Risk Factors for Healthcare-Associated Infections

A recently published article, Rodríguez-Acelas et al. 2017, systematically reviewed the scientific literature, and identified risk factors for healthcare-associated infections (HAI) in hospitalized patients. What factors are proved to increase significantly the risk of HAI?

The review followed the PRISMA protocol (Preferred Reporting Items for Systematic Reviews and Meta-Analyses). They searched for publications from the 2009–16 period, identifying 867 relevant studies. After careful inspection, 65 met the criteria for inclusion. Methodologic quality of these articles was evaluated using the Newcastle-Ottawa Scale (NOS), the Assessment of Multiple Systematic Reviews (AMSTAR) and the Cochrane Collaboration’s tool. Data of 18 were summarized in a meta-analysis.

Would you try to guess what factors really increase significantly the chance of HAI?

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Risk factors were grouped into two clusters. Intrinsic risk factors are patient’s characteristic that was known at the time of admission (e.g., age, body temperature, preconditions like diabetes). Extrinsic risk factors are related to the treatment (e.g., catheter placement, antibiotic use). If we keep these risk factors in mind, we can better understand what procedure or ward carries a special risk of HAI. We can also better consider which patient needs special attention and treatment.

Understandably, this study had some limitations. It only focused on adults, and it could not assess the publication bias. Technology and individual vulnerability are changing over time, thus the risk they carry; further research is deemed to be necessary. According to the authors, there is still a gap between theory and practice, therefore it is essential to keep the topic of HAI updated on a global basis.


It is important to be aware of the true risk factors of HAI. As the authors conclude, it may support the implementation of strategies for infection prevention, therefore maximizing patient safety. More evidence in this field is required; further high-quality, large-scale, detailed, and objective studies are needed.


Rodríguez-Acelas A.L. et al.: Risk factors for healthcare-associated infection in hospitalized adults: Systematic review and meta-analysis. American journal of infection control, 2017 Dec 1;45(12):e149-e156. DOI: 10.1016/j.ajic.2017.08.016