INTRODUCTION:Surveillance of healthcare associated infections is core to infection prevention and control however traditional methods are manual and resource intensive. Digital solutions may reduce workload and improve responsiveness, but design elements and their impact remain poorly understood. This review aimed to identify clinical and technical design elements used in digital surveillance solutions and associated impacts. METHODS:A systematic search identified original research describing digital healthcare associated infection (HAI) surveillance in hospitals. Studies were included if they incorporated at least one digital element fully developed at time of publication. Data on study characteristics, system features, implementation and outcomes were extracted and a narrative synthesis conducted, with findings mapped to the research questions. RESULTS:Forty-seven studies met the eligibility criteria, most were from Europe (n=28) or the USA (n=10). Design elements were commonly associated with detection, validation, automation and data integration. Digital systems were predominantly internally developed and government funded. HAI outcome reporting was heterogeneous, with limited evaluation of patient impact, implementation or sustainability. System integration into routine clinical practice was rarely described. CONCLUSION:This review identified considerable variation in the clinical and technical design of digital HAI surveillance systems, with limited evidence of integration into clinical practice. While some studies reported improved surveillance efficiency, the absence of patient, quality and safety outcomes means it remains unclear which design approaches deliver the greatest clinical value. Future research should prioritise implementation, clinical integration and patient-centred outcomes to identify digital surveillance designs most likely to improve infection prevention practice and patient care.
BACKGROUND:Carbapenemase-producing Enterobacterales, particularly New Delhi metallo-β-lactamase (NDM) producers, are spreading rapidly in European hospitals despite reinforced control measures. Risk factors specifically associated with hospital carriage of NDM-producing Enterobacterales in France remain poorly defined. We aimed to identify factors independently associated with in-hospital NDM carriage. METHODS:We performed a retrospective, single centre, 1:2 matched case -control study at Avicenne University Hospital (Paris, France) over 2024. Cases were patients with NDM-producing Enterobacterales identified at least three days after admission. Each case was matched to two controls hospitalized in the same ward, during the same period, with a comparable length of stay and at least two negative rectal screenings. Clinical, demographic, and epidemiological variables were analyzed using conditional logistic regression. RESULTS:Seventy-two cases were matched to 144 controls. In multivariable analysis, NDM carriage was independently associated with a Charlson comorbidity index ≥5 (adjusted odds ratio [aOR] 2.84, 95% CI 1.30-6.19), prior surgery (aOR 2.92, 95% CI 1.47-8.44), endoscopic procedures during hospitalization (aOR 3.52, 95% CI 1.47-8.44), recent travel abroad (aOR 3.58, 95% CI 1.41-9.13), and hospitalization in two or more epidemic wards during the same year (aOR 5.85, 95% CI 1.84-18.55). CONCLUSION:Carriage of NDM-producing Enterobacterales results from the interplay between patient vulnerability, invasive procedures, international exposure, and intra-hospital transmission dynamics. These findings support targeted screening strategies and reinforced infection prevention measures for high-risk patients, particularly those undergoing invasive procedures or transferred between epidemic wards.
BACKGROUND:Candida auris is a multidrug-resistant yeast classified by the World Health Organization as a critical priority fungal pathogen. Following the first case notified through the national surveillance system in February 2023, nationally notified infections have risen rapidly. We aimed to describe the epidemiology, risk factors, infection profiles, and outcomes of C. auris infections captured by the national healthcare-associated infection (HAI) surveillance system in Türkiye. METHODS:We analysed all C. auris infections reported to INFLINE, Türkiye's national HAI surveillance system, between 12 February 2023 and 31 December 2025. Variables included patient demographics, hospital and unit type, geographic distribution, invasive device exposures, infection type, co-pathogens, and discharge status. RESULTS:A total of 2,829 C. auris infections were reported from 54 of 81 provinces, with annual counts rising from 179 (2023) to 1,924 (2025). Most infections occurred in intensive care units (86.6%), predominantly as bloodstream infection (96.6%), of which 76.4% were central line-associated. C. auris was the sole pathogen in 81.1% of cases; 18.9% were polymicrobial. Common device exposures included urinary catheter (71.2%), central line catheter (66.4%), and mechanical ventilation (54.9%). In-hospital mortality was 49.8% overall; among those with a recorded outcome (n=1,894), 74.4%, with outcome data missing for 33.1% of cases. CONCLUSIONS:C. auris has rapidly established itself as a significant nosocomial pathogen in Türkiye, predominantly affecting critically ill ICU patients. National responses include publication of a prevention and control guide, strengthened diagnostic capacity, infection control committee training, and integration of C. auris into the National Antimicrobial Resistance Action Plan.
