Abstract / Summary
Jing Che,1 Haiping Zhang,1 Yangjuan Xi,2 Lu Zhang,3 Pan Zhang,4 Na Duan11Department of Disinfection Supply, The First Affiliated Hospital of Xi’an Jiaotong University, Xian, Shaanxi, 710061, People’s Republic of China; 2Department of Nursing, The First Affiliated Hospital of Xi’an Jiaotong University, Xian, Shaanxi, 710061, People’s Republic of China; 3Department of Anesthesiology and Surgery, The First Affiliated Hospital of Xi’an Jiaotong University, Xian, Shaanxi, 710061, People’s Republic of China; 4Department of Medical Imaging, The First Affiliated Hospital of Xi’an Jiaotong University, Xian, Shaanxi, 710061, People’s Republic of ChinaCorrespondence: Na Duan, Email duannajtedu@outlook.comBackground: Healthcare-associated infections (HAIs) remain a major patient-safety challenge. Although infection prevention and control (IPC) programs are central to HAI prevention, evidence regarding comprehensive nurse-led IPC models in routine clinical practice remains limited. Unlike isolated educational or compliance-focused interventions, the present framework integrates nurse-led risk assessment, continuous surveillance, bedside auditing, performance feedback, and closed-loop quality improvement. This study evaluated the association between implementation of this framework and infection-related outcomes.Methods: This single-center retrospective observational pre–post study used electronic medical record data collected from July 2023 to May 2026. A total of 768 hospitalized patients were included: 410 in the pre-implementation period and 358 after hospital-wide implementation of a nurse-led closed-loop IPC program. The primary outcome was HAI incidence. Secondary outcomes included IPC compliance, multidrug-resistant organism (MDRO) detection, device-associated infections, length of hospital stay, and all-cause in-hospital mortality.Results: HAI incidence decreased from 22.0% to 7.8% after implementation (RR=0.36, 95% CI: 0.24– 0.53; p< 0.001). Significant reductions were observed in ventilator-associated pneumonia (4.6% vs 1.7%; p=0.021), catheter-associated urinary tract infection (7.8% vs 1.7%; p< 0.001), surgical site infection (6.3% vs 3.1%; p=0.035), and MDRO detection (23.4% vs 9.5%; p< 0.001). Overall IPC compliance increased from 57.8% to 81.3% (p< 0.001), and mean hospital stay decreased from 12.08± 3.30 to 8.83± 2.36 days (p< 0.001). In-hospital mortality decreased from 6.3% to 4.5%, but not significantly.Conclusion: In this single-center retrospective pre–post study, implementation of a nurse-led closed-loop IPC framework was associated with lower HAI incidence, reduced MDRO detection, shorter hospitalization, and improved IPC compliance. These findings suggest that structured nursing leadership may strengthen routine IPC implementation; however, residual confounding, temporal changes, and the single-center observational design limit causal inference and generalizability. Further multicenter controlled studies are warranted.Keywords: healthcare-associated infections, infection control, multidrug-resistant organisms, nurse leadership, patient safety