PONE-D-23-16216Magnitude of Standard Precautions Practices among Healthcare Workers in Health Facilities of Low and Middle Income Countries: A Systematic Review and Meta-analysis.PLOS ONE

Dear Mengistu Yilma,

Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process. Below, I have summarised the key comments by the reviewers that must be addressed. Any additional comment here must be addressed, in addition to those stated by the reviewers.

Abstract

• Consider merging lines 12-14 as both appear to say the same thing. Provide a succinct context for the study by including burden and impact of healthcare-associated infections and the challenges of implementing standard precautions in LMICs.
• The methods section should briefly describe the inclusion criteria, and statistical methods used for the meta-analysis.
• The conclusion section should highlight the implications and significance of the findings. It should avoid repeating the results.
• Report on the confidence intervals of the pooled prevalence in the abstract.

 Introduction

• Please describe the rationale for the review in the context of existing knowledge. This may involve summarising key studies carried out in the area and establish gap in evidence in support of the current study. Refer to PRISMA checklist point 3.

Methods

• Please address this comment by reviewer 1 ‘the authors' approach to searching for articles leaves room for evidence/article selection bias. Additional searches for both published and grey literature should have been done. Mention Google scholar as part of the sites searched for additional literature’. I would like to add that if Google scholar was searched, then that becomes your source of grey literature search.
• Line 86-88, the authors wrote ‘We systematically searched articles from PubMed Central, EMBASE, MEDLINE, Global Health, African Journals Online (AJOL), and Google Scholar. However, the Figure (PRISMA) shows search results for only PubMed. Please clarify this inconsistency.
• From line 88 – the authors discussed study selection and management of data retrieved. This section may be the wrong section to discuss managing retrieved data as no search has been done. I suggest having a separate heading after the search strategy and writing out how the total retrieved search results was managed.
• Please clarify whether reviewers who screened each record worked independently. The authors mentioned that disagreements were resolved by a third author. Clarify this process – was it a discussion, a consensus meeting, or another method?
• Lines 166-161 -More details on the data extraction process would be beneficial. For instance, explain if a standardized form was used for data extraction and how discrepancies between extractors were resolved.
• Please comment on the criteria and justification for conducting the subgroup analysis by publication year, types of IPC practices, study setting, profession, and sampling technique, and the significance and relevance of the findings from each subgroup.
• Line 150: It’s not clear what you mean by poor quality score.

Discussion

• The authors did not report how the review findings compare with other relevant evidence from previous reviews or primary studies. Please refer to  PRISMA guideline 23a

Please submit your revised manuscript by 22nd January, 2024 . If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org. When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file.

Please include the following items when submitting your revised manuscript:

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• An unmarked version of your revised paper without tracked changes. You should upload this as a separate file labeled 'Manuscript'.

If you would like to make changes to your financial disclosure, please include your updated statement in your cover letter. Guidelines for resubmitting your figure files are available below the reviewer comments at the end of this letter.

If applicable, we recommend that you deposit your laboratory protocols in protocols.io to enhance the reproducibility of your results. Protocols.io assigns your protocol its own identifier (DOI) so that it can be cited independently in the future. For instructions see: https://journals.plos.org/plosone/s/submission-guidelines#loc-laboratory-protocols. Additionally, PLOS ONE offers an option for publishing peer-reviewed Lab Protocol articles, which describe protocols hosted on protocols.io. Read more information on sharing protocols at https://plos.org/protocols?utm_medium=editorial-email&utm_source=authorletters&utm_campaign=protocols.

We look forward to receiving your revised manuscript.

Kind regards,

Isaac Amankwaa, Ph.D.

Guest Editor

PLOS ONE

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When submitting your revision, we need you to address these additional requirements.

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3. We noticed you have some minor occurrence of overlapping text with the following previous publication(s), which needs to be addressed:

https://aricjournal.biomedcentral.com/articles/10.1186/s13756-020-00801-x

https://journals.plos.org/plosone/article?id=10.1371%2Fjournal.pone.0245469

https://linkinghub.elsevier.com/retrieve/pii/S2213398420302104

4. In your revision ensure you cite all your sources (including your own works), and quote or rephrase any duplicated text outside the methods section. Further consideration is dependent on these concerns being addressed.

