Prevalence of hospital-associated infections and its association with discharge destinations and hospital readmissions in Brussels, Belgium, from 2008 to 2020: A hospital-based, cross-sectional study

Abstract

Objectives: To examine time trends of hospital-associated infections (HAIs) in people living in the Brussels–Capital Region, and to evaluate the consequences for hospitals and long-term care facilities (LTCFs). Design: Cross-sectional analyses of yearly hospital administrative data. Setting: All Belgian hospitals and discharge destinations, focusing on LTCFs. Participants: All individuals from the Brussels–Capital Region hospitalized for >1 day throughout Belgium between 2008 and 2020 (N = 1,915,572). Methods: We calculated HAI prevalences and then, adjusting for confounders, the odds of being discharged to a LTCF or being readmitted within 30 days postdischarge after an HAI. HAIs included hospital-associated bloodstream infections, hospital-associated urinary tract infections, hospital-associated pneumonia, ventilator-associated pneumonia, and surgical-site infections. Results: Between 2008 and 2020, we identified 77,004 HAIs. Changes in time trends occurred. We observed a decrease of all HAIs from 2012 to 2014 from 5.17% to 2.19% (P < .001) and an increase from 2019 to 2020 from 3.38% to 4.06% (P < .001). Among patients with HAIs, 24.36% were discharged to LTCFs and 13.51% underwent early readmission. For stays ≥4 days, HAIs were associated with higher odds of LTCF discharge (adjusted odds ratio [aOR], 1.25; 95% confidence interval [CI], 1.22–1.28), but with lesser odds of early readmission (aOR, 0.88; 95% CI, 0.85–0.90). Conclusions: Administrative data can be useful to detect HAIs trends, but they seem to underestimate the burden compared to surveillance systems. Risk factors of readmission should be identified during hospital stays to ensure continuity of care. Considering the results from 2020 coinciding with the COVID-19 pandemic, monitoring the impact of HAIs should continue.