Journal of Hospital Infection最新文献_第7页

First Train-the-Trainers in Hand Hygiene in Uganda: a multilevel evaluation. 乌干达首次手部卫生培训师培训：多层次评价。

IF 3.1 3区医学 Q1 INFECTIOUS DISEASES

Journal of Hospital Infection

Pub Date : 2025-12-03 DOI: 10.1016/j.jhin.2025.11.029

B Aber, E Nyawere, F Owori, E Tartari, C Fankhauser, H M Villarreal, H Saito, D Pittet

引用次数: 0

Measuring dynamic air quality in clean operating rooms using three methods: a prospective study 三种方法测量洁净手术室动态空气质量的前瞻性研究。

IF 3.1 3区医学 Q1 INFECTIOUS DISEASES

Journal of Hospital Infection

Pub Date : 2025-12-03 DOI: 10.1016/j.jhin.2025.11.028

M. Fu , Y. Zhang , J. Hu , M. Lei , K. Gan

Background

perating rooms (ORs) are critical environments where air quality directly impacts surgical site infection (SSI) rates.

Aim

To characterise dynamics of airborne contamination and identify risk factors in operating rooms during surgery.

Methods

A prospective observational study was conducted in three Class III (International Organization for Standardization (ISO) Class 7) clean gastrointestinal (GI) ORs at a tertiary hospital (China–Japan Friendship Hospital, Beijing) between March and April 2025. Thirty consecutive laparoscopic GI surgeries were monitored. Airborne bacteria, settling bacteria, and airborne particle counts were measured at four critical intraoperative phases: turnover–Anaesthesia–Disinfection (T1), Skin Incision (T2), 1 Hour into Surgery (T3), and Wound Closure (T4). Concurrently, personnel numbers and cumulative door openings were recorded.

Findings

Significant temporal variations occurred in all air quality parameters (P < 0.001). Airborne and settling bacteria concentrations peaked significantly at T4, exceeding levels at T2 (P < 0.001) and T3 (P < 0.001). Airborne bacteria at T1 were significantly higher than at T3 (P < 0.001). Particle counts for all sizes were highest at T3, significantly surpassing T1 and T2 (P < 0.001 for 0.3 μm, 0.5 μm, 1.0 μm; P < 0.0083 for others). Door opening frequency was highest at T4 and T1. Overall dynamic air quality compliance was 93.33% (28/30). Compliance was 100% at T2 and T3, 96.67% at T1, and 93.33% at T4.

Conclusion

Cleanroom OR air quality is highly dynamic, with distinct contamination peaks: microbial loads surge during wound closure (T4), while particulate matter peaks mid-surgery (T3). These peaks correlate strongly with increased door openings and activity levels. Current static standards inadequately reflect intraoperative contamination risks. Mandatory real-time dynamic monitoring during high-risk phases (T1, T3, and T4) and stringent protocols to minimise door openings are essential for effective SSI prevention.

目的：了解手术室手术过程中空气污染的动态特征及危险因素。方法：前瞻性观察研究于2025年3 - 4月在某三级医院（北京中日友好医院）的3间III级（ISO 7级）清洁胃肠手术室进行。对30例连续腹腔镜胃肠手术进行监测。在术中四个关键阶段：周转-麻醉-消毒（T1）、皮肤切开（T2）、手术1小时（T3）和伤口闭合（T4）测量空气中细菌、沉淀细菌和空气中颗粒计数。同时，记录人员数量和累计开门次数。结果：所有空气质量参数都发生了显著的时间变化（P < 0.001）。结论：洁净室或手术室的空气质量是高度动态的，具有明显的污染峰：微生物负荷在伤口闭合期间（T4）激增，而颗粒物在手术中期（T3）达到峰值。这些峰值与开门次数和活动水平的增加密切相关。目前的静态标准不能充分反映术中污染风险。在高危期（T1、T3、T4）进行强制性的实时动态监测和严格的手术方案是有效预防手术部位感染的必要条件。

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引用次数: 0

New Disinfectant for Greywater Systems: Evaluation of Antibacterial Activity 新型灰水系统消毒剂：抗菌活性评价。

IF 3.1 3区医学 Q1 INFECTIOUS DISEASES

Journal of Hospital Infection

Pub Date : 2025-12-02 DOI: 10.1016/j.jhin.2025.11.038

D. Castro , I. Ferreri , M. Henriques , I. Carvalho

In favourable environments, micro-organisms can persist or proliferate within biofilms that coat the insides of pipes in greywater systems over extended periods. This study aimed to develop an innovative disinfectant that adheres strongly to poly(vinyl chloride) (PVC) pipes and exhibits superior antibacterial properties. Standard tests and protocols were used to evaluate its effectiveness against biofilms during and before formation. The results showed that the new disinfectant was highly effective against Staphylococcus aureus, Enterococcus hirae, Escherichia coli, Klebsiella pneumoniae and Pseudomonas aeruginosa on PVC surfaces. Notably, its performance surpassed that of commonly used disinfectants. These results suggest that the new disinfectant could effectively and sustainably disinfect greywater system piping, reducing the need for excessive usage of disinfectants.

