Infection Prevention and Early Recognition in Older People in Viet Nam: From Routine Prevention to Atypical Presentation, Safe Escalation and Antimicrobial Stewardship Across Care Settings

LONG-TERM CARE QUALITY & AGE-FRIENDLY CARE QUALITY

Last reviewed: October 2026

An older person develops a chest infection but never develops a high fever. Instead, they become unusually quiet, stop finishing meals and need more help getting out of bed. Another person living with dementia suddenly becomes confused and restless; bacteria are detected in the urine, and the immediate assumption is that they have a urinary tract infection. A third person returns home after hospitalization with an antibiotic, a urinary catheter and several new instructions, but the family is unclear about when the antibiotic should stop, why the catheter is still needed or what changes should prompt urgent reassessment.

These situations illustrate why infection in older people is not simply an infectious-disease issue. It is also a problem of patient safety, functional decline, diagnostic uncertainty, medication safety, caregiver capability, care transitions and system reliability. Prevention matters, but so does recognizing deterioration early. Early recognition matters, but nonspecific changes should not automatically trigger antibiotics. Antibiotics can be lifesaving when serious bacterial infection is present, yet unnecessary exposure can cause harm and contribute to antimicrobial resistance.

The practical challenge across Viet Nam's care continuum is therefore broader than “How do we prevent infection?” A more useful question is:

“How do we reduce avoidable infection, recognize clinically important deterioration early, escalate safely, use antimicrobials responsibly and support recovery without creating preventable harm?”

Infection prevention is a quality-and-safety system, not simply hand hygiene

Hand hygiene is fundamental, but infection prevention and control, or IPC, is much broader. WHO's Global Strategy on Infection Prevention and Control and the Global Action Plan and Monitoring Framework on Infection Prevention and Control, 2024–2030 position IPC as a core component of patient and health-worker safety, health-care quality, antimicrobial-resistance prevention and health-system resilience.

For older people, this systems perspective is particularly important. Infection risk can accumulate through frailty, multimorbidity, impaired mobility, malnutrition, dysphagia, incontinence, skin breakdown, cognitive impairment, frequent health-care contact, invasive devices and dependence on other people for everyday care. Prevention may therefore involve hand hygiene, respiratory precautions, appropriate environmental cleaning, oral care, skin and wound care, safe continence care, food and water hygiene, vaccination where appropriate, nutrition and hydration, and minimizing unnecessary invasive devices.

No single intervention can compensate for failure elsewhere. A service may have excellent hand-hygiene compliance but still expose people to avoidable risk if urinary catheters remain in place without a continuing indication, equipment cleaning is unreliable, respiratory deterioration is missed, outbreak procedures are weak or antibiotics are started without adequate diagnostic review.

This systems view is supported by important new evidence. A 2026 systematic review in The Lancet Healthy Longevity, conducted to inform WHO work on infection prevention in long-term care, included 25 studies. The most consistent evidence favored multifaceted interventions, particularly approaches using WHO's multimodal improvement strategy. Evidence for several individual interventions—including education, hand-hygiene improvement, oral-care improvement, air-quality approaches, decolonization and surveillance—was less conclusive when considered separately. The evidence base also had important limitations, including high or unclear risk of bias, substantial heterogeneity and heavy reliance on studies from high-income settings.

The practical lesson is not that individual IPC measures are unimportant. It is that infection prevention works best when those measures operate together as a reliable system adapted to the actual care setting.

Viet Nam already has important foundations, but their legal scope matters

Viet Nam has several important regulatory and professional foundations relevant to infection prevention, but they do not all apply to the same settings.

Circular No. 16/2018/TT-BYT regulates infection prevention and control in medical examination and treatment establishments and remains in force as of October 2026. It applies to public and private medical examination and treatment establishments and addresses IPC organization, surveillance of health-care-associated infections, hand hygiene, standard and transmission-based precautions, personal protective equipment, environmental hygiene, management of equipment and waste, and preparedness for infectious-disease outbreaks.