BACKGROUND:The growing use of extracorporeal membrane oxygenation (ECMO) has brought attention to therapy-related complications. This study analysed the epidemiological profile and factors associated with healthcare-associated infections (HAI) in adult and paediatric patients on ECMO. METHODS:A retrospective cohort study was conducted including patients who received ECMO therapy. The evaluation included comorbidities, prior antibiotic exposure, and ECMO-related parameters. The outcome was the occurrence of HAI during ECMO therapy, for which the clinical and microbiological profiles were described. Multivariable binomial regression was performed only in adult patients to identify factors independently associated with HAI. RESULTS:173 patients (124 adults and 49 children) were included. Veno-arterial ECMO was the predominant mode (68.2%), and HAI emerged as the most frequent complication, especially among adults (64.5% vs. 20.4% in children). Among non-infectious complications, haemorrhagic complications (25.0%) were the most frequent in adults, while haemorrhagic complications and arterial thrombosis predominated in paediatric patients (10.2% each). Ventilator-associated pneumonia was the leading type of infection (31.1 cases/1,000 ECMO-days), mainly caused by Klebsiella pneumoniae, Pseudomonas aeruginosa, Serratia spp., and Staphylococcus aureus. Factors independently associated with HAI in adults included antibiotic use before ECMO initiation (RR:1.25; 95%CI:1.13-1.39), increased time on mechanical ventilation (RR:1.31; 95%CI:1.16-1.47), and prolonged ECMO support (RR:1.06; 95%CI:1.02-1.10). CONCLUSION:These findings underscore HAI as a frequent complication of ECMO and a major clinical challenge, highlighting the need for targeted infection control measures and optimized antimicrobial stewardship to improve outcomes in this high-risk population.
Antimicrobial stewardship programmes are central to antimicrobial resistance control, but regional evidence from Asian hospitals remains heterogeneous. We aimed to update evidence on inpatient interventional ASP/AMS studies in Southeast and East Asia and to map intervention components, antibiotic-use outcomes, and resistance outcomes to IDSA/SHEA recommendations, WHO AWaRe categories, and the WHO Bacterial Priority Pathogens List.Medline via PubMed, Embase, and Scopus were searched for studies published from 20 June 2016 to 22 March 2026. Eligible studies were adult inpatient interventional ASP/AMS studies reporting antibiotic consumption, AMR incidence, mortality, or costs/expenditures. Two reviewers independently selected studies, extracted data, and assessed quality or risk of bias. Controlled and interrupted time-series designs were assessed using EPOC criteria; non-controlled before-after studies were assessed using ICROMS. Synthesis was descriptive because of heterogeneity.Thirty-two studies were included. Most were single-centre (29/32, 90.6%) and conducted in China (22/32, 68.8%) or Singapore (6/32, 18.8%). Preauthorization and/or prospective audit and feedback was the most common mapped IDSA/SHEA component (22 studies), followed by education (18 studies), shortest effective duration (13 studies), facility-specific guidelines (9 studies), and computerized clinical decision support (8 studies). Antibiotic-use and cost outcomes were consistently favourable, with AWaRe-classifiable reductions concentrated in Watch and selected Reserve antibiotics. Resistance outcomes were less consistently reported but included reductions in selected WHO critical- and high-priority phenotypes; mortality was generally unchanged.ASPs in Southeast and East Asia are increasingly multifaceted. This combined implementation and public-health mapping identifies progress and highlights gaps in diagnostic stewardship, special populations, and standardized outcome reporting.