在有利的环境中，微生物可以在长时间覆盖在灰水系统管道内部的生物膜内持续存在或增殖。本研究旨在开发一种创新的消毒剂，它能牢固地附着在PVC管道上，并具有优异的抗菌性能。采用标准测试和方案评估其在形成和预形成过程中对生物膜的有效性。结果表明，该消毒剂对PVC表面的金黄色葡萄球菌、鼠疫杆菌、大肠杆菌、肺炎克雷伯菌和铜绿假单胞菌均有较好的杀灭效果。值得注意的是，其性能超过了常用的消毒剂。结果表明，该新型消毒液能够有效、可持续地对中水系统管道进行消毒，减少了消毒剂的过量使用。

引用次数: 0

A Before-and-After Study on Hand Hygiene Knowledge, Practices, and Environmental Cleanliness in an Anaesthesia Department Following Educational and Protocol Interventions. 麻醉科手部卫生知识、实践和环境清洁的教育和方案干预前后对比研究。

IF 3.1 3区医学 Q1 INFECTIOUS DISEASES

Journal of Hospital Infection

Pub Date : 2025-12-02 DOI: 10.1016/j.jhin.2025.11.030

Y-C Chen, C-E Liu, Y-L Wu, C-H Yang, J-Y Li, Y-C Lin

Background: Hand hygiene is a key measure to prevent healthcare-associated infections, yet compliance remains low among anaesthesia staff. This study evaluated the impact of hand hygiene education and standardised cleaning protocols on knowledge, behaviour and bacterial contamination in an anaesthesia department.

Methods: A before-and-after study was conducted over 10 months in a medical centre in northern Taiwan. Interventions included hand hygiene training, alcohol-based hand rubs and cleaning with disinfectant wipes. Pre-intervention and postintervention assessments included knowledge questionnaires, hand cultures, adenosine triphosphate (ATP) bioluminescence and environmental agar cultures.

Results: Following the intervention, significant improvements were observed in hand hygiene knowledge, particularly in areas such as the types of micro-organisms effectively eliminated by alcohol-based hand rub, and the recommended duration for effective hand hygiene using both alcohol rub and soap and water (P < 0.01). The number of hands with negative bacterial growth from hand cultures increased from 1 before intervention to 9 post intervention. Frequently isolated organisms included Staphylococcus aureus, coagulase-negative staphylococci (CoNSs) and Gram-positive bacilli. ATP bioluminescence testing demonstrated significant reductions in contamination levels on multiple surfaces, including monitoring devices, the anaesthesia machine, work cart surfaces, computers, the Bair Hugger control panel and hands (P < 0.05).

Conclusion: Educational and environmental interventions can enhance hand hygiene compliance and reduce microbial contamination, supporting infection control in anaesthetic practice.

背景：手部卫生是预防卫生保健相关感染的关键措施，但麻醉人员的依从性仍然很低。本研究评估了手卫生教育和标准化清洁方案对麻醉科知识、行为和细菌污染的影响。方法：在台湾北部某医疗中心进行为期10个月的前后对照研究。干预措施包括手部卫生培训、含酒精的洗手液和用消毒湿巾清洁。干预前和干预后的评估包括知识问卷、手部培养、三磷酸腺苷（ATP）生物发光和环境琼脂培养。结果：干预后，手卫生知识有了显著提高，特别是在使用酒精洗手液有效消除微生物类型、使用酒精洗手液和肥皂水有效洗手的推荐时间等方面（p < 0.01）。手培养细菌生长阴性的手从干预前的1只增加到干预后的9只。经常分离的微生物包括金黄色葡萄球菌、凝固酶阴性葡萄球菌（con）和革兰氏阳性杆菌。ATP生物发光测试显示多个表面的污染水平显著降低，包括监测设备、麻醉机、工作车表面、计算机、hair Hugger控制面板和手（p < 0.05）。结论：教育和环境干预可提高麻醉实践中手卫生依从性，减少微生物污染，支持感染控制。

