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

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 1st January 2001 to 31st May 2022. The random-effects model was used to estimate odds ratio (OR). Heterogeneity was assessed based on the sb2 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 socio-demographic 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 immuno-suppression (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)), immunosup-pression (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. 2023 The Author(s). Published by Elsevier Ltd on behalf of The Healthcare Infection Society. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).