5. Please include a separate caption for each figure in your manuscript.

6. In your Data Availability statement, you have not specified where the minimal data set underlying the results described in your manuscript can be found. PLOS defines a study's minimal data set as the underlying data used to reach the conclusions drawn in the manuscript and any additional data required to replicate the reported study findings in their entirety. All PLOS journals require that the minimal data set be made fully available. For more information about our data policy, please see http://journals.plos.org/plosone/s/data-availability.

"Upon re-submitting your revised manuscript, please upload your study’s minimal underlying data set as either Supporting Information files or to a stable, public repository and include the relevant URLs, DOIs, or accession numbers within your revised cover letter. For a list of acceptable repositories, please see http://journals.plos.org/plosone/s/data-availability#loc-recommended-repositories. Any potentially identifying patient information must be fully anonymized.

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We will update your Data Availability statement to reflect the information you provide in your cover letter.

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Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented.

Reviewer #1: Yes

Reviewer #2: Yes

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2. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: Yes

Reviewer #2: Yes

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3. Have the authors made all data underlying the findings in their manuscript fully available?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #1: Yes

Reviewer #2: Yes

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4. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #1: Yes

Reviewer #2: Yes

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5. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #1: Thank you for the opportunity to review this manuscript. Generally, the problem and the justification for this study is not well articulated in the background. The methods that guided the conduct of the systematic review is not reportedwith sufficient detail and transparency. My main comments are appended below.

Abstract:

Introduction- the introduction in the abstract should capture the problem and the gap identified in the literature. You may delete some of the general background information already provided with the problem and the gap.

Results: The results should also capture some of the main findings of the study (in accordance with the objectives of this review).

Main manuscript.

Introduction-

1. Please use a box bracket instead to enclose the intext citation.

2. The problem is not well stated. The authors need to further look at the introduction again. The introduction should clearly establish the problem, context and significance.

3. Line 76:........ The paucity of evidence about the current subject............ this statement is incorrect and only shows you did not do a good review of the literature. the outbreak of COVID-19, Ebola, Flu has drawn more attention to infection prevention practices leading to increased research and publication in this area. In 2023 alone, hundreds of articles have been published various components of infection prevention.

4. In the concluding part of your revised introduction, it should capture the implication of your study on healthcare policies.

Methods

5. Line 88: Google scholar is not considered as a major database.

6. the authors' approach to searching for articles leaves room for evidence/article selection bias. Additional searches for both published and grey literature should have been done. Mention Google scholar as part of the sites searched for additional literature.

7. Reference list of included articles should have been used as snowball. Hand searches and consultation with experts /personal correspondence should have been mentioned.

8. How many reviewers conducted the electronic search for articles and on which day did you begin and when was the final searches completed?

9. I stand to be corrected but i doubt if you adhered to the reported items outlined in PRISMA.

10. How were duplicates removed?

Search Strategy

11. Line 105-128: I doubt if PubMed will understand the search language and give you accurate and precise search outcome. When two words are combined together as infection prevention or infection control, quotation marks are used ("infection prevention") to communicate to PubMed that it is one word.

Inclusion

12. Be specific with the study design type. you mentioned observational studies, were case studies and qualitative research articles included? Please clarify.

13. the publication year should be indicated in the inclusion : for instance, articles published within the 10 years from 2013 to 2023.

14. Line 150: Its not clear what you mean by poor quality score.

15. line 157: Statement is unclear.

Results

16. Line 183-188: Its unthinkable and unrealistic how 112 articles were retrieved from EMBASE, MEDLINE, Global Health, AJOL and Google scholar. I can emphatically say you only searched PubMed and Google scholar.

17. Page 12: Provide a legend for the table and state the abbreviations in full.

18. Fig 1: PRISMA flow diagram: it is unclear how the authors arrived at the 429 articles from the 8016 remaining articles.

19. Discuss the limitations with the few databases used, purposive inclusion criteria used and the limits placed on language of published articles.