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引用次数: 0

In vitro and in situ analysis of novel copper-based antimicrobial surface coatings designed to reduce the microbial bioburden of high-touch surfaces in a hospital environment 一种新型铜基抗菌表面涂层的体外和原位分析，旨在减少医院环境中高接触表面的微生物生物负担。

IF 3.1 3区医学 Q1 INFECTIOUS DISEASES

Journal of Hospital Infection

Pub Date : 2025-12-02 DOI: 10.1016/j.jhin.2025.11.032

G. Ackers-Johnson , J.M. Lewis , P. Killen , V. Bellido-Gonzalez , L. Maroto-Diaz , D. Monaghan , J. Eite , R. Spencer , A. Yunus , D. McLaughlan , A. Doyle , T. Neal , S. Todd , A.P. Roberts

Background

The hospital environment plays a crucial role in healthcare-associated infections. Current cleaning protocols to address this are costly and labour intensive, with further complications related to compliance, efficiency and the environmental impact of cleaning agents.

Findings

We developed a nano-structured coating, iC-nano™, which exhibits high antimicrobial activity. The 73 unique formulations assessed showed a range of activity in vitro. The best coatings displayed high activity within 15 min and were equally effective against all ESKAPE(e) pathogens except Enterococcus faecium, which required an increased contact time.

Analysis within an active hospital environment identified 44% fewer colony-forming units (cfu) recovered from coated surfaces, though with some uncertainty in estimates of effect size (1.77 fold [95% credible interval {CrI}: 0.98, 3.13]). The highest counts were observed among toilet exits, whilst samples collected on a Wednesday had 45% less cfu than on Monday (0.55 fold [95% CrI: 0.32, 0.91]). Whilst the durability and antimicrobial activity of the coating remained stable, a key concern raised was the aesthetic of the product that gave the appearance of being soiled after sustained use, potentially leading to behaviour change.

Conclusions

Through this study, we highlighted the promising potential of antimicrobial surfaces coatings. We suggest that future interventions, be they enhanced cleaning protocols or specialised coatings, should initially focus on locations such as toilet door handles, where the largest recoverable microbial bioburden was observed. Conversely, patient check-in screens saw minimal human interaction and are therefore considered a lower priority.

医院环境在医疗保健相关感染中起着至关重要的作用。目前用于解决这一问题的清洁方案成本高昂，劳动密集，并且与清洁剂的合规性、效率和环境影响有关。我们开发了一种具有高抗菌活性的纳米结构涂层iC-nanoTM。评估的73种独特配方在体外显示出一定范围的活性。最佳涂层在15分钟内显示出较高的活性，并且除需要增加接触时间的屎肠球菌外，对所有ESKAPE(e)病原体都具有相同的效果。在活跃的医院环境中进行的分析发现，涂层表面回收的CFUs减少了44%，尽管效应大小的估计存在一些不确定性（1.77倍[95% CrI: 0.98, 3.13]）。在厕所出口观察到最高的计数，而周三收集的样本的CFUs比周一减少了45%（0.55倍[95% CrI: 0.32, 0.91]）。虽然涂层的耐用性和抗菌活性保持稳定，但人们提出的一个关键问题是产品的美学，在持续使用后给人一种被污染的感觉，可能导致行为改变。通过这项研究，我们强调了抗菌表面涂层的潜力。我们建议未来的干预措施，无论是加强清洁方案还是专门的涂层，都应该首先关注厕所门把手等位置，因为在这些位置观察到最大的可恢复微生物负荷。相反，患者检查屏幕很少看到人类互动，因此被认为是较低的优先级。

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引用次数: 0

Silent transmission of clonal Pseudomonas aeruginosa via duodenoscopes: microbiological and genomic investigation of a prolonged episode 克隆性铜绿假单胞菌通过十二指肠镜的沉默传播：长期发作的微生物学和基因组学调查。

IF 3.1 3区医学 Q1 INFECTIOUS DISEASES

Journal of Hospital Infection

Pub Date : 2025-12-02 DOI: 10.1016/j.jhin.2025.11.025

A. Cissé , A. Morin-Le Bihan , M. Pagenault , V. Cattoir , S. Reissier , G. Ménard

Background

Duodenoscope-associated infections are typically linked to multidrug-resistant organisms (MDROs) and detected during outbreak investigations. However, the true burden of transmission involving non-MDRO pathogens remains largely underestimated. This study reports a prolonged episode of silent Pseudomonas aeruginosa transmission through duodenoscopes.