BACKGROUND:/Purpose: Environmental surfaces that interface with hand hygiene may serve as underrecognized sites of microbial contamination. Paper-towel dispensers are frequently used but are often excluded from routine cleaning and surveillance. This study aimed to assess the prevalence and burden of bacterial contamination on paper-towel dispensers, compare contamination between manual and touch-free units, and characterize recovered organisms. METHODS:We conducted a cross-sectional environmental surveillance study at a tertiary care hospital, sampling 40 paper-towel dispensers (30 manual, 10 touch-free) in public and staff bathrooms, hallway sinks, public kitchenette/nutrition station areas, and break areas. Dispenser apertures were swabbed using premoistened ESwabs. Samples were cultured on blood agar and assessed semi-quantitatively. Organisms were identified via MALDI-TOF. Contamination prevalence and CFU burden were compared between dispenser types using Fisher's exact and Mann-Whitney U tests. RESULTS:Surveillance cultures identified bacterial contamination in 70% (28/40) of paper-towel dispensers. Contamination was more frequent among manual dispensers than touch-free dispensers (80% vs. 40%; relative risk 2.0, 95% confidence interval 0.92-4.36; Fisher's exact test, P=0.04). The most commonly recovered organisms were Bacillus spp. and Coagulase-negative staphylococci. Organisms of clinical or IPC concern were identified in 14% of dispensers, with most located in the emergency department. No multidrug-resistant organisms were detected. CONCLUSION:Although the findings should be interpreted with caution given the wide confidence interval and exploratory design of the analysis, they indicate that paper-towel dispensers may harbor bacterial contamination at the hand hygiene interface. These observations may guide future environmental hygiene policies and the development of targeted infection prevention interventions in healthcare settings.
BACKGROUND:Whole genome sequencing (WGS) resolves transmission relationships in carbapenemase-producing Enterobacterales (CPE) outbreaks at nucleotide level. Whether this translates into changed infection prevention and control (IPC) practice or improved patient outcomes is unclear. OBJECTIVE:To review IPC actions and patient outcomes arising from WGS-informed CPE outbreak detection. METHODS:We conducted a scoping review, searching MEDLINE, Embase, Web of Science and the Cochrane Library from January 2010 to January 2026. Eligible studies used WGS for CPE outbreak detection or investigation and reported at least one IPC action or clinical outcome. For each, we recorded whether a WGS finding informed the IPC action or whether the action occurred concurrently, without being WGS-driven. RESULTS:Of 4,114 records, 44 studies met the inclusion criteria. WGS findings informed a documented IPC action or resolved suspected transmission in 16 studies (36%) and generated recommendations in a further 5 (11%); in 21 (48%), IPC actions occurred concurrently with a WGS-characterised outbreak but were not attributable to a WGS finding. Outcomes were variably reported: study-specific mortality in 15 studies (34%), with a crude case-fatality range of 0%-75%. Turnaround time was rarely quantified, and no study compared outcomes between WGS-informed and conventional management. Retrospective application (59%) and absent comparator groups limited causal inference. CONCLUSION:WGS for CPE outbreak detection consistently identifies transmission missed by conventional methods, and in a minority of studies demonstrably changed IPC practice. Evidence that it improves patient outcomes remains absent, limited by the lack of comparative designs.
