A systematic review and meta-analysis of risk factors associated with healthcare-associated infections among hospitalized patients in Chinese general hospitals from 2001 to2022

X Liu; Y Long; C Greenhalgh; S Steeg; J Wilkinson; H Li; A Verma; A Spencer

doi:10.1016/j.jhin.2023.02.013

A systematic review and meta-analysis of risk factors associated with healthcare-associated infections among hospitalized patients in Chinese general hospitals from 2001 to2022

J Hosp Infect. 2023 May:135:37-49. doi: 10.1016/j.jhin.2023.02.013. Epub 2023 Mar 11.

Authors

X Liu¹, Y Long², C Greenhalgh³, S Steeg⁴, J Wilkinson³, H Li², A Verma³, A Spencer³

Affiliations

¹ Division of Population Health, Health Services Research and Primary Care, School of Health Sciences, University of Manchester, Manchester Academic Health Sciences Centre, Manchester, UK. Electronic address: xinliang.liu@postgrad.manchester.ac.uk.
² Global Health Institute/School of Health Sciences, Wuhan University, Wuhan, China.
³ Division of Population Health, Health Services Research and Primary Care, School of Health Sciences, University of Manchester, Manchester Academic Health Sciences Centre, Manchester, UK.
⁴ Division of Psychology and Mental Health, School of Health Sciences, University of Manchester, Manchester Academic Health Sciences Centre, Manchester, UK.

PMID: 36907333
DOI: 10.1016/j.jhin.2023.02.013

Abstract

Background: Healthcare-associated infections (HAIs) are a serious global public health issue. However, a comprehensive analysis of risk factors for HAIs has yet been undertaken at a large scale among general hospitals in China. The aim of this review was to assess risk factors associated with HAIs in Chinese general hospitals.

Methods: Medline, EMBASE and Chinese Journals Online databases were searched to find studies published from 1^st January 2001 to 31^st May 2022. The random-effects model was used to estimate odds ratio (OR). Heterogeneity was assessed based on the τˆ² and I² statistics.

Results: A total of 5037 published papers were identified from the initial search and 58 studies were included in the quantitative meta-analysis; 1,211,117 hospitalized patients were incorporated covering 41 regions in 23 provinces of China and 29,737 were identified as having HAIs. Our review showed that HAIs were significantly associated with sociodemographic characteristics including age older than 60 years (OR: 1.74 (1.38-2.19)) and male sex (1.33 (1.20-1.47)); invasive procedures (3.54 (1.50-8.34)); health conditions such as chronic diseases (1.49 (1.22-1.82)), coma (OR: 5.12 (1.70-15.38)) and immunosuppression (2.45 (1.55-3.87)). Other risk factors included long-term bed (5.84 (5.12-6.66)), and healthcare-related risk factors such as chemotherapy (1.96 (1.28-3.01)), haemodialysis (3.12 (1.80-5.39)), hormone therapy (2.96(1.96-4.45)), immunosuppression (2.45 (1.55-3.87)) and use of antibiotics (6.64 (3.16-13.96)), and longer than 15 hospitalization days (13.36 (6.80-26.26)).

Conclusions: Being male and aged over 60 years, invasive procedure, health conditions, healthcare-related risk factors, and longer than 15 hospitalization days were the main risk factors associated with HAIs in Chinese general hospitals. This supports the evidence base to inform the relevant cost-effective prevention and control strategies.

Keywords: China; General hospitals; Healthcare-associated infections; Risk factors; Systematic review and meta-analysis.

Publication types

Meta-Analysis
Systematic Review
Review

MeSH terms

Aged
Cross Infection* / prevention & control
Delivery of Health Care
East Asian People
Female
Hospitals, General*
Humans
Male
Middle Aged
Risk Factors