Methods

A retrospective and prospective investigation was conducted at a French tertiary-care hospital from May 2021 to December 2022. Cases were defined as patients who underwent endoscopic retrograde cholangiopancreatography (ERCP) with duodenoscope D2 and developed P. aeruginosa infection or colonisation. Duodenoscope sampling was performed in accordance with national guidelines. Isolates were characterised using antibiotic susceptibility testing, quantitative antibiogram, Fourier transform infrared spectroscopy, and whole genome sequencing (WGS). Longitudinal surveillance of all duodenoscopes was implemented post-incident.

Results

Eight patients were infected or colonised with P. aeruginosa after ERCP with D2, despite compliant routine microbiological testing in April and July 2021. D2 was declared non-compliant only in October 2021, revealing persistent contamination. Two patients developed non-biliary infections, suggesting overlooked transmission routes. During prospective surveillance, D4 was found to be contaminated after being used in two additional cases. WGS confirmed a clonal cluster (ST1320) comprising all patient isolates and those from D2 and D4. The similarity of isolates (0–6 single nucleotide polymorphisms) supports device persistence and delayed detection.

Conclusion

This study demonstrates that clonal P. aeruginosa contamination of duodenoscopes can persist undetected despite routine testing and strict reprocessing. Infections may arise outside typical outbreak settings and involve non-MDRO strains. Enhanced detection strategies, improved endoscope designs, and broader post-procedural surveillance are needed to prevent such silent transmission.

背景：十二指肠镜相关感染通常与多重耐药微生物有关，并在疫情调查期间被发现。然而，涉及非mdro病原体的真正传播负担在很大程度上仍被低估。本研究报告了一个通过十二指肠镜传播的沉默性铜绿假单胞菌的长时间发作。方法：于2021年5月至2022年12月在法国一家三级医院进行回顾性和前瞻性调查。病例定义为在D2十二指肠镜下进行内窥镜逆行胆管造影（ERCP）并发生铜绿假单胞菌感染或定植的患者。按照国家指南进行十二指肠镜取样。分离株采用抗生素药敏试验、定量抗生素谱、傅里叶变换红外光谱和全基因组测序进行鉴定。事后对所有十二指肠镜进行纵向监测。结果：8例患者在2021年4月和7月进行了常规微生物检测，但在D2十二指肠镜下进行内窥镜逆行胰胆管造影（ERCP）后仍感染或定植铜绿假单胞菌。直到2021年10月，D2才被宣布不合规，显示出持续的污染。两名患者出现非胆道感染，提示忽视了传播途径。在前瞻性监测中，D4十二指肠镜在另外两个病例中使用后发现被污染。WGS确认了一个克隆簇（ST1320），包括所有患者分离株和D2和D4仪器分离株。隔离的相似性（0-6个snp）支持设备持久性和延迟检测。结论：该事件表明克隆性铜绿假单胞菌污染的十二指肠镜可以持续存在，尽管常规检查和严格的再处理。感染可能出现在典型爆发环境之外，并涉及非mdro菌株。需要加强检测策略、改进内窥镜设计和更广泛的术后监测来防止这种无声传播。

{"title":"Silent transmission of clonal Pseudomonas aeruginosa via duodenoscopes: microbiological and genomic investigation of a prolonged episode","authors":"A. Cissé , A. Morin-Le Bihan , M. Pagenault , V. Cattoir , S. Reissier , G. Ménard","doi":"10.1016/j.jhin.2025.11.025","DOIUrl":"10.1016/j.jhin.2025.11.025","url":null,"abstract":"<div><h3>Background</h3><div>Duodenoscope-associated infections are typically linked to multidrug-resistant organisms (MDROs) and detected during outbreak investigations. However, the true burden of transmission involving non-MDRO pathogens remains largely underestimated. This study reports a prolonged episode of silent <em>Pseudomonas aeruginosa</em> transmission through duodenoscopes.</div></div><div><h3>Methods</h3><div>A retrospective and prospective investigation was conducted at a French tertiary-care hospital from May 2021 to December 2022. Cases were defined as patients who underwent endoscopic retrograde cholangiopancreatography (ERCP) with duodenoscope D2 and developed <em>P. aeruginosa</em> infection or colonisation. Duodenoscope sampling was performed in accordance with national guidelines. Isolates were characterised using antibiotic susceptibility testing, quantitative antibiogram, Fourier transform infrared spectroscopy, and whole genome sequencing (WGS). Longitudinal surveillance of all duodenoscopes was implemented post-incident.</div></div><div><h3>Results</h3><div>Eight patients were infected or colonised with <em>P. aeruginosa</em> after ERCP with D2, despite compliant routine microbiological testing in April and July 2021. D2 was declared non-compliant only in October 2021, revealing persistent contamination. Two patients developed non-biliary infections, suggesting overlooked transmission routes. During prospective surveillance, D4 was found to be contaminated after being used in two additional cases. WGS confirmed a clonal cluster (ST1320) comprising all patient isolates and those from D2 and D4. The similarity of isolates (0–6 single nucleotide polymorphisms) supports device persistence and delayed detection.</div></div><div><h3>Conclusion</h3><div>This study demonstrates that clonal <em>P. aeruginosa</em> contamination of duodenoscopes can persist undetected despite routine testing and strict reprocessing. Infections may arise outside typical outbreak settings and involve non-MDRO strains. Enhanced detection strategies, improved endoscope designs, and broader post-procedural surveillance are needed to prevent such silent transmission.</div></div>","PeriodicalId":54806,"journal":{"name":"Journal of Hospital Infection","volume":"169 ","pages":"Pages 15-23"},"PeriodicalIF":3.1,"publicationDate":"2025-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145669928","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Assessing environmental contamination in Dutch and Belgian nursing homes: a cross-border ATP-based study 评估荷兰和比利时养老院的环境污染：一项基于atp的跨境研究。

