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The Prevalence of Healthcare-Associated Infections in Mainland China: A Systematic Review and Meta-analysis

Published online by Cambridge University Press:  15 April 2018

Jiancong Wang ,
Fangfei Liu ,
Ermira Tartari ,
Jianan Huang ,
Stephan Harbarth ,
Didier Pittet  and
Walter Zingg
Jiancong Wang
Affiliation:
Infection Control Program and WHO Collaborating Centre on Patient Safety, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland Institute of Global Health, Faculty of Medicine, University of Geneva, Geneva, Switzerland Department of Infection Control, Dong Guan Hospital of Traditional Chinese Medicine, Dong Guan City, Guang Dong Province, China
Fangfei Liu
Affiliation:
Department of Nosocomial Infection Management, The Second Affiliated Hospital, Xi’an Jiaotong University, Xi’an, Shaanxi Province, China
Ermira Tartari
Affiliation:
Infection Control Program and WHO Collaborating Centre on Patient Safety, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland Institute of Global Health, Faculty of Medicine, University of Geneva, Geneva, Switzerland Infection Control Department, Mater Dei Hospital, Msida, Malta
Jianan Huang
Affiliation:
Department of Health Sciences and Health Policy, University of Lucerne and Swiss Paraplegic Research, Nottwil, Switzerland
Stephan Harbarth
Affiliation:
Infection Control Program and WHO Collaborating Centre on Patient Safety, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland
Didier Pittet
Affiliation:
Infection Control Program and WHO Collaborating Centre on Patient Safety, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland
Walter Zingg*
Affiliation:
Infection Control Program and WHO Collaborating Centre on Patient Safety, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland National Institute for Health Research Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance Imperial College of London, London, United Kingdom
*
Address correspondence to PD Walter Zingg, MD, Infection Control Programme, University of Geneva Hospitals and Faculty of Medicine, Rue Gabrielle Perret-Gentil 4, 1211 Geneva 14, Switzerland ([email protected]).
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Abstract

OBJECTIVE

To assess the prevalence of healthcare-associated infections (HAIs) in mainland China.

DESIGN

Systematic review and meta-analysis.

SETTING

Adults and children from secondary and tertiary acute-care hospitals in mainland China.

METHODS

We searched PubMed, the China National Knowledge Infrastructure, and Wan Fang for multicenter point-prevalence surveys of acute-care hospitals in mainland China from January 2006 to August 2016. All reports related to HAI, using a point-prevalence methodology and published either in English or Chinese were eligible.

RESULTS

In total, 3,021 publications were identified; 115 were eligible for quality assessment and data abstraction. The weighted HAI prevalence (95% confidence interval [CI]) overall, in general hospitals, children’s hospitals, maternal and child health hospitals, and oncology hospitals were 3.12% (95% CI, 2.94%–3.29%), 3.02% (95% CI, 2.79%–3.26%), 4.43% (95% CI, 3.39%–5.47%), 1.88% (95% CI, 1.47%–2.29%), and 3.96% (95% CI, 3.12%–4.79%), respectively. In general hospitals, prevalence was highest in adult intensive care units (26.07%; 95% CI, 23.03%–29.12%), followed by surgery (3.26%; 95% CI, 2.96%–3.57%), and internal medicine (3.06%; 95% CI, 2.67%–3.46%). Overall, lower respiratory tract infection was the most frequent HAI (24,185, 47.28%), followed by urinary tract infection (5,773, 11.29%) and upper respiratory tract infection (5,194, 10.15%). Gram-negative bacilli were the most frequently isolated pathogens, and Pseudomonas aeruginosa (3,395, 14.91%), and Escherichia coli (2,918, 12.82%) were the most common single microorganisms.

CONCLUSIONS

This study is the largest systematic review on the prevalence of HAI in mainland China. These results provide a benchmark for future PPSs and a reference for infection prevention and control strategies in mainland China.

Infect Control Hosp Epidemiol 2018;39:701–709

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 39 , Issue 6 , June 2018 , pp. 701 - 709
Copyright
© 2018 by The Society for Healthcare Epidemiology of America. All rights reserved 

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Footnotes

PREVIOUS PRESENTATION. These results were presented in part as poster at the Fourth International Conference on Prevention and Infection Control on June 21, in Geneva, Switzerland.