Maintaining high indoor air quality in operating rooms is an important element of surgical site infection prevention. Although ventilation system performance may be assessed using both at-rest and operational measurements, airflow-related tests used for commissioning and acceptance procedures are commonly conducted under controlled conditions without patients or medical staff present. The aim of this study was to evaluate the influence of medical staff presence, patient presence, patient sex, and supply air temperature on air velocity within the surgical microenvironment. Experiments were conducted in a laboratory operating room equipped with unidirectional airflow (UDAF) and mixing ventilation (MV) systems. Sixteen experimental scenarios were analysed, including at-rest conditions, thermal manikins representing medical staff, real volunteers representing patients (female and male patient groups) and supply-air temperatures of 19 °C and 26 °C. Air velocity was measured at five locations within the surgical microenvironment, with the sensors positioned 0.35 m above the operating table surface. The presence of occupants significantly altered local air velocity in both ventilation systems. Depending on the measurement location, differences between occupied and unoccupied conditions reached up to 50% under UDAF ventilation and up to 65% under MV ventilation. The observed changes indicated a redistribution of airflow within the surgical microenvironment rather than a uniform reduction in velocity. Patient sex influenced airflow conditions, particularly under UDAF ventilation at a supply-air temperature of 19 °C. Increasing the supply-air temperature from 19 °C to 26 °C generally reduced air velocity in both systems.
OBJECTIVE:To explore how different compressed air application durations influence biopsy channel drying of flexible endoscopes via borescope visualization, and determine the optimal drying parameters for hospital endoscope reprocessing workstations. METHODS:Seventy-six flexible endoscopes were randomly allocated into four equal groups receiving 35 s, 40 s, 45 s and 50 s of air application at 0.25 MPa air pressure. A 30 s air application group following national Chinese guidelines was set as baseline. We used a borescope to observe residual droplets inside biopsy channels and quantified drying quality with a self-developed Drying Defect Weighted Score (DDWS), where lower scores represent superior dryness. RESULTS:The 30 s baseline group presented massive residual droplets, with a median DDWS of 430 and 0% complete drying rate, failing to reach qualified drying. DDWS decreased markedly with prolonged air application (Z=-9.218, P<0.001). The 45 s group (median DDWS=0) achieved significantly better drying than the 40 s group (median DDWS=29, P=0.001), while no difference existed between the 45 s and 50 s groups (median DDWS=0, P=1.000). ATP bioluminescence detection showed all endoscopes in 45 s and 50 s groups met the <200 RLU standard, with 100% passing rate and no intergroup discrepancy (P=0.243). CONCLUSION:Borescopic objective evaluation indicates that the air application time of workstation under 0.25 MPa pressure should be no less than 45 s to obtain satisfactory biopsy channel drying efficacy.
BACKGROUND:Endoscope-related infections remain a concern despite improved reprocessing protocols. Transport conditions between sampling and analysis may significantly affect sample reliability, yet current guidelines remain imprecise. AIM:To evaluate the stability of endoscope samples collected using a pharmacopoeia diluent neutralizer with sodium thiosulfate (PND + thio) stored at 5 °C ± 3 °C, and to determine the maximum acceptable time before microbiological analysis. METHODS:Artificially contaminated endoscope samples were prepared using four indicator microorganisms (Escherichia coli, Pseudomonas aeruginosa, Staphylococcus aureus, Candida albicans). Samples were stored at 5 °C ± 3 °C and analysed at predefined time points up to 72 hours. Microbial counts were compared to initial values using statistical analysis and ISO 11133 acceptance criteria. FINDINGS:Microbial concentrations remained stable or within acceptable variation ranges up to 48 hours for all tested microorganisms. The presence of neutralizing and surfactant agents appeared to preserve microbial viability and counteract disinfectant residues. CONCLUSION:Endoscope samples collected with PND + thio can be stored up to 48 hours at 5 °C ± 3 °C without compromising microbiological analysis, supporting more flexible and sustainable transport conditions.