Reviewer #2: Many thanks for the opportunity to review this manuscript. I would like to thank the authors for the time and effort that went into the preparation of the manuscript. I have a few comments for the authors;

1. Line 54-line 58--I believe these two statements could be put together into a single concise statement. At the moment they appear unwieldy and have a few repetitions.

2. Line 64-line 65--"In recent years, more attention has been given to IPC practices in health care facilities as a result of the occurrence of new and emerging health problems". This is a claim that was not supported. What is the evidence that more attention has been given to IPC practices in recent years?

3. Line 67-line 70--According to the report from the Organization for Economic Co-operation and Development (OECD), it is

estimated that promoting simple IPC measures such as hand hygiene could reduce the AMR burden by about 40%.

What OECD report is this? The authors need to provide a citation for this report

4. Line 72-75--Healthcare associated infections are the major concern worldwide for the health systems.

This statement sounds as if this is the only 'major' issue plaguing health care systems. However, this is not necessarily true. What about the rising incidence of non-communicable diseases in LMICs? What about the challenges associated with Universal Health Coverage? It is probably fair to say it is AMONG the issues but not THE MAJOR issue. The same applies to the statement that follows--- "Ebola, MERS, COVID-19, and monkey pox are the major concerns that have imposed an additional burden on the health system in recent years".

While these are among the plethora of challenges that affect healthcare systems, they are not the only ones.

5. In line 75-76, the authors wrote "In addition to the aforementioned situations, the

paucity of evidence about the current subject drove the initiation of this meta-analysis"----The problem is not well established here. What shows that there is a paucity of research on this issue? The authors should have teased out the problem in a better way. For example, there may be single studies in LMICs but these are scattered and not pulled together for evidence purposes etc. I feel the problem or question should be framed in such a way that it will inform the need for a systematic review in this area. As it stands, we only have a piecemeal presentation of the main research issue and why it is worth using a systematic review.

6. Discussion section--In general, the discussion section is very lame. What do these findings mean in the light of infection control in LMICs? What are the implications for healthcare practice, research and policy? A great number of studies were conducted in Nigeria—how does this impact your interpretation (although the authors talked briefly about Ethiopia)? The authors should use published research to explain and discuss the trends in prevalence of infections and how this should inform the evidence scenario for HAIs in low resource settings moving forward.

7. There are so many repetitions in the manuscript. For example, under the subsection "Meta-analysis for IPC practices among healthcare workers"--there are so many repetitions there. The authors should check for other statements that are repeated throughout the manuscript. e.g. This systematic review and meta-analysis included 46 papers in total.

8. The article should be edited for grammatical errors. There are so many editorial mistakes in the manuscript. The authors should take some time to read through the document critically and get them corrected.

9. The first statement in the discussion section refers to a CDC document. What document is this? A citation is needed there

10. The conclusion section should present a succinct summary of the findings as well as the key lessons, implications or recommendations regarding how this evidence informs infection control practices and policies for healthcare workers, patients etc

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6. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files.

If you choose “no”, your identity will remain anonymous but your review may still be made public.

Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy.

Reviewer #1: No

Reviewer #2: No

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PONE-D-23-16216R1Magnitude of Standard Precautions Practices among Healthcare Workers in Health Facilities of Low and Middle Income Countries: A Systematic Review and Meta-analysis.PLOS ONE

Dear Dr. Dilnessie,

Thank you for submitting your manuscript to PLOS ONE. First and foremost, I want to express my appreciation for the revisions made. Your work contributes significantly to the field, and we commend your efforts.

