Determinants of (over)use and de-implementation of low-value infection prevention practices and care procedures that carry infection risks in hospitals: a scoping review

Introduction Infection prevention (IP) practices are critical to patient safety. However, some IP measures or care procedures associated with a risk of infection are used inappropriately or excessively. This overuse can be considered low-value care (LVC) as it contributes to potential negative health outcomes for patients, unnecessary healthcare costs, and environmental strain. This scoping review aims to identify determinants of (over)use and de-implementation of LVC general IP measures and non-surgical care practices linked to infection risk in hospitals. Methods We conducted a scoping review following Arksey and O’Malley methodology. A systematic search was performed in OVID/Medline, Embase.com, Elsevier/Scopus, and Ebsco/CINAHL up to January 29-February 2, 2026. Study selection was supported by the artificial intelligence tool ASReview using the SAFE-procedure. Data was charted using a piloted extraction form including type of study, type of LVC practice, and determinants of (over)use or de-implementation. Determinants were categorized according to Augustsson's de-implementation framework. Results A total of 13,738 records were retrieved of which 57 studies were included. Most included studies were empirical and focused on care procedures with an infection risk ( n = 40), predominantly urinary catheter use ( n = 37). Other studies addressed general IP measures ( n = 17), mainly glove use, sometimes combined with gowns/aprons ( n = 5) with two studies also including isolation practices. Across studies, determinants mainly related to professional-, patient-, and inner-context, and were primarily associated with continued (over)use rather than de-implementation. Many studies described situations of (over)use rather than explicitly probing the underlying motivations driving these behaviors. None of the studies explicitly labeled the examined care practices as LVC, and several did not specify criteria that distinguished appropriate from inappropriate use. Conclusions Current literature on determinants of (over)use and de-implementation in infection prevention focuses predominantly on urinary catheter and glove use, with a strong emphasis on determinants driving (over)use. Systematic study of overuse in infection prevention and subsequent development of effective de-implementation strategies is hindered by studies not clearly defining care practices as LVC. Advancing this field requires more theory informed and context-sensitive approaches to better characterize overuse, identify barriers and facilitators to reduce overuse, and to support the development of targeted de-implementation strategies.