IF 3.1 3区医学 Q1 INFECTIOUS DISEASES

Journal of Hospital Infection

Pub Date : 2025-12-02 DOI: 10.1016/j.jhin.2025.11.037

A. van Arkel , I. Willemsen , A. Schuermans , C. Wijkmans , W. Dhaeze , C.J.P.A. Hoebe , J. Kluytmans

Background

To reduce the spread of micro-organisms in nursing homes adequate measurement of cleaning is necessary. ATP measurements can be a helpful tool in quantifying contamination.

Aim

To objectively measure environmental contamination within multiple nursing homes, such that cleaning can be focused on the most contaminated fomites.

Methods

Standardized ATP measurements were conducted in 28 nursing homes on multiple wards. Fifteen pre-defined surfaces per ward were measured with the 3M Clean Trace NG luminometer. Results are displayed in relative light units (RLU). RLU >1000 was considered as ‘not clean’. Differences in RLU values were compared between countries and fomite groups.

Findings

A total of 1794 ATP measurements were performed, ranging from 28 up to 202 per nursing home. The median RLU value was 1037 (range: 1–376,880) and 51.3% of the measurements had RLU values >1000. There were significant differences between countries and fomite groups.

Conclusion

ATP measurements can be used as an objective approach to determine the level of environmental contamination in nursing homes. Significant differences in ATP levels were found between nursing homes and countries. Moreover, pronounced differences were found between fomite groups. These findings offer potential targets for improvement of cleanliness within nursing homes.

背景：本研究的目的是确定荷兰/比利时边境地区养老院的环境污染水平，使用ATP测量。目的：本研究的目的是客观地测量多个养老院内的环境污染，因此清洁可以集中在污染最严重的污染物上。方法：对28家养老院的多个病房进行标准化ATP测量。使用3M Clean Trace NG光度计测量每个病房15个预先定义的表面。结果以相对光单位（RLU）显示。RLU bbb1000被认为“不干净”。比较了不同国家和不同人群RLU值的差异。研究结果：共进行了1794次ATP测量，每个养老院的ATP测量值从28到202不等。RLU值的中位数为1,037（范围：1 - 376,880），51.3%的测量结果的RLU值为bb0 1000。国家和种族群体之间存在显著差异。结论：三磷酸腺苷测量可作为判断养老院环境污染水平的客观方法。养老院和国家之间的ATP水平存在显著差异。此外，在不同的种族群体之间发现了明显的差异。这些发现为改善养老院的清洁提供了潜在的目标。

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引用次数: 0

Time-dependent persistence of blood as a contaminant in medical device processing 在医疗器械加工过程中，血液作为污染物随时间的持久性。

IF 3.1 3区医学 Q1 INFECTIOUS DISEASES

Journal of Hospital Infection

Pub Date : 2025-12-02 DOI: 10.1016/j.jhin.2025.11.039

B.R. Wulff, S. Lohse, M. Tschoerner

In order to ensure safe processing of medical equipment, it is mandatory to study all factors that may affect the results of cleaning. Previously, it has been shown that superficial blood residues are most difficult to clean when they have coagulated but not dried. The present study aimed to verify this finding in the joints of surgical forceps, using real instruments under realistic conditions. The persistence of blood in the joints of surgical forceps showed significant time-dependent differences within the first hours after contamination. This can have a noticeable impact on validation practices and cleaning processes in a central sterile services department.