However, upon careful examination, there are a few points that require further clarification and attention to ensure transparency, rigor, and accurate reporting. I would like to highlight these aspects:

1. PubMed Database Screening and Rayyan Process:
   • In your manuscript, you mentioned that 317 articles were selected from PubMed Central based on your search strategy. However, the PRISMA flow chart indicates an initial identification of 8,115 records through PubMed database screening.
   • Could you kindly elaborate on the primary screening process on PubMed pages? Specifically, why was this step performed before using Rayyan for further selection?
   • Additionally, how were the 211 possible duplicates identified by the Rayyan system resolved? Were they excluded during the PubMed screening or at a later stage?
2. “Other Sources” and Database Clarity:
   • From the PRISMA Flow Chart, you state that PubMed was the sole database used in this systematic review.
   • However, you also mention retrieving 112 studies from other sources. It remains unclear whether these “other sources” refer to databases such as EMBASE, MEDLINE, Global Health, African Journals Online (AJOL), and Google Scholar.
   • To enhance transparency, could you explicitly clarify which databases fall under the category of “other sources”? If these databases include EMBASE, MEDLINE, and others, it would be essential to explain why this selection was made.
3. Statistical Analysis Review:
   • We engaged a statistician to review your statistical analysis. While your work is commendable, there are concerns raised by the reviewer.
   • We kindly request that you address these concerns in your manuscript to ensure the robustness of your findings.

Given the importance of transparency and rigor in systematic reviews, we believe that addressing these points will strengthen your work.

Please submit your revised manuscript by Mar 31 2024 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org. When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file.

Please include the following items when submitting your revised manuscript:

• A rebuttal letter that responds to each point raised by the academic editor and reviewer(s). You should upload this letter as a separate file labeled 'Response to Reviewers'.
• A marked-up copy of your manuscript that highlights changes made to the original version. You should upload this as a separate file labeled 'Revised Manuscript with Track Changes'.
• An unmarked version of your revised paper without tracked changes. You should upload this as a separate file labeled 'Manuscript'.

If you would like to make changes to your financial disclosure, please include your updated statement in your cover letter. Guidelines for resubmitting your figure files are available below the reviewer comments at the end of this letter.

If applicable, we recommend that you deposit your laboratory protocols in protocols.io to enhance the reproducibility of your results. Protocols.io assigns your protocol its own identifier (DOI) so that it can be cited independently in the future. For instructions see: https://journals.plos.org/plosone/s/submission-guidelines#loc-laboratory-protocols. Additionally, PLOS ONE offers an option for publishing peer-reviewed Lab Protocol articles, which describe protocols hosted on protocols.io. Read more information on sharing protocols at https://plos.org/protocols?utm_medium=editorial-email&utm_source=authorletters&utm_campaign=protocols.

We look forward to receiving your revised manuscript.

Kind regards,

Isaac Amankwaa, Ph.D.

Guest Editor

PLOS ONE

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Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. If the authors have adequately addressed your comments raised in a previous round of review and you feel that this manuscript is now acceptable for publication, you may indicate that here to bypass the “Comments to the Author” section, enter your conflict of interest statement in the “Confidential to Editor” section, and submit your "Accept" recommendation.

Reviewer #3: (No Response)

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2. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented.

Reviewer #3: Yes

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3. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #3: N/A

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4. Have the authors made all data underlying the findings in their manuscript fully available?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #3: Yes

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5. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #3: Yes

**********

6. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #3: In this paper the authors performed a systematic review and meta-analysis of the prevalence of standard precautions practices among healthcare works in heath facilities of low- and middle-income countries. The final analysis included 46 articles and between study heterogeneity was observed. A pooled prevalence of 53.05% was reported.

I have a few questions/comments specific to the meta-analysis as listed below.

Was a data transformation used in the meta-analysis? As specified below, the values in several plots did not appear to be based on prevalence directly. Maybe a transformation was applied?

Table 1. Add a column of prevalence so that all the information is together.

Table 2. It says log(prevalence) in the column header, but shouldn’t all values be <0 since prevalence cannot be bigger than 1? Why a log-transformation is used?

Table 3. Please give a more detail description of the sample techniques in “others” group. The same comment applies to the “Others” group for Study Design.

Figure 3. What is ”b” in the plot? A transformation of the prevalence?

Figure 4. Again, what is the estimate? A transformation of the prevalence?

Figure 7. Funnel plot: Was Log(prevalence) shown on the x-axis? Shouldn’t all the values be <0 since prevalence is between 0 and 1.