BACKGROUND:Residual contaminants in lumen-type medical devices pose infection risks. Conventional white swab detection has a limited detection rate, underscoring the need for a cost-effective on-site screening tool. METHODS:In a single-center, prospective comparative study (Feb-May 2025), 1,100 cleaned orthopedic devices (500 intramedullary nails, 100 flexible bone drills, 500 others) were evaluated pre- and post-cleaning using a luminal visualization system and white swab detection. Outcomes included positive detection rates, time per item, material cost, and contaminant removal rate. RESULTS:Pre-cleaning, positive rates were 63.5% (698/1,100) for visualization vs. 18.9% (208/1,100) for swabs; post-cleaning, 35.2% (387/1,100) vs. 8.5% (94/1,100) (P<0.05). Median detection times were comparable (visualization: 34 s, IQR 20.0-44.0; swab: 32 s, IQR 16.0-38.0). Material cost was significantly lower for visualization (median 1.0 yuan, IQR 0.8-1.0) than for swabs (20.0 yuan, IQR 20.0-20.0) (P<0.05). Overall contaminant removal rate by visualization was 44.6%, highest for nails (68.1%) and lowest for drills (2.0%). CONCLUSION:Luminal visualization offers superior detection rates and significantly lower cost versus white swab detection, supporting its use for on-site screening of lumen device cleaning quality.
BACKGROUND:The hospital environment contributes to the transmission of healthcare-associated infections (HAIs). Probiotic-based cleaning represents an ecological approach aimed at modulating the surface microbiota through bacterial competition rather than eliminate it. OBJECTIVE:To assess whether probiotic cleaning was associated with a change in the incidence density of microbiologically documented healthcare-associated infection (HAI) episodes compared with conventional biocide cleaning. METHODS:A single-centre, quasi-experimental before-and-after study compared two consecutive 12-month cleaning periods. Potential HAI episodes were identified through monthly retrospective extraction of routine laboratory data and adjudicated from medical records using European Centre for Disease Prevention and Control (ECDC) definitions. Incidence densities were expressed per 1,000 patient-days and compared using an exact Poisson rate test. RESULTS:The study included 5,753 hospitalisations, representing 37,511 patient-days during the biocide period and 32,453 during the probiotic period. Among the 475 laboratory-identified potential HAI episodes, 188 episodes during the conventional biocide control period and 117 episodes during the probiotic intervention period met the relevant ECDC criteria for an HAI. Incidence density was lower during the probiotic period (3.61 versus 5.01 episodes per 1,000 patient-days; crude incidence rate ratio, 0.72; 95% confidence interval, 0.57-0.91; p = 0.005), corresponding to an approximately 28% lower crude rate. CONCLUSION:Probiotic cleaning was associated with a lower crude incidence rate of microbiologically documented HAI episodes. Given the non-randomised design, potential residual confounding, and absence of environmental sampling, causal and mechanistic conclusions cannot be drawn. Controlled multicentre studies are needed to confirm these findings.
OBJECTIVES:Methicillin-resistant Staphylococcus aureus (MRSA) carriage at admission to rehabilitation facilities may favour onward transmission, infectious complications, and poorer rehabilitation outcomes. Although individual observational studies have explored associated risk factors, no systematic review and meta-analysis has specifically addressed this issue in rehabilitation settings. METHODS:We performed a systematic review and meta-analysis of observational studies evaluating risk factors for MRSA carriage at admission to rehabilitation facilities. MEDLINE, PubMed, and Embase were searched from inception to 4th February 2025. Studies were eligible if they enrolled patients screened for MRSA at admission and reported quantitative data on associated risk factors. Adjusted effect estimates were preferentially pooled using random-effects models when at least two sufficiently comparable studies were available, whereas crude estimates were analysed separately when adjusted data were unavailable. Because of the small number of included studies and the limited number of studies per comparison, meta-regression by country, calendar period, or screening strategy was not feasible; therefore, pooled estimates were interpreted as exploratory. RESULTS:Six studies were included in both the qualitative and quantitative synthesis. Exploratory adjusted analyses suggested associations between MRSA screening positivity at admission and previous hospitalization, male sex, and previous MRSA carriage/history. Previous MRSA carriage/history showed the largest effect estimate, although heterogeneity was substantial and definitions were not uniform across studies. Crude analyses were reported separately and were considered hypothesis-generating because of potential confounding and heterogeneity in screening protocols. CONCLUSIONS:Available evidence suggests that previous MRSA carriage/history and recent healthcare exposure may help identify patients with increased likelihood of MRSA screening positivity at admission to rehabilitation facilities. However, these findings should be interpreted as exploratory because of heterogeneity in study period, country, screening protocols, and definitions of previous MRSA carriage.