为了确保医疗设备的安全处理，必须研究可能影响清洁结果的所有因素。以前发现，表面的血液残留物在凝固但未干燥时是最难清洗的。在本研究中，我们使用手术钳关节在现实条件下用真实的器械来验证这些发现。在污染后的最初几个小时内，手术器械关节内血液的持久性表现出显著的时间依赖性差异。这对CSSD中的验证实践和清理过程都有明显的影响。

引用次数: 0

Early prediction model for antibiotic treatment failure in bacteraemia: Japan bacteremia inpatient cohort association 菌血症抗生素治疗失败的早期预测模型：日本菌血症住院患者队列协会。

IF 3.1 3区医学 Q1 INFECTIOUS DISEASES

Journal of Hospital Infection

Pub Date : 2025-12-02 DOI: 10.1016/j.jhin.2025.11.031

H. Iwata , M. Kaneko , K. Kamada , K. Endo , Y. Honda , Y. Homma , T. Wakabayashi , K. Kanto , Y. Nagai , S. Hamada , T. Saito , T. Aoki

Introduction

Early antibiotic treatment failure (EATF) is a clinically important concept but remains underrecognized among frontline physicians. Moreover, no validated prediction models currently exist that specifically target EATF in patients with bacteraemia. The present study aims to develop and internally validate a clinical prediction model for EATF in hospitalised adults with bacteraemia.

Methods

This multi-centre retrospective cohort study included adult inpatients with bacteremia from the Japan Bacteremia Inpatient Cohort Association, conducted across eight community hospitals in Japan from 2018 to 2022. Based on review results, we defined EATF as an outcome that included changes in antibiotics and advanced treatment after 72 h of admission. Using 28 candidate variables from previous studies, models and clinical expertise, we developed our model through backward elimination based on the Akaike Information Criterion. After constructing the score model, discrimination was assessed using the area under the curve (AUC), while calibration was evaluated using a plot. Internal validation used the bootstrap method to assess AUC and overfitting.

Findings

Among the 1084 eligible patients, 388 experienced EATF. The model included abnormal white blood cell count, low serum albumin, occlusive lesions, transfer admission and oxygen therapy. Internal validation demonstrated an AUC of 0.66, 95% confidence interval (0.62, 0.69) and a calibration slope of 1.01.

Conclusions

Although the model’s discrimination was modest, this study highlights the importance of EATF as a clinical outcome and demonstrates the inherent difficulty of developing predictive models for bacteraemia. External validation is warranted.

早期抗生素治疗失败（EATF）是一个重要的临床概念，但仍未得到一线医生的充分认识。此外，目前还没有经过验证的预测模型专门针对菌血症患者的EATF。本研究旨在开发并内部验证住院成人菌血症患者的EATF临床预测模型。方法：本多中心回顾性队列研究纳入了日本菌血症住院患者队列协会（JA-BICA）的成年菌血症住院患者，于2018年至2022年在日本8家社区医院进行。基于回顾结果，我们将EATF定义为入院72小时后抗生素变化和高级治疗的结果。使用来自先前研究、模型和临床专业知识的28个候选变量，我们基于赤池信息标准通过反向消去建立了我们的模型。在构建评分模型后，用曲线下面积（AUC）评估区分度，用图评估校准度。内部验证使用自举法来评估AUC和过拟合。结果：在1084例符合条件的患者中，388例经历了EATF。该模型包括白细胞计数异常、血清白蛋白低、闭塞病变、转移入院和氧疗。内部验证显示AUC为0.66,95%置信区间（0.62,0.69），校准斜率为1.01。结论：尽管该模型的鉴别程度不高，但本研究强调了EATF作为临床结果的重要性，并证明了开发菌血症预测模型的固有困难。外部验证是必要的。

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引用次数: 0

Investigation of the current status of peracetic acid residues in flexible endoscopes and analysis of influencing factors 柔性内窥镜中过氧乙酸残留现状调查及影响因素分析。