This is an important legal foundation for hospitals, clinics and other medical examination and treatment establishments. It should not, however, automatically be presented as the governing IPC regulation for every residential or social-care organization supporting older people. The applicable legal obligations depend on the organization's legal status, the services it actually provides and whether it operates as a medical examination and treatment establishment under Vietnamese law.

For home and community care, Ministry of Health Decision No. 1976/QĐ-BYT of 1 July 2026 provides a different but highly relevant foundation. Infection-prevention practices such as hand hygiene, use of gloves or masks where appropriate and cleaning procedures appear within practical instructions for everyday care. The guidance also recognizes sudden confusion as potentially related to acute causes including infection.

Decision 1976 is not a comprehensive infection-control guideline. Its importance is different: it embeds infection prevention and recognition of acute change within ordinary care of older people at home and in the community rather than treating infection safety as something that begins only inside a hospital.

Vietnamese evidence highlights the importance of device-related infection

Nationally representative evidence describing infection specifically among older people across hospitals, homes, community services and long-term care remains limited. Most available Vietnamese studies are facility-based and should not be converted into national prevalence estimates.

A 2026 study from the intensive care department of the National Geriatric Hospital examined 138 patients with urinary catheters. Using the study's definitions, the researchers reported a catheter-associated urinary tract infection rate of 31.68%, equivalent to 34.2 cases per 1,000 catheter-days. Longer catheter duration was associated with a substantially higher likelihood of CAUTI in that selected ICU population.

These findings should not be generalized to all older people, all Vietnamese hospitals or community settings. They do, however, reinforce a fundamental quality principle:

The safest catheter is often one that is not inserted without a clear indication, or one that is removed as soon as that indication no longer exists.

The same logic applies more broadly to invasive devices. A device may be clinically necessary, but its indication, correct use, monitoring and continuing need should be reviewed rather than assumed.

Device-related infection prevention therefore begins with a simple question:

“Does this person still need this device?”

Older people may not present with infection in the expected way

Early recognition becomes more difficult when infection does not produce a textbook presentation.

An older person with pneumonia may not develop high fever or dramatic respiratory symptoms. Viet Nam's 2026 Ministry of Health professional guideline on community-acquired pneumonia in adults specifically notes that clinical manifestations may be less pronounced in older or immunocompromised people and that fever may be absent.

That matters because families and care workers may wait for a high temperature before seeking help, while clinicians may also be falsely reassured by its absence. In some older people, a meaningful change from baseline can be as important as one classical symptom.

New or worsening breathlessness, cough, reduced intake, lethargy, acute confusion or sudden functional decline may accompany infection. But these changes are nonspecific. Dehydration, medication effects, hypoglycemia, pain, constipation, stroke and many other conditions can produce similar deterioration.

This creates one of the central tensions in infection care for older people:

Atypical presentation should increase clinical attention, not lower the threshold for indiscriminate antibiotic prescribing.

Acute confusion can signal infection, but infection is not the only explanation

An older person who suddenly becomes confused needs assessment.

Decision 1976/QĐ-BYT identifies infection among the possible causes of acute confusion in older people. Internationally, WHO is currently developing its first global guideline on the prevention, diagnosis and management of delirium in older adults, including medication safety and deprescribing. WHO's current guideline-development materials identify infection, dehydration, medication-related factors, environmental stressors and other acute physiological disturbances among important potential precipitants.

The reasoning should nevertheless not stop at “confusion equals infection.” Delirium is a clinical syndrome with many possible causes, and several contributors may coexist.

This becomes particularly important when urine testing is involved. Bacteria may be present in the urine of an older person who has no symptomatic urinary infection. If bacteriuria is automatically accepted as the explanation for delirium, another important diagnosis may be missed while the person is exposed to unnecessary antibiotics.