It is worth delving deeper into the causes of heterogeneity. Over half of the studies were in Ethiopia. Does restricting studies to Ethiopia-only alleviate the heterogeneity? Can any factor explain the heterogeneity?

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7. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files.

If you choose “no”, your identity will remain anonymous but your review may still be made public.

Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy.

Reviewer #3: No

**********

[NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". If this link does not appear, there are no attachment files.]

While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, https://pacev2.apexcovantage.com/. PACE helps ensure that figures meet PLOS requirements. To use PACE, you must first register as a user. Registration is free. Then, login and navigate to the UPLOAD tab, where you will find detailed instructions on how to use the tool. If you encounter any issues or have any questions when using PACE, please email PLOS at figures@plos.org. Please note that Supporting Information files do not need this step.

PONE-D-23-16216R2 NoteMagnitude of Standard Precautions Practices among Healthcare Workers in Health Facilities of Low and Middle Income Countries: A Systematic Review and Meta-analysis.

PLOS ONE

Dear Dr. Dilnessie,

Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process. 

I have reviewed your response to my comment on the databases used for this review. Your response indicates that you relied on only one database. I find this a significant limitation of the systematic review, particularly in terms of the scope of data source Note s and inclusivity criteria. To move this paper to the next level, I will encourage you to address these issues:

1. Use of a Single Database: The current limitations statement acknowledges the use of purposive inclusion criteria and the language of included studies. However, it does not sufficiently address the significant limitation stemming from the utilization of only one database for your literature search. Please expand on this point by discussing the potential impact of this limitation on the comprehensiveness of your review and the generalizability of your findings.
2. Access to Databases and Language Restrictions: The brief mention of limited access to databases and the language of included studies warrants further elaboration. It is crucial to explicitly state how these factors might have influenced the selection of studies and the potential biases introduced as a result.
3. Please address the comment by reviewer 3 on the meta-analysis approach used for this review.

Please ensure that each of these points is addressed comprehensively to provide readers with a clear understanding of the scope and potential limitations of your review. This will not only strengthen the credibility of your study but also offer valuable insights for future research in this area.

Please submit your revised manuscript by Apr 11 2024 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org. When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file.

Please include the following items when submitting your revised manuscript:

• A rebuttal letter that responds to each point raised by the academic editor and reviewer(s). You should upload this letter as a separate file labeled 'Response to Reviewers'.
• A marked-up copy of your manuscript that highlights changes made to the original version. You should upload this as a separate file labeled 'Revised Manuscript with Track Changes'.
• An unmarked version of your revised paper without tracked changes. You should upload this as a separate file labeled 'Manuscript'.

If you would like to make changes to your financial disclosure, please include your updated statement in your cover letter. Guidelines for resubmitting your figure files are available below the reviewer comments at the end of this letter.

If applicable, we recommend that you deposit your laboratory protocols in protocols.io to enhance the reproducibility of your results. Protocols.io assigns your protocol its own identifier (DOI) so that it can be cited independently in the future. For instructions see: https://journals.plos.org/plosone/s/submission-guidelines#loc-laboratory-protocols. Additionally, PLOS ONE offers an option for publishing peer-reviewed Lab Protocol articles, which describe protocols hosted on protocols.io. Read more information on sharing protocols at https://plos.org/protocols?utm_medium=editorial-email&utm_source=authorletters&utm_campaign=protocols.

We look forward to receiving your revised manuscript.

Kind regards,

Isaac Amankwaa, Ph.D.

Guest Editor

PLOS ONE

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Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. If the authors have adequately addressed your comments raised in a previous round of review and you feel that this manuscript is now acceptable for publication, you may indicate that here to bypass the “Comments to the Author” section, enter your conflict of interest statement in the “Confidential to Editor” section, and submit your "Accept" recommendation.

Reviewer #3: (No Response)

**********

2. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented.

Reviewer #3: (No Response)

**********

3. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #3: (No Response)

**********

4. Have the authors made all data underlying the findings in their manuscript fully available?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #3: (No Response)

**********

5. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #3: (No Response)

**********

6. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #3: Is log transformation used throughout the paper including the forest plot, only that the values in the forest plot were back transformed? This needs to be clearly stated in the paper.

