PHWR Public Health Weekly Report

Healthcare-associated infections (HAIs) present a significant challenge to patient health, often resulting in complications such as prolonged hospital stays, an elevated risk for mortality, augmented antimicrobial resistance, and escalating healthcare expenditures [1]. HAIs have been documented in 7–15% of patients admitted to acute care hospitals [2]. According to the World Health Organization (WHO), approximately 23.6% of sepsis cases in healthcare settings are associated with HAIs [2,3], and the disease burden from six major HAIs (pneumonia, urinary tract infections, etc.) is more than twice that of 32 infectious diseases, including influenza and tuberculosis. Such infections have been shown to lead to increased antimicrobial use, which in turn exacerbates the problem of antimicrobial resistance and results in a significant increase in socioeconomic costs, including higher healthcare expenses and lost productivity. Nevertheless, the implementation of effective infection control measures poses a considerable challenge for healthcare organizations globally. The integration of novel technologies and procedures frequently gives rise to additional infection control issues, thereby exacerbating the complexity of the task and necessitating substantial budgetary allocations. On a global scale, network initiatives are being pursued not only through cooperative networks aimed at improving infection control standards internationally but also through national-level infection control cooperation systems. These initiatives aim to enhance the quality of healthcare, strengthen patient safety, and minimize costs. In the United States, the implementation of dedicated infection control personnel and systematic program operations has led to a 32% reduction in the incidence of HAIs. In contrast, organizations lacking infection control programs exhibited an 18% surge in infection rates. One notable example is the regional network–based infection control model centered on Duke University Hospital in the United States, which has shown positive outcomes, including a 50% decrease in infection rates, annual cost savings of approximately USD 100,000 per hospital, and the protection of dozens of lives [4,5].

The WHO has also identified the establishment of infection prevention and control systems in healthcare facilities as a crucial policy imperative, recommending the development of infection prevention and control policies and enhanced surveillance systems in each country. In the Republic of Korea (ROK), the institutional framework for preventing HAIs has been in place since the early 1990s, undergoing continual refinement and reinforcement. A series of events led to the establishment of a framework for infection control. In 1992, guidelines for the control of hospital infections were established. In 2004, evaluations of healthcare organizations were initiated. In 2010, a system for the accreditation of healthcare organizations was implemented, and a nationwide surveillance system for HAIs was established. Hospitals with 100 or more beds are now required to establish an Infection Control Committee and an Infection Control Office. The Infection Control Department has been entrusted with a set of pivotal responsibilities, such as conducting surveillance to identify outbreaks of infection, evaluating the efficacy of infection control measures, administering training programs to staff members on infection control best practices, and overseeing the health management of staff [6]. Consequently, infection control within healthcare institutions has evolved from an elective measure to an indispensable mandatory requirement. Nevertheless, disparities persist in the level of staffing for infection control specialists and in preventive management capabilities among healthcare organizations. In particular, healthcare organizations with small bed capacities and insufficient infection control staff or resources face difficulties in actively implementing infection prevention and control activities, requiring support for their efforts to strengthen infection control and the establishment of a network system to enhance collaboration among healthcare institutions. Accordingly, the Korea Disease Control and Prevention Agency (KDCA) is building a healthcare organization network to promote capacity building within these organizations.

1. Establishment of a Regional Medical Organization Network

To address the disparities in infection control capabilities across different regions, a collaborative network of 24 regional healthcare organizations spanning 17 cities and provinces is being established. Each network comprises one central hospital and approximately nine participating hospitals. Depending on regional characteristics and the number of healthcare organizations, one to three networks were established per city or province. Currently, 24 core hospitals and 227 participating hospitals are engaged in the initiative (Table 1). In collaboration with local governments, general hospitals and higher-level healthcare organizations with robust infection control capabilities are designated as core hospitals. These core hospitals fulfill a pivotal function by offering technical assistance, facilitating information exchange, and providing hands-on training to the participating hospitals within the regional network. Participating hospitals are classified as healthcare organizations requiring infection control technical support and capacity building. This category includes general hospitals, hospitals, and long-term care hospitals equipped with infection control departments and able to actively participate in network activities (Figure 1).

