Abstract
Background: Healthcare-associated infections (HAIs), antimicrobial resistance (AMR), and
inappropriate antimicrobial use (AMU) pose major public health threats in Thailand, yet national
evidence that integrates disease burden, resistance, prescribing, and the maturity of infection
prevention and control (IPC) and antimicrobial stewardship (AMS) systems is lacking.
Objectives: To estimate the prevalence, risk factors, and impacts of HAI, AMR, and AMU and to
evaluate the implementation maturity of IPC and AMS systems in 100 hospitals across Thailand.
Methods: A mixed-methods study was conducted in 100 hospitals across Thailand between
September 2025 to January 2026. A point prevalence survey captured clinical data, with
multivariable logistic regression used to identify associated factors. IPC and AMS systems were
evaluated using the WHO IPCAF, WHO HHSAF 2010, and EE-AMR Tool, complemented by direct
observation and interviews.
Results: Among 29,414 surveyed inpatients, HAI prevalence was 2.9% (95% confidence interval
[CI] 2.7–3.1), highest in university hospitals (6.4%) and intensive care units (9.0%). Respiratory tract
infections were the most common HAI type (43.6%). A length of stay ≥7 days carried the strongest
association with HAI (adjusted odds ratio [aOR] 10.22; 95% CI 8.28–12.62). AMR prevalence based
on the WHO GLASS and ESKAPEE frameworks was 48.0% (95% CI 46.1–50.0) and was significantly
higher among HAI than non-HAI isolates (62.6% vs. 43.7%). Neonatal ward admission was the
strongest associated factor for AMR (aOR 3.80; 95% CI 1.86–7.80) ( aOR 3.80; 95% CI 1.86-7.80).
AMU prevalence was 48.1% (95% CI 47.6–48.7), with Watch-group antibiotics accounting for 62.2%
of prescriptions and 29.6% deemed inappropriate. Surgical antimicrobial prophylaxis was the
strongest independent factor (aOR 12.18; 95% CI 10.77–13.77). Compared with non-HAI patients,
those with HAIs had higher 90-day mortality (23.3% vs. 5.3%), nearly five-fold longer length of
stay, and 7.7-fold greater total costs.
Regarding IPC and AMS evaluation, Mean scores were 669.5 ± 84.8/800 for WHO IPCAF (Advanced),
378.0 ± 86.5/500 for WHO HHSAF 2010 (Advanced), and 313.3 ± 85.6/500 for the EE-AMR Tool
(Intermediate), with marked disparities between regional referral hospitals and community
hospitals. Key gaps included workload and staffing, institutional safety climate, integrated data
analysis, and AMR governance. On-site assessment revealed overall acceptable practice but
persistent gaps in hand hygiene, appropriate use of personal protective equipment, airborne
transmission precautions, timely removal of invasive devices once no longer required, and
consistent monitoring of compliance.
Conclusion: HAIs, AMR, and AMU are interconnected challenges in Thai hospitals. These findings
provide a national evidence base for strengthening surveillance, formulating IPC and AMS
measures, and prioritizing resource allocation to enhance patient safety and AMR containment in
Thailand.
