This study was carried out at Guangdong Second Provincial General Hospital, a university-affiliated tertiary hospital located in Guangzhou, Guangdong Province, China, with a bed capacity of approximately 1,730. In 2020, the Infection Prevention and Control team was augmented by two additional full-time staff members, bringing the total number of team members to eight. This staffing level is in accordance with the national standard of one full-time infection preventionist (IP) per 200 beds. The IPC team consists of experts from diverse fields, spanning clinical medicine, nursing, public health, clinical pharmacy, and humanities management. Notably, the team includes four professionals with intermediate titles, one with an associate senior title, and three with full senior titles, reflecting a robust expertise in infection control.

The team of infection control observers was established at the end of 2019, all infection control observers have undergone intensive training. Initially, the primary responsibilities of the observers were to maintain the normal operation of negative pressure isolation wards, supervise the implementation of disinfection, ensure an adequate supply of protective materials, arrange specimen examinations, and alleviate the anxiety of healthcare workers when treating patients, in order to address the airborne transmission in negative pressure isolation wards. This team also plays a significant role in daily operations. In their routine work, they participate in the supervision and management of hospital infection control. They can identify and correct issues in departmental infection control work, as well as potential infection risks in personal protection and operations during medical activities. They also guide the handling of occupational exposure, which can further enhance the quality and safety of medical care provided by healthcare professionals. The IPC team at the hospital regularly conducts relevant knowledge training and assessments for supervisors, and organizes emergency drills on a regular basis to continuously improve the theoretical foundation and capability level of the infection control observers team. The main responsibilities of the infection control observers team differ between emergency periods and non-emergency Period (Supplementary Table S1). To better manage and leverage the infection control observers team, the hospital has established a relevant reward and punishment system in terms of performance. There is a fixed performance-based reward for each person every month. At the end of the year, infection control observers are selected, and corresponding performance rewards are given. If an infection control observers fails to fulfill their duties properly or makes work-related mistakes that lead to hospital-acquired infection incidents or other impacts, the responsibility of the infection control observers will be pursued, and their infection control observers qualification and labor subsidy will be revoked.

Since the end of 2019, the hospital has been responsible for a portion of the infection control costs for clinical departments, including the costs of infection control and prevention supplies, and the costs of vaccinations for occupational exposure to infectious pathogens. The supplies include hand sanitizers, alcohol-free hand disinfectants, and antibacterial hand soaps for healthcare workers’ hand hygiene, disposable disinfectant wipes for surface disinfection, disposable isolation gowns, disposable shoe covers, disposable protective suits, medical protective masks, face shields, and eye shields. We use the average total cost of hand sanitizers, disposable disinfectant wipes, shoe covers, and isolation gowns from the past 3 years in each department as the benchmark value. The hospital’s infection control cost-sharing plan is structured as follows: for costs below the department’s benchmark value, the hospital covers 80% of the expenses, while the department covers 20%. For costs above the benchmark value, both the hospital and the department share the responsibility equally, each bearing 50% of the expenses. Subsequently, every 2 years, the benchmark value of infection control costs will be dynamically adjusted based on the workload of the department.

The data from the Blue Dragon Hospital Infection Real-time Monitoring and Management System (Hunan Blue Dragon Network Technology Co., Ltd., version 6.0) and the Hospital Intelligent Infection Management System (Shanghai Lilian Information Technology Co., Ltd.) are used to collect hospital infection cases. These cases are reviewed and tracked by dedicated infection control specialists in the hospital. For cases of exogenous Healthcare-associated infections, a multidisciplinary discussion and joint ward rounds are conducted, including the diagnosis of hospital infections, the use of antimicrobial drugs, the risk assessment of invasive procedures, the preventive use of antimicrobial drugs, and isolation measures. The final determination of whether a case is a hospital infection is made by two infection control professionals with senior titles. Data on occupational exposure reports from the office automation system of the Affiliated Guangdong Second Provincial General Hospital of Jinan University are obtained. IPs consult and interview the exposed staff to collect demographic information about the affected personnel, which is recorded in the automated office system for easy reference in subsequent risk assessment and measures. Other data are statistically compiled by the information department. Antimicrobial use density (AUD) = antimicrobial dose (g) per period/DDD/number of patients under extended hospitalization during thesame period × 1,000. DDD was defined as the hypothetical mean daily estimated dose for adults for the main indicated illnesses for the medication. Patient-days were defined as the number of nights a hospitalized patient remained in the hospital, calculated based on the number of times their stay extended past midnight. Exclusion criteria for this calculation included individuals discharged without formal admission and newborns in obstetric units who roomed-in with their mothers. The study was approved by the Ethics Committee of The Affiliated Guangdong Second Provincial General Hospital of Jinan University, Guangzhou, China (Approval No. 2025-KY-KZ-102-01).