Figure 1. Regional healthcare facility network for healthcare-associated infection prevention and control

Table 1 Status of regional healthcare institution network by province and city, 2025

Region	No. of network	Hub hospital (A)	Participating hospital (B)	Total (A+B)
Seoul Metropolitan City	3	3	28	31
Busan Metropolitan City	2	2	18	20
Daegu Metropolitan City	1	1	9	10
Incheon Metropolitan City	2	2	15	17
Gwangju Metropolitan City	1	1	10	11
Daejeon Metropolitan City	1	1	8	9
Ulsan Metropolitan City	1	1	10	11
Sejong Citya)	0	0	2	2
Gyeonggi-do	3	3	27	30
Gangwon state	1	1	12	13
Chungcheongbuk-do	1	1	12	13
Chungcheongnam-do	1	1	11	12
Jeonbuk state	1	1	10	11
Jeollanam-do	1	1	9	10
Gyeongsangbuk-do	2	2	19	21
Gyeongsangnam-do	2	2	18	20
Jeju Special Self-Governing province	1	1	9	10
Total	24	24	227	251

^a)The two participating hospitals in Sejong are part of the Daejeon regional healthcare network..

2. Operation of a Regional Healthcare Organization Network

1) Operation of communication channels among local healthcare organizations

Organic cooperation and information-sharing among healthcare organizations are essential to improving the effectiveness of infection control. Accordingly, 17 city and provincial core hospitals have been designated to serve as cooperative hubs in their respective regions. The core hospitals are responsible for collecting and coordinating the needs of participating organizations and establishing a horizontal communication channel through regular meetings to facilitate practical information exchange and consultation. This network structure facilitates the rapid dissemination of infection control practices and response experiences, enables problem-solving, and promotes preemptive containment of infection spread associated with patient movement. The significance of effective communication channels is underscored, especially in identifying infection transmission routes associated with patient transfers within the region and facilitating proactive responses.

2) Support for infection control risk assessment and planning

Infection control risk assessment is a systematic procedure that analyzes the probability of infection occurring within healthcare facilities and its resulting impact, thereby establishing priorities for infection prevention strategies and setting standards for efficient infection control. For effective implementation of infection control, a systematic framework is required to support the entire process: systematically assessing and evaluating infection control risk factors, establishing and executing organization-specific infection prevention plans based on these results, and analyzing and evaluating project performance. To provide a foundation for this initiative, the core hospitals involved in this project administer risk assessments at least once a year for each of the participating hospitals. They also foster educational opportunities and facilitate strategic planning, empowering each organization to formulate its own infection control plan for the subsequent year, with a focus on its unique priorities.

3) Sharing of infection control prevention and management techniques and activities

By leveraging the infection control on-site advisory program developed in 2019, tailored advice was provided according to the type of healthcare organization. This program is structured by category of healthcare organization, such as small and medium-sized hospitals, specialized hospitals, long-term care hospitals, and clinics. It employs a step-by-step approach: on-site evaluation → problem identification → implementation consultation → follow-up management. Further, key issues and outcomes gathered during the consultation process are shared between regional core hospitals and participating hospitals, thereby fostering the expansion of quality improvement activities within the region. Observations of CRE outbreaks occurring in intensive care units because of insufficient isolation rooms at general hospitals and CRE outbreaks in long-term care hospitals were considered in the development of standard operating modules for regional healthcare network activities (including training scenarios and performance indicators for responding to HAI outbreaks). For healthcare organizations experiencing outbreaks, tailored consultations were provided to bring the outbreaks to an end, and subsequent support measures, including indicator-based monitoring and the provision of promotional materials, were implemented to strengthen their self-response capabilities in solving on-site problems during the process of responding to HAIs. The tabletop exercise (TTX) program, based on standardized response scenarios, enhances the capacity to respond to outbreaks. In particular, the increased effectiveness of preemptive containment measures against multidrug-resistant bacteria was attributed to cooperation and information-sharing systems among healthcare institutions.

4) Management of network activity outcomes by regional healthcare organizations

An indicator-based performance management system was implemented to quantitatively assess the infection control performance of participating institutions. This indicator-based evaluation not only enables the diagnosis of the level of infection control at each organization but also provides crucial data for identifying regional disparities, as well as strengths and weaknesses, thereby drawing out directions for improvement. Data on infectious disease outbreaks, hand hygiene and environmental management compliance rates, and awareness of infection control activities during HAI outbreaks were collected, analyzed, and shared with 17 core hospitals across the country. Key indicator results demonstrated that healthcare organizations engaged in regional healthcare network initiatives exhibited statistically significant increases in infectious disease outbreaks, in some instances, when compared with non-participating institutions. Concurrently, hand hygiene compliance rates among healthcare workers exhibited a steady annual increase.