IF 3.1 3区医学 Q1 INFECTIOUS DISEASES

Journal of Hospital Infection

Pub Date : 2025-12-02 DOI: 10.1016/j.jhin.2025.11.026

S. Zhu , Q. Wang , J. Hu , X. Chen , M. Hendi , L. Tong

<div><h3>Objective</h3><div>To assess peracetic acid residues following automated cleaning and disinfection of flexible endoscopes at the endoscopy centre of a tertiary hospital in Zhejiang province, analyse factors influencing residue levels and provide a basis for standardising the disinfection process.</div></div><div><h3>Methods</h3><div>A cross-sectional survey was conducted at the endoscopy centre of a tertiary hospital in Zhejiang province from May to June 2025. Samples were collected from the lumens of gastroscopes and colonoscopes after final rinsing and drying on days 1, 3, 5 and 7 of disinfectant use, following cleaning and disinfection with two types of automatic cleaning and disinfection machine. A specific disinfectant concentration analyser was used to determine the concentration of peracetic acid residues in the lumens.</div></div><div><h3>Results</h3><div>A total of 279 gastrointestinal endoscopes were tested in this study. On the first day of disinfectant use, the residues in endoscopes processed using machines A and B were 7.36 ± 4.07 mg/L and 17.08 ± 26.11 mg/L, respectively (<em>t</em> = -2.018, <em>P</em> = 0.047). The residue in endoscopes with a service life of 1–3 years was 5.24 ± 6.16 mg/L and that with a service life of 3–5 years was 16.72 ± 25.94 mg/L (<em>t</em> = 2.375, <em>P</em> = 0.020). On the third day of disinfectant use, the residues in endoscopes processed using machines A and B were 4.68 ± 3.32 mg/L and 7.03 ± 4.09 mg/L, respectively (<em>t</em> = −2.436, <em>P</em> = 0.018). The residue in endoscopes with a service life of 1–3 years was 4.32 ± 1.61 mg/L and that in endoscopes with a service life of 3–5 years was 7.35 ± 3.72 mg/L (<em>t</em> = 3.783, <em>P</em> < 0.005). On the fifth day of disinfectant use, the residues in endoscopes processed using machines A and B were 3.97±1.83 mg/L and 5.49 ± 3.37 mg/L, respectively (<em>t</em> = −2.554, <em>P</em> = 0.013). The residue in endoscopes with a service life of 1–3 years was 2.49 ± 1.35 mg/L and that in endoscopes with a service life of 3–5 years was 6.28 ± 3.20 mg/L (<em>t</em> = 5.339, <em>P</em> < 0.005). On the seventh day of disinfectant use, the residues in endoscopes processed using machines A and B were 3.28 ± 2.51 mg/L and 5.25 ± 2.42 mg/L, respectively (<em>t</em> = −3.272, <em>P</em> = 0.002). The residue in endoscopes with a service life of 1–3 years was 2.38 V ± 1.16 mg/L and that in endoscopes with a service life of 3–5 years was 5.44 ± 3.36 mg/L (<em>t</em> = 4.123, <em>P</em> < 0.005).</div></div><div><h3>Conclusions</h3><div>Peracetic acid residues were detected in both gastroscopes and colonoscopes, with no difference observed between the two instruments. Residual levels decreased with longer rinsing times of the cleaning and disinfection machine, whereas longer endoscope service life was associated with higher residual levels. Peracetic acid residues following endoscope cleaning and disinfection is influenced by both rinsing time

目的：对浙江省某三级医院内镜中心柔性内窥镜自动清洗消毒后的过氧乙酸残留量进行评估，分析影响残留水平的因素，为规范消毒流程提供依据。方法：于2025年5 - 6月在浙江省某三级医院内窥镜中心进行横断面调查。于使用后第1、3、5、7天对胃镜、结肠镜的管腔进行最后的冲洗和干燥，用自动清洗和可重复使用的两种消毒剂清洗和消毒。采用专用消毒液浓度分析仪测定管腔中过氧乙酸残留量。结果：本研究共检查了279例胃肠内窥镜。使用第1天，自动清洁消毒机A、B的残留分别为7.36±4.07 mg/L、17.08±26.11 mg/L （t=-2.018， P=0.047）。使用寿命为1 ~ 3年的内窥镜残留为5.24±6.16 mg/L，使用寿命为3 ~ 5年的内窥镜残留为16.72±25.94 mg/L （t=2.375， P=0.020）。使用第3天，自动清洁消毒机A、B的残留分别为4.68±3.32 mg/L、7.03±4.09 mg/L （t=-2.436， P=0.018）。使用寿命为1 ~ 3年的内窥镜残留量为4.32±1.61 mg/L，使用寿命为35年的内窥镜残留量为7.35±3.72 mg/L （t=3.783, P < 0.005）。使用第5天，自动清洁消毒机A、B的残留分别为3.97±1.83 mg/L、5.49±3.37 mg/L （t=-2.554， P=0.013）。使用寿命为13年的内窥镜残留为2.49±1.35 mg/L，使用寿命为35年的内窥镜残留为6.28±3.20 mg/L （t=5.339, P < 0.005）。使用第7天，自动清洁消毒机A、B的残留分别为3.28±2.51 mg/L、5.25±2.42 mg/L （t=-3.272， P=0.002）。使用寿命为1 ~ 3年的内窥镜残留为2.38±1.16 mg/L，使用寿命为35年的内窥镜残留为5.44±3.36 mg/L （t=4.123, P < 0.005）。结论：胃镜和结肠镜均检测到过氧乙酸残留，两种仪器之间无差异。清洗消毒机冲洗时间越长，残留水平越低，而内窥镜使用寿命越长，残留水平越高。内镜清洗消毒后过氧乙酸残留受自动清洗消毒机冲洗时间和内镜使用寿命的影响，提示临床管理者可通过延长内镜冲洗时间和减少管腔磨损来减少过氧乙酸残留。