All statistical analyses were performed using SPSS statistical software, version 29.0. Categorical variables were compared using the chi-square test. The hospital infection rate per 1,000 patient-days was compared between the periods 2015–2019 and 2020–2024 using the chi-square test. Counted data were described by the number of cases (percentage), and the Kolmogorov–Smirnov test was used to verify the normality of the data. For continuous variables that followed a normal distribution, the mean ± standard deviation (SD) was used to describe them, and the differences between the groups were assessed using Student’s t test. All statistical analyses were evaluated at the statistical significance level of p < 0.05 (two-sided).

Between 2015 and 2024, a cumulative total of 5,199 hospitalized patients experienced HAIs. The average number of such infections per year, with a SD, was 520 ± 83. The hospital infection rate, measured per 1,000 patient-days, stood at 8.31 per 1,000 patient-days. When comparing the periods from 2015 to 2019 against 2020 to 2024, the average number of HAIs patients per year, with SD, was 569 ± 36 versus 471 ± 91 (p < 0.001). Notably, the hospital infection rate per 1,000 patient-days declined, and this decrease was statistically significant. Specifically, the rates were 9.34 ± 0.25 and 7.29 ± 0.78 per 1,000 patient-days for the periods 2015–2019 and 2020–2024, respectively (p < 0.001) (Table 1). The trend in hospital infection rates per 1,000 patient-days from 2015 to 2024 is illustrated in Figure 1 and Supplementary Figure S1.

A comparative analysis of the period from 2015 to 2019 versus 2020 to 2024 revealed a declining trend in the hospital infection rate of ventilator-associated pneumonia (VAP) per 1,000 ventilator days within the Intensive Care Unit (ICU), with a statistically significant difference (6.31 ± 1.50 vs. 2.72 ± 1.01, p = 0.002). Similarly, the hospital infection rate of catheter-associated urinary tract infection (CAUTI) per 1,000 catheter days exhibited a downward trend, with a statistically significant difference (1.66 ± 0.33 vs. 0.99 ± 0.28, p = 0.008). The hospital infection rate of catheter-related bloodstream infection (CRBSI) per 1,000 catheter days also showed a significant decrease, with a statistically significant difference (1.39 ± 0.35 vs. 0.43 ± 0.14, p < 0.001) (Table 2). The trend in hospital infection rates of Episodes per 1,000 ventilator/catheter days in the ICU from 2015 to 2024 is illustrated in Figure 2 and Supplementary Figure S2.

From 2015 to 2024, the mean ± SD hand hygiene compliance rate among healthcare workers was 72.76 ± 5.87. A significant improvement in hand hygiene compliance was observed when comparing the periods from 2015 to 2019 and 2020 to 2024, with a statistically significant difference (68.13 ± 3.55 vs. 77.39 ± 3.37, p = 0.003) (Figure 3A). Over the same period, a total of 670 episodes of needlestick & sharp injuries (NSIs) were reported to the infection control team, with an average ± SD of 67 ± 14 episodes per year, equating to an overall mean ± SD of 10.69 ± 1.98 episodes per 10,000 patient days. A notable reduction in NSIs per 10,000 patient days was observed when comparing the periods from 2015 to 2019 and 2020–2024, with a statistically significant difference (12.17 ± 1.47 vs. 9.20 ± 1.07, p = 0.006) (Figure 3B). The monitoring of antimicrobial prophylaxis for Class I incisions began in 2019, with a mean ± SD of 24.77 ± 10.23 for the use of antibiotics for prevention of Class I surgical site infection from 2019 to 2024, demonstrating a downward trend over time (Figure 3C). The monitoring of antimicrobial usage density began in 2018, with a mean ± SD of 40.49 ± 6.07 for antimicrobial usage density from 2018 to 2024, showing a downward trend over time (Figure 3D).

Since the end of 2019, the hospital has initiated a Campaign to Cluster-based intervention approaches aimed at reducing infection control risks, encompassing the establishment of an infection control observation team, the hospital’s partial assumption of infection control costs for clinical departments, an increase in the number of dedicated infection control personnel, and a series of measures including enhanced training and assessment. For the infection control observation team, the average age of junior level is 31.50 ± 3.95 years, whereas that of intermediate level and above is 41.23 ± 6.60 years. In terms of numbers, the majority (n = 43, 72.88% of 59) are at the intermediate level and above. Professionally, doctors constitute the majority (79.66%, 47/59). Comparatively, the proportion of surgical departments among junior level and intermediate level and above personnel is 62.50 and 23.26%, respectively, with a statistically significant difference (p = 0.013), as shown in Table 3. From 2019 to 2024, the total infection control costs for all departments amounted to 2.17 ± 1.11 million RMB, with departments and the hospital bearing 1.06 ± 0.55 vs. 1.11 ± 0.58 million RMB, respectively (p = 0.88). The average infection control cost per inpatient was 34.60 ± 19.59 RMB, with departments and the hospital, respectively, assuming 17.00 ± 9.88 vs. 17.61 ± 10.06 RMB per inpatient (p = 0.92), as shown in Figure 4. Furthermore, since 2019, the hospital has intensified training for all levels and types of personnel, increased the frequency of training and assessment, and implemented specialized training programs and content for various levels and types of personnel such as doctors, nurses, and support staff by the infection control team.