A safer sequence is:

recognize acute change → assess the whole person → consider infection and other causes → assess severity → investigate selectively → treat what is clinically supported → reassess.

The goal is early recognition without early diagnostic anchoring.

Bacteriuria is not the same thing as symptomatic urinary tract infection

Urinary tract infection is one of the clearest examples of where diagnostic stewardship and antimicrobial stewardship meet.

Asymptomatic bacteriuria means bacteria are present in the urine without signs or symptoms attributable to urinary infection. It becomes more common in older populations, particularly among people living in long-term care and those with urinary devices. Its presence alone does not establish symptomatic UTI.

The Infectious Diseases Society of America recommends against screening for or treating asymptomatic bacteriuria in functionally impaired older community-dwelling adults and older residents of long-term care facilities, except in defined circumstances such as before certain invasive urological procedures. In older people with bacteriuria and delirium but without local urinary symptoms or systemic evidence suggesting infection, the guideline recommends assessment for other causes and careful observation rather than automatically attributing delirium to UTI and prescribing antibiotics.

A 2026 scoping review of antimicrobial stewardship in long-term care reinforces this concern. Across 74 included studies, overdiagnosis and treatment of asymptomatic bacteriuria remained important drivers of unnecessary antimicrobial exposure. Diagnostic uncertainty, poor documentation, inadequate review processes, gaps in knowledge and inconsistent adherence to evidence-based guidance also contributed.

This does not mean that urinary tract infections in older people are unimportant. Symptomatic UTI can become severe and requires timely assessment and treatment.

The distinction is more precise:

Do not treat a laboratory finding instead of treating the person.

Respiratory infection prevention begins before pneumonia appears

Respiratory infection risk in older people often develops through several interacting factors.

An older person may have chronic respiratory disease, impaired cough, poor mobility, dysphagia, reduced oral hygiene or dependence on another person for feeding. Someone recovering from stroke may aspirate food or oral secretions. A frail person who spends prolonged periods in bed may have difficulty clearing secretions. Shared residential environments can also facilitate transmission of respiratory pathogens.

Prevention therefore extends beyond masks and hand hygiene. Depending on the individual, oral care, swallowing assessment, safer feeding, mobility, positioning, smoking cessation, chronic-disease management and vaccination may all be relevant.

Viet Nam's 2026 national guideline on community-acquired pneumonia in adults recognizes older age and chronic disease among important risk factors, acknowledges that impaired airway protection can increase aspiration risk and includes vaccination among preventive measures in accordance with current Ministry of Health guidance.

This illustrates why infection prevention belongs within integrated older-person care. Oral health, dysphagia, nutrition, mobility and respiratory safety may look like separate clinical topics, but they often converge in the same person.

Vaccination matters, but older-adult vaccination should not be confused with the current Expanded Programme on Immunization

Vaccination can be an important component of infection prevention in later life, but advice should be based on current Vietnamese guidance, the person's age and clinical risk, vaccination history, licensed product indications, availability and financing.

One policy distinction is particularly important in 2026. Viet Nam is expanding its National Expanded Programme on Immunization, including pneumococcal vaccination. However, the pneumococcal rollout under the current 2026–2028 EPI plan is directed toward children, not older adults. The broader program during this period focuses primarily on immunization for children and pregnant women, with HPV vaccination for eligible girls in the relevant implementation areas.

This should therefore not be described as a national pneumococcal vaccination program for older people.

Older adults may have access to vaccines through other vaccination services, and particular vaccines may be clinically appropriate according to individual risk, current professional guidance and licensed product indications. Access through voluntary or other services, however, is different from inclusion in a publicly funded national immunization program specifically for older adults.

The quality question for an older-person service is therefore not simply “Do we provide vaccines?” It is:

“Do we review vaccination history and provide accurate, current advice based on the person's clinical risk and the Vietnamese recommendations and services that actually apply?”

This distinction matters because importing another country's older-adult immunization schedule without checking the Vietnamese policy, availability and financing context can create inaccurate expectations.

