Biofilms are highly organized microbial communities embedded within an extracellular polymeric matrix and represent a critical yet underappreciated driver of healthcare-associated infections (HAIs). Their ability to colonize medical devices and host tissues underlies major infections, including central line-associated bloodstream infections, catheter-associated urinary tract infections, ventilator-associated pneumonia, and surgical site infections. Biofilm formation is dynamic, multistage process involving attachment, maturation, and dispersal of microorganisms, each phase reinforcing persistence and therapeutic failure. The matrix impedes immune clearance and antimicrobial penetration, while quorum sensing, metabolic heterogeneity, and persister cell formation further enhance tolerance. Clinically important bacterial and fungal biofilms, particularly those formed by Staphylococcus aureus, Pseudomonas aeruginosa, and Candida species, exhibit resistance far exceeding planktonic cells. Diagnostic limitations obscure true disease burden, and current strategies relying on antimicrobials and device removal remain inadequate amid rising resistance. This manuscript provides comprehensive synthesis of existing and novel strategies to mitigate HAIs, with particular emphasis on translational relevance.
The availability of medical devices (MDs) is commonly viewed as a challenge related to procurement, logistics, or reprocessing. However, recent conflicts, disasters, pandemics, and attacks on healthcare systems have shown that the availability of MDs depends on a broader network of interdependent resources. Disruption to these dependencies may not only compromise the acquisition of new MDs, but also the continued use and reprocessing of existing ones. This recommendation conceptualises MD availability as a system-dependent healthcare capability. Five key dependency domains are proposed to describe the resources and functions required to maintain device availability in degraded conditions. Based on these dependencies, a seven-component adaptive response framework (7R) is presented: Relocate, Rebuy, Rebuild, Rethink, Reduce, Reuse, and Reprocess. Adaptive reprocessing is examined as a representative high-dependency response strategy because it necessitates the coordinated interaction of multiple dependency domains while simultaneously introducing risks relating to infection prevention, functionality, operations, and governance. Rather than eliminating risk, adaptive measures redistribute risk across domains. The proposed framework links dependencies, adaptive response options, reprocessing functions and residual risk, supporting preparedness planning and operational decision-making when conventional standards can no longer be fully maintained.
Despite the greater effort required for reprocessing, reusable endoscopes may be environmentally more beneficial than disposable products, particularly when used frequently and with optimized reprocessing procedures. Single-use endoscopes generate more waste and require more resources per usage but may offer advantages in certain situations with regard to infection prevention and logistical simplicity. It is crucial to carefully weigh environmental considerations, patient safety, practical feasibility, and economic factors. For both systems, sustainability considerations must be taken into account in addition to their targeted, indication-specific use. Facility-specific decisions regarding the use of reusable versus single-use endoscopes require knowledge of the patients being treated, the scope of care, care structures, and procedure-specific risks.
Equipping medical handwashing stations with cold water only as a standard is recommended for the following reasons: contribution to sustainability through a reduced carbon footprint, reduced risk of Legionella spp. proliferation in the drinking water system, elimination of the need to test hot water for Legionella spp., prevention of accidental scalding, reduced skin irritation, and cost savings – all while achieving the same reduction of transient skin flora as with warm water.
Aim: During the COVID-19 pandemic, quarantine measures were widely implemented and may have contributed to perceived discrimination. However, empirical evidence on its prevalence and associated factors remains limited. This study aimed to assess perceived discrimination in workplace and private contexts during quarantine and to identify associated factors. Methods: Data from 3,853 participants of the CoCo-Fact cohort study (Cologne Corona counselling and support for index and contact persons during the quarantine period) in Cologne, Germany were analysed. Perceived discrimination was assessed using a single-item measure (yes/partly/no), complemented by qualitative free-text responses. Logistic regression models were used to identify associated factors. Results: Perceived discrimination was reported by 5.3% of participants in the workplace and by 6.9% in private life. Workplace discrimination was primarily organisational or economic, while private-life discrimination was predominantly psychosocial. Associated factors included migrant background, higher psychological distress, and lower coping skills. Additional factors associated with private-life discrimination included younger age, higher socioeconomic status, and unemployment. The model explained 8.3% and 14.2% of the variance, respectively. Conclusion: Although overall prevalence was low, vulnerable groups were disproportionately affected. Findings highlight the need for targeted psychosocial and structural support measures in future public health crises.
