Publication date: Jan 31, 2025

It is crucial to quantify the impact of healthcare associated COVID-19 infections (HAI) and the resulting mortality to evaluate the requirement for implementing infection prevention and control strategies within the healthcare setting. To investigate the occurrence of HAI and associated mortality among hospitalised patients in Norway. A retrospective registry-based study was conducted using national health data in Norway. The study included patients hospitalised between January 1, 2019, and January 1, 2023, comparing those with HAI and community-associated COVID-19 infections (CAI). 54,885 COVID-19 cases were identified, of which 1,188 cases met our HAI definition. 742 hospitalised patients with HAI were matched to 2583 hospitalised patients diagnosed with COVID-19 at a later stage by age, sex, length of stay, and hospital unit. A HAI was defined as a registered positive SARS-CoV-2 test at least 7 days after hospitalisation, but before hospital discharge. The primary outcome was 365-day mortality, categorised by HAI or CAI status, quantified by cox regression and adjusted for age, sex and diagnoses. Secondary outcomes included mortality variations based on vaccination status and causes of death. Mortality rates were consistently higher among HAI patients compared to CAI patients, the difference being highest shortly after infection. Vaccination significantly reduced all-cause and COVID-19 mortality risk. HAI consistently led to higher mortality than CAI, especially during the Omicron phase. Vaccination effectively reduced mortality across both groups. These findings emphasise the importance of infection prevention and control (IPC) measures and vaccination in mitigating the impact of healthcare-associated infections.

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