Impact of a robotic system for standardized bedside hygiene, surveillance and prevention on healthcare-associated infections and ward microbial pressure: A 24-month real-world study in an acute-care ward

Background Healthcare-associated infections (HAIs) remain a major challenge in acute-care wards caring for frail and dependent patients. Repeated high-contact bedside care may create cumulative opportunities for microbial transfer, particularly in settings with high microbial burden and susceptible patients. Aim To evaluate whether a robotic system for standardized bedside hygiene, surveillance and prevention, designed to standardize and trace high-contact bedside care, was associated with reduced HAIs, lower ward microbial pressure and decreased clinically expressed microbial burden. Methods We conducted a 24-month quasi-experimental before-during-after study in a single acute-care hospital ward. First admissions were recorded from January 2024 to December 2025. Patients admitted with infection or sepsis were excluded, leaving 813 patients at risk: PRE, n = 218; intervention, n = 294; POST, n = 301. The robotic system was implemented by existing ward staff without staffing changes. HAIs were defined as infections occurring at least 48 hours after admission. Ward microbial pressure was assessed using positive microbiological samples. Results Thirty-four HAIs occurred. HAI incidence decreased from 6.88% in PRE to 2.04% during intervention, with partial increase to 4.32% in POST. Compared with PRE, the reduction during intervention was significant by chi-square test with Yates correction (chi-square = 6.28; p = 0.012) and confirmed by segmented Poisson regression. Ward microbial pressure and clinically expressed microbial burden decreased in parallel. Conclusions The robotic system was associated with reduced HAIs, lower ward microbial pressure and reduced clinically expressed microbial burden by improving the reliability and traceability of repeated high-contact bedside care in susceptible patients.