Mandatory reporting of healthcare-associated infections: a global comparative policy analysis using Kingdon's multiple streams framework.

BACKGROUND

Healthcare-associated infections (HAIs) impose a substantial burden on healthcare systems worldwide. Despite strong evidence of their impact and preventability, national infection prevention and control (IPC) surveillance systems remain inconsistently implemented. In contrast, the COVID-19 pandemic catalyzed rapid surveillance reforms, highlighting policy conditions that facilitate surveillance-based IPC strategies.

OBJECTIVE

To examine policy factors influencing the implementation of national HAI surveillance and compare the policy window created during COVID-19 with the more limited political attention devoted to HAI surveillance.

METHODS

A qualitative comparative policy analysis was conducted using Kingdon's Multiple Streams Framework. World Health Organization policy documents, peer-reviewed literature, reports from international public health organizations, and selected national policy documents were synthesized to examine how the problem, policy, and political streams influenced the implementation of HAI surveillance.

RESULTS

The problem stream was well established, with extensive evidence of the burden of HAIs. The policy stream was similarly well developed through established surveillance frameworks, whose feasibility was demonstrated during the COVID-19 pandemic. In contrast, the political stream remained comparatively weak, characterized by fragmented political commitment, inconsistent legal mandates, limited public visibility, and variable implementation across countries. Consequently, convergence of the three streams required to sustain a policy window for HAI surveillance remained incomplete.

CONCLUSION

The principal barrier to national HAI surveillance is insufficient alignment of the problem, policy, and political streams rather than a lack of evidence or technical solutions. Strengthening political commitment through legal mandates, sustained investment, governance, and advocacy is essential to institutionalize surveillance systems and strengthen long-term IPC.