BACKGROUND:Time-related sterility maintenance (TRSM) remains common in Japanese operating rooms, requiring re-sterilisation of unopened supplies at fixed intervals, although microbiological evidence indicates that sterility loss is event-driven, not time-driven. Its avoidable burden remains unquantified. AIM:to quantify the annual cost, carbon dioxide-equivalent (CO2e) emissions, water use, and labour from re-sterilising expired supplies under TRSM, and the upper-bound proportion avoidable by transition to event-related sterility maintenance (ERSM). METHODS:single-centre observational and modelling study integrating a gate-to-gate environmental assessment (a partial boundary rather than a full cradle-to-grave life-cycle assessment), cost-consequence analysis, and discrete-event simulation (DES). A one-month complete census of expired supplies (746 items) was annualised with the institutional modality mix (steam:vaporised hydrogen peroxide [VH2O2]:ethylene oxide [EO] = 8:1:1) and literature-derived emission factors. As re-sterilisation is predominantly co-loaded, costs were allocated as a marginal increment by load factor. A competing-risk DES, with an event-related contamination hazard from five-year data, yielded a modelled upper bound; conservative scenarios retaining re-sterilisation for legitimate non-time triggers (damage, recall, audit, inventory checks) were added. Uncertainty was assessed by probabilistic (Monte Carlo, 5,000 iterations) sensitivity analysis. FINDINGS:An estimated 8,952 items were re-sterilised annually at one 643-bed centre. The avoidable fraction was a modelled upper bound of 99.9% (95% uncertainty interval: 99.6%-100%); under conservative scenarios, 80%-95% remained avoidable. At the upper bound, median avoidable burden was Japanese yen (¥) 1.24 million/year (≈US$8,300), 1,768 kg CO2e/year, 10,727 L of water/year, and 147 h/year. CONCLUSION:TRSM generated approximately 1.8 tonnes of avoidable CO2e, over ¥1 million, and up to 147 h of avoidable labour annually, supporting evaluation of ERSM as a decarbonisation and efficiency measure.
BACKGROUND:Candidozymaauris has emerged as a globally relevant healthcare-associated pathogen characterized by environmental persistence, outbreak potential, and multi-drug resistance. Current yeasticidal disinfectant efficacy testing relies on Candidaalbicans as the standard surrogate organism. However, emerging evidence suggests that susceptibility may vary by clade, active substance, and formulation, questioning the universal adequacy of surrogate-based testing. AIM:The aim of this study was to determine whether C. albicans adequately serves as a surrogate organism for yeasticidal disinfectant efficacy testing against C. auris, with particular focus on oxidative disinfectants, especially peracetic acid-based formulations. METHODS:A stepwise comparative design was applied. Standardized quantitative suspension testing assessed intrinsic susceptibility differences between C. albicans and C. auris using defined active substances. Subsequently, commercially available oxidative disinfectant products were evaluated under standardized application-relevant conditions. C. auris isolates representing different phylogenetic clades were included to assess clade-dependent susceptibility differences. FINDINGS:C. auris showed susceptibility comparable to or greater than that of C. albicans for alcohols, aldehydes, and quaternary ammonium compounds. In contrast, marked differences emerged for peracetic acid-based disinfectants. Several oxidative products demonstrated robust yeasticidal efficacy against all tested organisms, whereas selected peracetic acid-based products showed reduced efficacy against C. auris. The most pronounced differences were observed for clade I isolates. CONCLUSION:Surrogate-based yeasticidal efficacy testing using C. albicans remains appropriate for most disinfectant product groups. However, for selected peracetic acid-based formulations, this approach may not universally provide a reliable assessment. Targeted inclusion of C. auris may therefore refine efficacy testing in selected scenarios.
