Original Investigation 

Infectious Diseases

Preferences for Infection Prevention in Hospital-Acquired Infections

Shalini Elangovan, Sameera Senanayake, Indumathi Venkatachalam, et al

JAMA Netw Open 2026;9;(4):e267432. doi:10.1001/jamanetworkopen.2026.7432

Key Points

Question  What factors most affect health care professionals’ decisions when selecting infection prevention and control practices for hospital-acquired infections across different contexts?

Findings  In this survey study including 256 health care professionals, cost-effectiveness was consistently the most important factor associated with adoption, while implementation duration was least important. Two latent classes identified were evidence seekers from low- and middle-income countries who valued strong clinical evidence, and efficiency seekers from high-income countries who prioritized cost-effectiveness.

Meaning  These results suggest there are global contextual differences in preferences for characteristics of infection prevention and control practices that may explain willingness to adopt infection prevention and control practices across settings.

Abstract

Importance  Hospital-acquired infections worsen health care outcomes and increase costs. The decision-making process guiding selection of infection prevention practices for hospital-acquired infections is not well understood; understanding how health care professionals prioritize infection prevention practices is critical for guiding efficient and equitable implementation.

Objective  To determine the characteristics of infection control practices that affect health care professional decision-making.

Design, Setting, and Participants  This survey study was a discrete choice experiment conducted between February 27 and March 27, 2025, with data analyzed from March 28 to June 3, 2025. Health care professionals who had participated in infection prevention and control decision-making identified through authorship in related journals were eligible to participate. Attributes were identified through literature review and expert consultation. Data were analyzed using mixed logit and latent class models. Scenario and relative attribute importance analyses were performed to explore heterogeneity in preferences.

Main Outcome and Measures  Respondents chose between infection control practices varying in 4 attributes: quality of clinical evidence, economic costs and benefits, implementation duration, and additional time required per patient. Preference weights, relative attribute importance, and probability of clinical practice uptake were assessed.

Results  A total of 256 respondents were included (161 male [62.9%]), with a median age group of 40 to 49 years (84 [32.8%]) and mostly from high-income countries (160 [62.5%]). Respondents preferred infection prevention practices with strong clinical evidence, shorter implementation durations, lower time burdens, and favorable cost-effectiveness profiles. Two latent classes were identified: evidence seekers in low- and middle-income countries who prioritized high-quality evidence and showed high willingness to adopt practices, and efficiency seekers, including respondents from high-income countries who were more selective and prioritized cost-effectiveness. Economic costs and benefits were consistently the most important attribute across all regions, with marked regional variation in secondary priorities.

Conclusions and Relevance  In this survey study of health care professionals, preferences for infection control practices varied across income levels and geographic regions, reflecting the need for further research to better understand contextual factors influencing infection prevention and control decision-making, particularly in low- and middle-income settings. Strengthening economic evidence and tailored implementation support may promote sustainable adoption.