Prevention at home should be practical

A family caring for an older person does not need to turn the home into an acute-care isolation unit. It does need a small number of reliable and understandable practices.

These may include appropriate hand hygiene, safe assistance with continence, cleaning of frequently used care equipment, respiratory hygiene, appropriate use of protective equipment in relevant situations and knowing when a change in the older person's condition needs professional assessment.

Decision 1976/QĐ-BYT provides a useful local foundation because infection-prevention steps such as hand hygiene, gloves, masks and cleaning appear within practical care procedures for older people at home and in the community.

Implementation also needs to consider the caregiver. Asking one family member to perform technically demanding infection-control procedures without adequate training, supplies or support does not create a safe system. Prevention plans need to reflect the actual home environment, water and sanitation, available equipment, caregiver capability and the older person's preferences.

The aim is not to make family life clinical. It is to reduce avoidable risk while keeping care feasible, respectful and sustainable.

Safe escalation means knowing when routine care is no longer enough

Not every infection requires hospitalization, but delayed escalation can be dangerous in a frail older person.

New or rapidly worsening breathlessness, cyanosis, marked reduction in consciousness, hemodynamic instability, inability to maintain oral intake, severe dehydration, persistent acute confusion or other signs of significant systemic deterioration require prompt clinical assessment. A sudden loss of previously stable function or a fall occurring together with acute illness should also prompt consideration of an underlying medical problem rather than simply being recorded as another geriatric event.

When sepsis or another serious bacterial infection is suspected, antimicrobial stewardship does not mean delaying necessary treatment. Appropriate specimens should be obtained before antibiotics when clinically feasible and when doing so will not create a harmful delay, but seriously ill patients require timely assessment, stabilization and empiric treatment based on the likely source, severity, applicable clinical guidance and available microbiological information.

Good stewardship therefore has two equally important sides:

Do not give antibiotics when they are unlikely to benefit the person, and do not delay effective antibiotics when serious bacterial infection is likely.

Antimicrobial stewardship is part of patient safety

Antimicrobial resistance is not an abstract future problem for Viet Nam. The National Strategy for Prevention and Control of Antimicrobial Resistance for 2023–2030, with a vision to 2045, places responsible antimicrobial use, infection prevention, surveillance and prevention of infectious disease within the national response.

At hospital level, Ministry of Health Decision No. 5631/QĐ-BYT provides detailed guidance on antibiotic-use management. Among other measures, it supports obtaining microbiological specimens before antibiotics when feasible, reviewing empirical therapy when clinical and microbiological information become available, de-escalating treatment, discontinuing antibiotics when there is insufficient evidence of infection and reviewing therapy at approximately 48–72 hours. It also addresses appropriate conversion from intravenous to oral therapy.

For older people, these principles need an additional geriatric lens. Renal and hepatic function, frailty, allergy history, recent antibiotic exposure, swallowing ability, drug interactions and vulnerability to treatment-related adverse effects can all influence antimicrobial choice and dosing.

The “right antibiotic” is therefore not simply the drug to which an organism appears susceptible. It is the treatment that is appropriate for the person, infection, likely or confirmed organism, organ function, other medicines and care setting.

Stewardship should ask:

Does this person actually have an infection requiring antibiotics? What is the likely source? Is the initial choice appropriate for severity and individual risk? What do the microbiology results show? Can treatment be narrowed, changed, switched from intravenous to oral therapy, shortened or stopped?

A prescription without a review point is an incomplete stewardship plan.

Hospitals need IPC and antimicrobial stewardship to function together

IPC and antimicrobial stewardship should not operate as separate hospital projects.

Circular 16/2018/TT-BYT provides the organizational framework for infection prevention and control in medical examination and treatment establishments. Decision 5631/QĐ-BYT provides a framework for hospital antibiotic-use management. Viet Nam's national antimicrobial-resistance strategy connects both functions within a broader national response.

