Healthcare-associated infections in home care settings: a systematic review of prevalence, risk factors, and prevention strategies

Background Early hospital discharge has shifted complex care to domestic settings, increasing the risk of Healthcare-Associated Infections (HAIs). This review evaluates home care HAI prevalence, risk factors, and preventive challenges. Methods Following PRISMA guidelines, a systematic search identified original studies on adult home care patients. Methodological quality was assessed using the RTI Item Bank and MMAT. Results Ten studies were included in the narrative synthesis. Findings suggest that the overall prevalence of HAIs in the home care setting varies widely depending on reporting criteria and specific populations, also highlighting a critical epidemiological shift. In fact, up to 56% of home-managed HAIs were imported from previous hospitalizations thus actively introducing Multidrug-Resistant Organisms (MDROs)—such as ESBL-producing E. coli and Clostridium difficile —into the community setting. The prolonged use of invasive medical devices (e.g., urinary catheters, implantable ports), combined with severe chronic comorbidities like dementia, diabetes, and hypoalbuminemia, strongly amplifies infection risks. Furthermore, adherence to standard Infection Prevention and Control (IPC) protocols is frequently hindered by structural barriers, including a lack of cleanliness (85.4%) and space (77.1%). In this unregulated setting, the capability and education of informal caregivers act as primary determinants of infection outcomes. Conclusion The home care environment is increasingly vulnerable to severe HAIs. Mitigating these risks requires the development of setting-specific IPC guidelines and the formal integration of caregiver education into public health policies. Systematic review registration https://www.crd.york.ac.uk/PROSPERO/view/CRD42024594811 , identifier PROSPERO (CRD42024594811).