Nurse-Led Closed-Loop Infection Prevention and Control and Healthcare-Associated Infection Outcomes: A Retrospective Pre–Post Study

Abstract

Background 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.