The relationship is straightforward. Better IPC can prevent infections and therefore reduce the need for antibiotics. Better antimicrobial stewardship can reduce unnecessary antimicrobial exposure, adverse effects and selection pressure. Surveillance helps identify infection patterns and antimicrobial resistance. Microbiology supports diagnosis and de-escalation. Quality-improvement systems connect those data back to clinical practice.

Older people can be particularly affected when these systems fail because both infection and treatment-related harm can rapidly influence cognition, mobility, nutrition and independence.

Long-term care needs an IPC system before an outbreak occurs

Residential long-term care has a distinctive challenge. It is a living environment, but for many residents it is also where substantial personal and health-related care occurs.

The solution is not to transform a home-like setting into a hospital. Yet communal living, close-contact personal care, cognitive impairment, dependency, shared staff and frequent movement between hospitals and facilities can allow infections to spread rapidly when prevention systems are weak.

A long-term-care IPC system should therefore be proportionate to the setting but reliable. Responsibilities need to be clear. Staff need access to appropriate hand-hygiene and protective supplies. Environmental and equipment hygiene need consistent processes. Services need plans for respiratory and gastrointestinal outbreaks, mechanisms for recognizing deterioration and workable pathways for clinical assessment and transfer.

The 2026 Lancet Healthy Longevity review is important here because it suggests that multifaceted implementation approaches are more promising than relying on isolated education alone. At the same time, the evidence is not strong enough to justify mechanically importing a foreign nursing-home protocol into Viet Nam. Staffing models, physical environments, professional support, resources and resident needs differ.

WHO's draft Global Standards for Long-Term Care are also currently under public consultation, which remains open until 30 October 2026. They represent WHO's first global standards framework under development for long-term care, addressing areas including home and community care, facility-based care, support for unpaid carers, workforce, financing, governance and quality monitoring. They are consultation drafts, not finalized standards, and should not be presented as binding requirements.

The broader direction is nevertheless important: long-term care is increasingly being treated internationally as a quality-governance system, not merely a collection of caregiving tasks.

The legal obligations of a long-term-care organization depend on the services it actually provides

This distinction is particularly important in Viet Nam.

The Law on Medical Examination and Treatment and related regulations establish a licensing framework for medical examination and treatment establishments. A residential or social-care organization does not automatically become such an establishment merely because older residents need health-related support.

Some long-term-care models may combine accommodation, personal assistance, nursing support and licensed medical services. Where medical examination and treatment services that require licensing are actually provided, the organization needs to understand and comply with the legal requirements applicable to those services.

The governance questions are therefore:

What does Vietnamese law require of this organization? What health-care services is it legally authorized to provide? And what additional evidence-based infection-safety practices should it adopt because residents need them, even when those practices go beyond minimum legal compliance?

Good governance starts by distinguishing legal compliance from quality improvement.

Infection information must survive the care transition

An infection can be managed well in hospital and still become a safety problem after discharge if the necessary information does not travel with the person.

A rehabilitation service, residential facility or family may need to know what infection was suspected or confirmed, whether an organism was identified, whether antimicrobial resistance is relevant, which antimicrobial is being used, the intended duration, whether microbiological results are still pending, what devices remain in place and what changes should prompt reassessment.

If transmission-based precautions remain relevant, those also need to be communicated in a form the receiving setting can realistically implement.

The same principle works in the opposite direction. When someone moves from home or long-term care to hospital, clinicians benefit from knowing the person's baseline cognitive and functional status, recent antimicrobial exposure, previous resistant organisms, current devices, recent infections and the change that triggered transfer.

A new confusion state is difficult to interpret if nobody knows what “normal yesterday” looked like.

Recovery from infection includes recovery of function

An infection can be clinically controlled while the older person remains substantially worse.

Several days in bed may lead to weakness and deconditioning. Delirium may continue after the infection begins to improve. Appetite and weight may decline. Mobility may deteriorate. Someone who walked independently before pneumonia may leave hospital requiring help with transfers.