{"title":"Investigation of the current status of peracetic acid residues in flexible endoscopes and analysis of influencing factors","authors":"S. Zhu , Q. Wang , J. Hu , X. Chen , M. Hendi , L. Tong","doi":"10.1016/j.jhin.2025.11.026","DOIUrl":"10.1016/j.jhin.2025.11.026","url":null,"abstract":"<div><h3>Objective</h3><div>To assess peracetic acid residues following automated cleaning and disinfection of flexible endoscopes at the endoscopy centre of a tertiary hospital in Zhejiang province, analyse factors influencing residue levels and provide a basis for standardising the disinfection process.</div></div><div><h3>Methods</h3><div>A cross-sectional survey was conducted at the endoscopy centre of a tertiary hospital in Zhejiang province from May to June 2025. Samples were collected from the lumens of gastroscopes and colonoscopes after final rinsing and drying on days 1, 3, 5 and 7 of disinfectant use, following cleaning and disinfection with two types of automatic cleaning and disinfection machine. A specific disinfectant concentration analyser was used to determine the concentration of peracetic acid residues in the lumens.</div></div><div><h3>Results</h3><div>A total of 279 gastrointestinal endoscopes were tested in this study. On the first day of disinfectant use, the residues in endoscopes processed using machines A and B were 7.36 ± 4.07 mg/L and 17.08 ± 26.11 mg/L, respectively (<em>t</em> = -2.018, <em>P</em> = 0.047). The residue in endoscopes with a service life of 1–3 years was 5.24 ± 6.16 mg/L and that with a service life of 3–5 years was 16.72 ± 25.94 mg/L (<em>t</em> = 2.375, <em>P</em> = 0.020). On the third day of disinfectant use, the residues in endoscopes processed using machines A and B were 4.68 ± 3.32 mg/L and 7.03 ± 4.09 mg/L, respectively (<em>t</em> = −2.436, <em>P</em> = 0.018). The residue in endoscopes with a service life of 1–3 years was 4.32 ± 1.61 mg/L and that in endoscopes with a service life of 3–5 years was 7.35 ± 3.72 mg/L (<em>t</em> = 3.783, <em>P</em> < 0.005). On the fifth day of disinfectant use, the residues in endoscopes processed using machines A and B were 3.97±1.83 mg/L and 5.49 ± 3.37 mg/L, respectively (<em>t</em> = −2.554, <em>P</em> = 0.013). The residue in endoscopes with a service life of 1–3 years was 2.49 ± 1.35 mg/L and that in endoscopes with a service life of 3–5 years was 6.28 ± 3.20 mg/L (<em>t</em> = 5.339, <em>P</em> < 0.005). On the seventh day of disinfectant use, the residues in endoscopes processed using machines A and B were 3.28 ± 2.51 mg/L and 5.25 ± 2.42 mg/L, respectively (<em>t</em> = −3.272, <em>P</em> = 0.002). The residue in endoscopes with a service life of 1–3 years was 2.38 V ± 1.16 mg/L and that in endoscopes with a service life of 3–5 years was 5.44 ± 3.36 mg/L (<em>t</em> = 4.123, <em>P</em> < 0.005).</div></div><div><h3>Conclusions</h3><div>Peracetic acid residues were detected in both gastroscopes and colonoscopes, with no difference observed between the two instruments. Residual levels decreased with longer rinsing times of the cleaning and disinfection machine, whereas longer endoscope service life was associated with higher residual levels. Peracetic acid residues following endoscope cleaning and disinfection is influenced by both rinsing time ","PeriodicalId":54806,"journal":{"name":"Journal of Hospital Infection","volume":"168 ","pages":"Pages 178-182"},"PeriodicalIF":3.1,"publicationDate":"2025-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145679528","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

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