Surveillance based assessment of reported healthcare associated infections in Canton Sarajevo Bosnia and Herzegovina in 2023

Abstract Healthcare-associated infections (HAIs) represent a significant challenge to modern healthcare systems due to their clinical and public health impact and are important indicators of healthcare safety and infection prevention and control performance. Continuous surveillance and standardized reporting are essential for effective prevention and control. In Canton Sarajevo (CS), Bosnia and Herzegovina, no published studies have previously described HAI reporting within existing routine surveillance systems. This study aimed to describe reported HAIs in acute care hospitals in CS during 2023 and to provide a baseline assessment of available surveillance data to support future improvements in HAI surveillance and infection prevention and control practices. A retrospective descriptive surveillance assessment was conducted using aggregated secondary data from the 2023 annual Reports on Operations and Financial Performance of the Clinical Centre of the University of Sarajevo (CCUS), the General Hospital “Prim. dr. Abdulah Nakaš” (GH Nakaš), and the Public Health Institute of Canton Sarajevo (PHI CS). The study included all HAIs reported through routine surveillance among hospitalized and discharged patients in acute care hospitals in CS between 1 January and 31 December 2023. Analyses were based on aggregated surveillance data, without patient-level variables, risk adjustment or detailed clinical information. A total of 666 HAIs were reported in CS hospitals during 2023, including 542 at CCUS and 124 at GH Nakaš. The reported proportion of HAI cases among hospital discharges at CCUS was 1.20% (95% CI 1.10–1.30%) and 0.65% (95% CI 0.54–0.77%) at GH Nakaš. The reported HAI rate at CCUS was 1.86 per 1,000 patient-days (95% CI 1.71–2.02), and at GH Nakaš 1.62 per 1,000 patient-days (95% CI 1.36–1.93). These findings should be interpreted as outputs of a routine surveillance system rather than precise epidemiological estimates, likely reflecting under-ascertainment and limited comparability with standardized international frameworks, but they provide a useful baseline assessment of HAI surveillance activity and highlight areas requiring improvement in surveillance systems and infection prevention and control strategies in CS.