Infection management should therefore not end with:

“Antibiotic course completed.”

Reassessment should ask whether the person has regained their previous mobility, cognition, nutritional intake and ability to perform everyday activities; whether rehabilitation is needed; and whether family caregivers can safely manage any new level of dependency.

For some older people, an infection is the event that reveals previously unrecognized frailty. For others, it precipitates a lasting increase in care needs.

The quality outcome is therefore not simply survival, resolution of symptoms or microbiological response. It includes how well the person recovers the ability to function and participate in everyday life.

Measurement needs more than infection counts

Hospitals and long-term-care organizations need infection data, but raw counts alone can be misleading. A service caring for people with severe frailty, urinary catheters, feeding devices or complex wounds has a different risk profile from a community day-care program.

Measures therefore need appropriate denominators, context and exposure.

Useful indicators may include device-associated infection rates, catheter utilization, reliability of key IPC practices, outbreaks, antimicrobial starts, microbiological testing practices, antibiotic review at 48–72 hours, de-escalation or discontinuation where appropriate, hospital transfers because of infection and assessment of post-infection functional decline.

Diagnostic quality also matters. If every resident with confusion undergoes urine testing and every bacteriuria finding leads to antibiotics, the service may appear highly responsive while actually creating a diagnostic and stewardship problem.

Measurement should therefore answer more than:

“How many infections occurred?”

It should also ask:

“Was prevention reliable? Was deterioration recognized appropriately? Was testing clinically justified? Was antimicrobial treatment necessary and reviewed? And did the person recover safely?”

A practical infection-safety framework for Viet Nam

Viet Nam does not need to wait for one comprehensive geriatric infection guideline before strengthening infection-related quality across older-person services. Existing Vietnamese regulations and professional guidance, WHO IPC frameworks, national antimicrobial-resistance policy and emerging long-term-care evidence already provide important building blocks.

Routine prevention should use layered IPC appropriate to the setting: reliable hand hygiene, respiratory precautions where indicated, environmental and equipment hygiene, oral and skin care, safe continence care and minimization of unnecessary invasive devices. Vaccination review should follow current Vietnamese guidance, product indications, individual clinical risk, availability and financing rather than assuming that every older adult is covered by one national immunization schedule.

Early recognition should pay attention to meaningful changes from baseline as well as classical symptoms. Fever may be absent, but nonspecific deterioration is not proof of infection. Assessment and escalation should distinguish illness that can be managed safely in routine care from deterioration requiring urgent clinical review.

Diagnostic stewardship should avoid testing without a meaningful clinical question and avoid treating colonization or asymptomatic findings as disease. Antimicrobial stewardship should balance timely treatment of serious bacterial infection with appropriate specimen collection, selection of the right drug and dose, reassessment, de-escalation, intravenous-to-oral conversion and discontinuation when bacterial infection is not supported.

Transition management should carry relevant infection, microbiology, antimicrobial and device information between settings. Recovery planning should consider mobility, cognition, nutrition, rehabilitation and caregiver needs after acute illness. Measurement and learning should show whether the system reliably prevents avoidable infections, recognizes deterioration, treats infection appropriately and learns from failures.

These elements only work when they operate together. Hand hygiene cannot compensate for an unnecessary catheter. Bacteriuria cannot substitute for a clinical diagnosis. Antibiotics cannot compensate for delayed recognition of deterioration. Stewardship cannot mean withholding urgent treatment from someone with a serious bacterial infection. And a good hospital plan cannot protect an older person if nobody understands how that plan should continue after discharge.

From preventing infection to protecting function and dignity

For an older person, infection prevention is not simply about avoiding microorganisms. It is about avoiding a pneumonia that turns independent walking into prolonged dependency, preventing a catheter-associated infection that contributes to delirium and hospitalization, or recognizing deterioration early enough that a manageable illness does not become a crisis.