References

REFERENCES

1. Allegranzi, B, Bagheri Nejad, S, Combescure, C, et al. Burden of endemic health-care-associated infection in developing countries: systematic review and meta-analysis. Lancet 2011;377:228–241.CrossRefGoogle ScholarPubMed
2. Bagheri Nejad, S, Allegranzi, B, Syed, SB, Ellis, B, Pittet, D. Health-care–associated infection in Africa: a systematic review. Bull World Health Org 2011;89:757–765.CrossRefGoogle ScholarPubMed
3. Ling, ML, Apisarnthanarak, A, Madriaga, G. The burden of healthcare-associated infections in Southeast Asia: a systematic literature review and meta-analysis. Clin Infect Dis 2015;60:1690–1699.CrossRefGoogle ScholarPubMed
4. Bates, DW, Larizgoitia, I, Prasopa-Plaizier, N, Jha, AK. Global priorities for patient safety research. BMJ 2009;338:b1775.CrossRefGoogle ScholarPubMed
5. Burke, JP. Infection control—a problem for patient safety. N Engl J Med 2003;348:651–656.CrossRefGoogle ScholarPubMed
6. Sun, B. Nosocomial infection in China: management status and solutions. Am J Infect Control 2016;44:851–852.CrossRefGoogle Scholar
7. Organization for Economic Co-operation and Development. Health at a glance, 2015. Israel Ministry of Health website. http://www.health.gov.il/publicationsfiles/healthataglance2015.pdf. Published 2015. Accessed January 25, 2018.Google Scholar
8. Xu, H, Sun, J, Gu, A, et al. Prevention and control of catheter-associated urinary tract infection in China. Chin J Infect Control 2016;15:671–675.Google Scholar
9. Wang, Y, Zhang, X, Li, S, Guo, Y, Liu, Q, Wang, Y. Comparative analysis of hospital beds resource utilization and average days of stay between China and abroad. Chin J Hosp Admin 2016;32:361–364.Google Scholar
10. Weiss, AJ, Elixhauser, A. Overview of hospital stays in the United States, 2012: Statistical Brief #180. In: Healthcare Cost and Utilization Project (HCUP) Statistical Briefs. Rockville, MD: US Agency for Healthcare Research and Quality; 2006.Google Scholar
11. European Centre for Disease Prevention and Control. Point prevalence survey of healthcare associated infections and antimicrobial use in European acute care hospitals. Stockholm: ECDC; 2013.Google Scholar
12. Jia, H, Hou, T, Li, W, et al. Economic loss due to healthcare-associated infection in 68 general hospitals in China. Chin J Infect Control 2016;15:637–641.Google Scholar
13. Health expenditure in 2014. World Bank website. http://data.worldbank.org/indicator/SH.XPD.TOTL.ZS?end=2014&locations=CN&start=2014&view=chart. Published 2014. Accessed January 25, 2018).Google Scholar
14. Health expenditure per capita in China in 2014. World Bank website. http://data.worldbank.org/indicator/SH.XPD.PCAP?end=2014&locations=CN&start=2014&view=chart. Published 2014. Accessed January 25, 2018).Google Scholar
15. Anand, S, Fan, VY, Zhang, J, et al. China’s human resources for health: quantity, quality, and distribution. Lancet 2008;372:1774–1781.CrossRefGoogle ScholarPubMed
16. Magill, SS, Edwards, JR, Bamberg, W, et al. Multistate point-prevalence survey of health care-associated infections. N Engl J Med 2014;370:1198–1208.CrossRefGoogle ScholarPubMed
17. Wang, J, Hu, J, Harbarth, S, Pittet, D, Zhou, M, Zingg, W. Burden of healthcare-associated infections in China: results of the 2015 point prevalence survey in Dong Guan City. J Hosp Infect 2017;96:132–138.CrossRefGoogle Scholar
18. Zhang, Y, Zhang, J, Wei, D, Yang, Z, Wang, Y, Yao, Z. Annual surveys for point-prevalence of healthcare-associated infection in a tertiary hospital in Beijing, China, 2012–2014. BMC Infect Dis 2016;16:161.CrossRefGoogle Scholar
19. Li, C, Wen, X, Ren, N, et al. Point-prevalence of healthcare-associated infection in China in 2010: a large multicenter epidemiological survey. Infect Control Hosp Epidemiol 2014;35:1436–1437.CrossRefGoogle Scholar
20. Xie, DS, Xiong, W, Xiang, LL, et al. Point prevalence surveys of healthcare-associated infection in 13 hospitals in Hubei Province, China, 2007–2008. J Hosp Infect 2010;76:150–155.CrossRefGoogle ScholarPubMed
21. Liu, JY, Wu, YH, Cai, M, Zhou, CL. Point-prevalence survey of healthcare-associated infections in Beijing, China: a survey and analysis in 2014. J Hosp Infect 2016;93:271–279.CrossRefGoogle Scholar
