research topic. As such we have updated the Methodology and supporting reference (13) on page 10, lines 154 to 159: “The study design of each study will be determined and a critical appraisal of the paper performed by MS using the appropriate JBI checklist according to their manual for evidence synthesis. (13). A second member of the study group will complete this process in duplicate for the 20% of included studies.” New reference 13: Johanna Briggs Institute (JBI). Manual for Evidence Synthesis. Johanna Briggs Institute (JBI). 2024. [Available from: https://synthesismanual.jbi.global 11. Mention the reason for ‘at least five studies identified using similar patient satisfaction measures’ and reporting plan for less than five studies. Response: Thank you to the reviewer for pointing out this omission. We have now added a supporting reference (14) which discusses the suitable number of studies for inclusion in a meta-analysis on page10, line 168: “Data extracted will be summarised where possible and at least five studies identified using similar patient satisfaction measures. 14” New reference 14: Schriger DL, Altman DG, Vetter JA, et al. Forest plots in reports of systematic reviews: a cross-sectional study reviewing current practice. Int J Epidemiol. 2010;39(2):421-9. 12.Acknowledgment of potential limitations needs to be mentioned, e.g. varying definitions of IPC practices across studies/ subjectivity of patient satisfaction measures. Response: Thanks to Reviewer 1 for this feedback. We have added a Potential limitations subsection on page 11, lines 187 to 190 with the following text: “Potential limitations As data extraction and risk of bias assessment will not be conducted in full duplicate for all studies, there is a small potential for error or bias. This will be highlighted in the results and discussion of the systematic review.” Alongside their report, reviewers assign a status to the article: - Approved - Approved with reservations - Not approved | Invited Reviewers | || |---|---|---| | 1 | 2 | | | Version 2 (revision) 23 Sep 25 | read | | | Version 1 26 Sep 24 | read | read | Sign up for content alerts You are now signed up to receive this alert Alongside their report, reviewers assign a status to the article: Approved - the paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations - A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. 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