Prioritizing Risk Factors for Nosocomial COVID-19 Infection in a Taiwanese Hospital: An Integrated DEMATEL–ANP–IPA Approach

Wei Hsu,1 I-Ting Yen21Department of Health Care Management, National Taipei University of Nursing and Health Sciences, Taipei City, Taiwan; 2Institute of Health Policy and Management, College of Public Health, National Taiwan University, Taipei City, TaiwanCorrespondence: Wei Hsu, Email weihsu@ntunhs.edu.twObjective: During the COVID-19 pandemic, the rapid influx of patients with undiagnosed or confirmed infection increased the risk of healthcare-associated transmission and nosocomial infection. Identifying and prioritizing risk factors is essential for strengthening infection prevention and supporting hospital risk management and resource allocation. This exploratory study aimed to prioritize factors associated with nosocomial COVID-19 infection from an expert-based perspective.Methods: An integrated multicriteria decision-making (MCDM) framework combining the decision-making trial and evaluation laboratory (DEMATEL), analytic network process (ANP), and importance-performance analysis (IPA) was used to examine the relative importance, interrelationships, and intervention priorities of risk factors. Eight experts from five hospitals in Taiwan participated in the assessment. One hospital in Taipei City was selected as the case hospital for exploratory evaluation and prioritization.Results: "Lack of hospital protective equipment” and "Superspreading event” were identified as the most influential attributes, while "Patients with high viral load” and "Close contact” were the key risk factors associated with nosocomial COVID-19 infection. The integrated MCDM analysis also revealed interrelationships among risk factors and identified priorities of risk factors of infection-control intervention for the case hospital.Conclusion: The case hospital should prioritize adequate hospital facilities and infection risks associated with patients with chronic diseases when developing nosocomial infection prevention strategies. The proposed framework may support hospital risk assessment, infection-control planning, and resource allocation during infectious disease outbreaks. Given the exploratory and single-hospital design, the findings should be validated in other hospital settings.Keywords: COVID-19, nosocomial infection, infection control, multi-criteria decision-making, MCDM