22. Tao, XB, Qian, LH, Li, Y, et al. Hospital-acquired infection rate in a tertiary care teaching hospital in China: a cross-sectional survey involving 2434 inpatients. Int J Infect Dis 2014;27:7–9.CrossRefGoogle Scholar
23. Chen, Y, Zhao, JY, Shan, X, et al. A point-prevalence survey of healthcare-associated infection in fifty-two Chinese hospitals. J Hosp Infect 2017;95:105–111.CrossRefGoogle ScholarPubMed
24. Moher, D, Liberati, A, Tetzlaff, J, Altman, DG, The, PG. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med 2009;6:e1000097.CrossRefGoogle ScholarPubMed
25. von Elm, E, Altman, DG, Egger, M, Pocock, SJ, Gøtzsche, PC, Vandenbroucke, JP. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. Lancet 2007;370:1453–1457.CrossRefGoogle ScholarPubMed
26. Data of GDP per capita and indices in China: China Statistical Yearbook 2016. China Staitstics Press website. http://www.stats.gov.cn/tjsj/ndsj/2016/indexeh.htm. Published 2017. Accessed February 28, 2018.Google Scholar
27. Li, Y, Huai, Y, Varma, J, Rao, C. Healthcare-associated infection in mainland China: a systematic review of point prevalence survey literature. ID Week: San Diego, CA; 2012.Google Scholar
28. Ren, N, Wen, X, Wu, A. Nationwide cross-sectional survey on healthcare-associated infection in 2014. Chin J Infect Control 2016;15:83–87.Google Scholar
29. Cai, Y, Venkatachalam, I, Tee, NW, et al. Prevalence of healthcare-associated infections and antimicrobial use among adult inpatients in Singapore acute-care hospitals: results from the first national point prevalence survey. Clin Infect Dis 2017;64:S61–S67.CrossRefGoogle ScholarPubMed
30. Morioka, H, Hirabayashi, A, Iguchi, M, et al. The first point prevalence survey of health care-associated infection and antimicrobial use in a Japanese university hospital: a pilot study. Am J Infect Control 2016;44:e119–e123.CrossRefGoogle Scholar
31. Li, Y, Xu, J, Wang, F, et al. Overprescribing in China, driven by financial incentives, results in very high use of antibiotics, injections, and corticosteroids. Health Aff (Millwood) 2012;31:1075–1082.CrossRefGoogle Scholar
32. Wang, Z, Zhang, H, Han, J, Xing, H, Wu, MC, Yang, T. Deadly sins of antibiotic abuse in China. Infect Control Hosp Epidemiol 2017;38:758–759.CrossRefGoogle ScholarPubMed
33. Zingg, W, Hopkins, S, Gayet-Ageron, A, Holmes, A, Sharland, M, Suetens, C. Health-care-associated infections in neonates, children, and adolescents: an analysis of paediatric data from the European Centre for Disease Prevention and Control point-prevalence survey. Lancet Infect Dis 2017;17:381–389.CrossRefGoogle ScholarPubMed
34. Zhou, Y, Zhang, D, Chen, Y, et al. Healthcare-associated infections and Shanghai clinicians: a multicenter cross-sectional study. PLoS One 2014;9:e105838.CrossRefGoogle ScholarPubMed
35. Yin, A, Ma, L, Deng, L, Chen, X, Tang, A. Cross-sectional surveys on healthcare-associated infection in a children’s hospital. Chin J Infect Control 2015;14:769–771.Google Scholar
36. Sohn, AH, Garrett, DO, Sinkowitz-Cochran, RL, et al. Prevalence of nosocomial infections in neonatal intensive care unit patients: results from the first national point-prevalence survey. J Pediatr 2001;139:821–827.CrossRefGoogle ScholarPubMed
37. Li, G, Zhu, D, Wang, F, et al. The distribution and antibiotic resistance of clinical isolates from blood culture in 2012 CHINET surveillance program in China. Chin J Infect Chemother 2014;14:474–481.Google Scholar
38. Point prevalence survey for healthcare-associated infections and antimicrobial use for acute care hospitals in Taiwan. Centers for Disease Control, Republic of China (Taiwan) website. http://www.cdc.gov.tw/english/programresultinfo.aspx?treeid=9d909a43ebf2819d&nowtreeid=7b5b3c66a1ff6e25&tid=780174C2F2D250FD. Accessed January 25, 2018.Google Scholar
39. Prevalence survey of infections in public hospitals. Center for Health Protection, Department of Health Hong Kong SAR, China website. https://www.chp.gov.hk/files/pdf/cdw_v8_16.pdf. Published 2010. Accessed January 25, 2018.Google Scholar
40. Report on the Burden of Endemic Health Care-Associated Infection Worldwide, 2011. World Health Organization website. http://apps.who.int/iris/bitstream/10665/80135/1/9789241501507_eng.pdf. Published 2011. Accessed January 25, 2018.Google Scholar
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