For families, safe infection care means knowing what changes matter without being expected to diagnose infection themselves. For hospitals, it means integrating IPC, diagnostic reasoning, antimicrobial stewardship and functional recovery. For home and community services, it means practical prevention and clear escalation pathways. For long-term care, it means making infection safety part of everyday governance rather than something activated only when an outbreak begins.

As Viet Nam develops a more integrated continuum of care for older people, the question should therefore not simply be:

“Did we prevent infection?”

A more meaningful question is:

“Did we reduce avoidable risk, recognize meaningful deterioration early, investigate appropriately, escalate safely, use antimicrobials responsibly and help this older person recover without creating preventable harm?”

That is the difference between infection control as a collection of tasks and infection safety as part of high-quality older-person care.

References

1. World Health Organization. Long-term care for older people: package for universal health coverage. Geneva: World Health Organization; 2024.

2. World Health Organization. Global strategy on infection prevention and control. Geneva: World Health Organization; 2023.

3. World Health Organization. Global action plan and monitoring framework on infection prevention and control, 2024–2030. Geneva: World Health Organization; 2024.

4. Gozdzielewska L, Andrews R, Collins J, Hill G, Hooker E, Kc D, et al. Effectiveness of infection prevention and control interventions in reducing health-care-associated infections in long-term care facilities for older people: a systematic review. The Lancet Healthy Longevity. 2026;7(6):100859.

5. World Health Organization. Global Standards for Long-Term Care: consultation draft. Geneva: World Health Organization; 2026.

6. World Health Organization. WHO guideline on the prevention, diagnosis and management of delirium in older adults, including medication safety and deprescribing: guideline development process. Geneva: World Health Organization; 2026.

7. National Assembly of Viet Nam. Law No. 15/2023/QH15 on Medical Examination and Treatment. 9 January 2023.

8. Ministry of Health of Viet Nam. Circular No. 16/2018/TT-BYT regulating infection prevention and control in medical examination and treatment establishments. 20 July 2018.

9. Ministry of Health of Viet Nam. Decision No. 1976/QĐ-BYT issuing professional guidance on care for older people at home and in the community. 1 July 2026.

10. Ministry of Health of Viet Nam. Decision No. 2147/QĐ-BYT issuing the professional guideline on diagnosis and treatment of community-acquired pneumonia in adults. 15 July 2026.

11. Ministry of Health of Viet Nam. Decision No. 5631/QĐ-BYT issuing guidance on management of antibiotic use in hospitals. 31 December 2020.

12. Prime Minister of Viet Nam. Decision No. 1121/QĐ-TTg approving the National Strategy for Prevention and Control of Antimicrobial Resistance in Viet Nam for 2023–2030, with a vision to 2045. 25 September 2023.

13. Ministry of Health of Viet Nam. Decision No. 2780/QĐ-BYT issuing the Expanded Programme on Immunization Plan for 2026–2028. 29 August 2025.

14. Mai Trung Duc, Nguyen Tuan Anh, Nguyen Dinh Quan, Ngo Trong Toan, Nguyen Trung Anh. Current situation of catheter-associated urinary tract infection in the Intensive Care Department of National Geriatric Hospital in 2024–2025. Vietnam Journal of Community Medicine. 2026;67(Special Issue 3).

15. Chand S, Davidson AR, Megaw P, Morgan M, Jones C, Dent E. Antimicrobial stewardship in long-term care facilities: A scoping review of prevalence, key concepts, and gaps in the management of suspected urinary tract infections. Archives of Gerontology and Geriatrics. 2026;146:106231.

16. Nicolle LE, Gupta K, Bradley SF, Colgan R, DeMuri GP, Drekonja D, et al. Clinical Practice Guideline for the Management of Asymptomatic Bacteriuria: 2019 Update by the Infectious Diseases Society of America. Clinical Infectious Diseases. 2019;68(10):e83–e110.