1. Hospital organization, management, and structure for the infection prevention and control of healthcare-associated infection in Chinese hospitals: a systematic review Jiancong Wang1, Fangfei Liu2, Walter Zingg1 1University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland 2 The Second Affiliated Hospital, Xi’an Jiaotong University, Xi’an, Shaanxi Province, China
Introduction
Healthcare associated infections (HAIs) are the most frequent adverse event threatening patients’ safety. Few data have been reported on infection prevention and control (IPC) activities in China, particularly about effectiveness of IPC programmes in HAI-prevention.
Methods
We searched PubMed and the Chinese National Knowledge Infrastructure (CNKI). Primary outcome in this review was reporting and/or explaining any of the IPC elements. Secondary outcomes were 1) change of any type of HAI or IPC process indicators; 2) improvement of antimicrobial use or reduction of antimicrobial resistance (AMR). The search terms addressed the following elements: 1) organization of IPC programmes (staffing, resources); 2) best practices guidelines; 3) education and training on IPC; and 4) surveillance of outcome and process indicators.
Conclusion
This systematic review provides an inventory on IPC organization and structure in Chinese acute-care hospitals. Results were compared to the ECDC key components and the WHO core components. They also revealed challenges and barriers for successful IPC activities in Chinese acute-care hospitals. Finally, this review serves as a reference to influence national IPC policy-making in Mainland China.
Objective
This study aimed to identify organizational and structural elements of IPC in acute-care hospitals in Mainland China between January 2012 and October 2017, based on reports published either in English or in Chinese.
Figure 3. The ratio of IPC training and surveillance in China,
Figure 1. Systematic review profile
Results
A total number of 6580 publications were retrieved, of which 76 publications were eligible for final analysis. The majority of tertiary- and secondary-care hospitals (TSCHs) reported having at least one IPC activity (e.g. IPC guideline, IPC committee, IPC department, monitoring and feedback, and IPC training), which is less common or even absent in primary-care hospitals (PCHs). In TSCHs, the ratio of IPC professionals (doctors and nurses) to hospital-beds was one IPC professional per 197 beds. Furthermore, in 44.4%, 22.2% and 5.6%, IPC trainings activities effectively improved hand hygiene compliance, reduced HAI, and positively changed the behavior of ICU-nurses on IPC practices, respectively. Reduction of HAI and AMR was reported by 25.0% and 3.6% surveillance studies reports.
6580 titles and abstracts:
PubMed (3851), CNKI (2729)
357 articles eligible for full text assessment
76 articles included for data extraction and analysis
6223 articles excluded: inclusion criteria not met
281 articles excluded after full text review
Note: AMR: antimicrobial resistance; ICU: intensive care unit; NICU: neonatal intensive care unit; SSI: surgical site infection; PPS: point prevalence survey
Figure 4. The ration of auditing basic IPC implementation in China,
Figure 2. The ratio of IPC organization and management in China,
Note: TSCH: tertiary- and secondary-care hospital; PCH: primary-care hospital
Note: TSCH: tertiary- and secondary-care hospital; PCH: primary-care hospital