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

  • Jiancong Wang (a1) (a2) (a3), Fangfei Liu (a4), Ermira Tartari (a1) (a2) (a5), Jianan Huang (a6), Stephan Harbarth (a1), Didier Pittet (a1) and Walter Zingg (a1) (a7)...



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


Systematic review and meta-analysis.


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


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.


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.


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


Corresponding author

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 (


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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.



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