The regional network project aimed at enhancing the prevention and management of HAI has undergone an incremental implementation process, culminating in the establishment of a nationwide system. This initiative, which began in 2021 with the participation of 247 healthcare institutions and 18 small-to-medium-sized and long-term care hospitals, expanded its system for providing close support to vulnerable organizations in 2023, with 164 small-to-medium-sized and long-term care hospitals joining the network. As of 2025, it has been organized and is operating as a total of 24 regional networks covering all 17 cities and provinces nationwide. The number of cases reported by healthcare organizations participating in the multidrug-resistant bacteria surveillance program was significantly higher than that of non-participating organizations, indicating that participating organizations are more actively engaged in infection surveillance and reporting.

The infection control capabilities of healthcare organizations vary significantly depending on the size of the organization, staffing composition, and organizational structure. A recent survey [7] indicates that while tertiary hospitals have relatively ample dedicated staff for infection control, general hospitals and especially long-term care hospitals face increasing difficulties in staffing. In particular, the expertise and job security of dedicated infection control nurses, along with the actual participation of infection control physicians, are among the key factors significantly influencing the effectiveness of infection control. To overcome these structural constraints, the KDCA has been implementing the “HAI Prevention and Management Project” since 2017. It provides technical support and focuses on prevention and management for healthcare organizations lacking infection control resources. As of 2025, a total of 24 regional healthcare organization networks are operating across 17 cities and provinces nationwide. Centered on core hospitals with strong infection control capabilities, these networks actively engage in collaborative activities such as providing consultation, education, TTX, and information-sharing to participating organizations [8]. Notably, healthcare organizations participating in this project exhibited lower rates of infectious disease outbreaks compared with non-participating organizations, suggesting that intensive prevention activities and a collaborative response system yield tangible results. Despite the existence of external factors, such as an aging population and increased antimicrobial use, which serve as background conditions for infectious disease outbreaks, it is evident that augmenting infection control infrastructure and providing network-based technical support play a pivotal role in the prevention of infections.

Therefore, the regional healthcare organization network exhibits sufficient scalability and sustainability as an infection control model in the ROK, thereby establishing itself as a core strategy for systematizing regional HAI response capabilities.

This project establishes a crucial basis for the formulation of a nationwide integrated surveillance and prevention system for HAIs. This is particularly salient in the context of heightened public concern regarding HAIs within healthcare organizations. Nationwide surveillance systems and region-based technical support activities contribute demonstrably and substantially to ensuring patient safety and reducing healthcare costs. Infectious diseases require national policy intervention and financial support, as outbreaks have far-reaching impacts beyond the healthcare sector and affect society as a whole. The project based on the regional healthcare organization networks (Table 2) is considered one of the core strategies for systematizing infectious disease response capabilities and fulfilling the national duty to protect public health.

Table 2 2025 Regional healthcare facility network activities

Category	Detail
Regional hub hospital	Convening meetings with participating institutions of the regional healthcare network. Providing individualized consultation on infection control risk assessment and planning. Offering consultation and on-site inspections regarding healthcare-associated infection response activities. Maintaining communication channels among network hospitals.
Participating hospital	Participation in regional healthcare network activities

A supportive policy approach that encourages voluntary participation rather than a regulatory one is required to enhance the effectiveness and sustainability of this project. The KDCA plans to continue strengthening its organic cooperation system with local governments and healthcare organizations, while maintaining national attention on and institutional support for infection control policies.

Ethics Statement: Not applicable.

Funding Source: None.

Acknowledgments: None.

Conflict of Interest: The authors have no conflicts of interest to declare.

Author Contributions: Conceptualization: NYK, SYL, SKP, ARK. Data curation: NYK. Formal analysis: NYK. Investigation: NYK. Methodology: SKP, NYK. Project administration: SKP, NYK. Supervision: SKP Validation: SKP. Writing – original draft: NYK. Writing – review & editing: SKP.