I guess my understanding of prevalence is a proportion while percentage (100* proportion) was used throughout the paper. This is fine. However, the standard errors of log Prevalence in Figure 7 seem to be high. Please double check. Please add standard errors of the prevalence in Table 1 as well. If log transformation was used please added the standard errors of the logPrevalence too.

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7. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files.

If you choose “no”, your identity will remain anonymous but your review may still be made public.

Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy.

Reviewer #3: No

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PONE-D-23-16216R3Magnitude of Standard Precautions Practices among Healthcare Workers in Health Facilities of Low and Middle Income Countries: A Systematic Review and Meta-analysis.

PLOS ONE

Dear Mengistu Yilma Dilnessie,

Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process:

1. Please address the comments by the third reviewer 
2. It's important to clarify a few points regarding your search to ensure the rigour of your systematic review process:
   • Google Scholar as a Search Engine: Google Scholar is a valuable search engine, but it is not a traditional academic database (as you've claimed). It lacks the controlled indexing, sophisticated search features, and quality filters necessary for systematic reviews. Indeed, your PRISMA flowchart currently reflects only a PubMed search. If you used Google Scholar as a database, then the flowchart needs to be updated to accurately depict your search strategy.
   • Addressing Limitations: Please expand your limitations section to consider the following:
     • What relevant studies might have been missed by not including traditional databases?
     • Could the reliance on PubMed and Google Scholar introduce bias into your study selection?
     • How might this impact the generalizability of your findings?

Please submit your revised manuscript by May 01 2024 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org. When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file.

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We look forward to receiving your revised manuscript.

Kind regards,

Isaac Amankwaa, Ph.D.

Guest Editor

PLOS ONE

Journal Requirements:

Please review your reference list to ensure that it is complete and correct. If you have cited papers that have been retracted, please include the rationale for doing so in the manuscript text, or remove these references and replace them with relevant current references. Any changes to the reference list should be mentioned in the rebuttal letter that accompanies your revised manuscript. If you need to cite a retracted article, indicate the article’s retracted status in the References list and also include a citation and full reference for the retraction notice.

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Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. If the authors have adequately addressed your comments raised in a previous round of review and you feel that this manuscript is now acceptable for publication, you may indicate that here to bypass the “Comments to the Author” section, enter your conflict of interest statement in the “Confidential to Editor” section, and submit your "Accept" recommendation.

Reviewer #3: (No Response)

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2. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented.

Reviewer #3: (No Response)

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3. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #3: (No Response)

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4. Have the authors made all data underlying the findings in their manuscript fully available?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #3: (No Response)

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5. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #3: (No Response)

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6. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #3: The funnel plot can be either plotted as log-odds vs 1/standard error or log-odds vs sample size. Please check the paper by Hunter et al for details.

Hunter et al "In meta-analyses of proportion studies, funnel plots were found to be an inaccurate method of assessing publication bias" 2014 Journal of Clinical Epidemiology

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Reviewer #3: No

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[NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". If this link does not appear, there are no attachment files.]

While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, https://pacev2.apexcovantage.com/. PACE helps ensure that figures meet PLOS requirements. To use PACE, you must first register as a user. Registration is free. Then, login and navigate to the UPLOAD tab, where you will find detailed instructions on how to use the tool. If you encounter any issues or have any questions when using PACE, please email PLOS at figures@plos.org. Please note that Supporting Information files do not need this step.

Magnitude of Standard Precautions Practices among Healthcare Workers in Health Facilities of Low and Middle Income Countries: A Systematic Review and Meta-analysis.

PONE-D-23-16216R4

Dear Mengistu Yilma,

We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements.

Within one week, you’ll receive an e-mail detailing the required amendments. When these have been addressed, you’ll receive a formal acceptance letter and your manuscript will be scheduled for publication.

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Kind regards,

Isaac Amankwaa, Ph.D.

Guest Editor

PLOS ONE

Additional Editor Comments (optional):

Reviewers' comments: