Healthcare-associated infections in Singapore’s long-term acute care hospitals: results from the first national point prevalence survey

Abstract Background: While healthcare-associated infection (HAI) surveillance in Singapore’s acute care hospitals is well established, comparable data from long-term acute care hospitals (LTACHs), known as community hospitals, are limited. We conducted the first national point prevalence survey (PPS) to determine HAI prevalence in Singapore LTACHs. Methods: A standardized protocol adapted from the Singapore acute care hospital HAI PPS protocol, which was adapted from the European Centre for Disease Prevention and Control protocol for acute care hospitals, was implemented across 9 LTACHs. Adult inpatients present in participating wards at 8 a.m. on the survey day were included. Data on patient characteristics, invasive devices, and active infections were collected from electronic medical records. Factors associated with HAIs were determined using multivariate logistic regression. Results: Among 1,546 patients, 86 had 94 HAIs, corresponding to a prevalence of 5.6% (95% confidence interval [CI]: 4.5–6.8). The most common infection types were unspecified sepsis (36.2%), urinary tract infection (UTI) (24.5%), and surgical site infection (18.1%). Microbiological confirmation was available for 25.5% of HAIs, with Enterobacterales (54.8%) most frequently identified. Presence of central vascular catheter (odds ratio [OR]: 3.88; 95% CI: 1.66–9.08) and peripheral vascular catheter (OR: 10.48; 95% CI: 6.45–17.03) were associated with HAIs, while larger hospital size (≥250 beds) was associated with reduced odds (OR: 0.62; 95% CI: 0.39–0.99). Conclusion: This inaugural PPS establishes the baseline for HAIs in Singapore’s LTACHs. Findings suggest broad infection prevention initiatives may provide the greatest benefit sector-wide, while the high UTI burden highlights an opportunity for targeted prevention strategies.