Journal of Hospital Infection最新文献

{"title":"Clinical prediction models for hospital-acquired infection of multidrug-resistant organism in intensive care units: a systematic review.","authors":"Pei Li, Bai Yi, Xiaoning Yuan, Huizhi Zhang, Fenghong Li, Jing Liu, Jun Du, Xing Yan","doi":"10.1016/j.jhin.2026.04.022","DOIUrl":"https://doi.org/10.1016/j.jhin.2026.04.022","url":null,"abstract":"<p><p>Multidrug-resistant organism (MDRO) infections pose a significant threat to patient safety in intensive care units (ICUs). Risk prediction models (RPMs) are promising tools for early identification, but their stability and generalizability remain uncertain. This systematic review aimed to evaluate the status, methodological quality, and performance of RPMs for MDRO infection in adult ICU patients. We searched five databases for studies published up to July 30, 2025. Studies that developed or validated a prediction model were included. Data on characteristics, predictors, methods, and performance were extracted. Quality was assessed using PROBAST. Sixty-two studies, comprising 100 prediction models, were included in the analysis. Most were single-center, retrospective studies from mainland China. Predictors were categorized into ten domains, with antibiotic use, comorbidities, and invasive procedures being the most frequent. Logistic regression was the most common technique. Model validation was insufficient: 37 studies did not report detailed validation, and only 17 performed external validation. PROBAST indicated a high risk of bias in 87.1% of studies, primarily due to analytical shortcomings like inappropriate predictor handling, suboptimal variable selection, and lack of proper validation. The systematic review reveals that existing RPMs have methodological limitations and constrained generalizability, hindering clinical application. Future efforts should focus on integrating dynamic predictors, conducting rigorous external validation, and developing models based on large-scale, prospective, multi-center data.</p>","PeriodicalId":54806,"journal":{"name":"Journal of Hospital Infection","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147857657","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}

{"title":"Nurse-led peer audits as a driver for improved peripheral intravenous catheter care and reduced bloodstream infections.","authors":"Camelia Bogaert, Anneleen De Greve, Charlotte Verfaillie","doi":"10.1016/j.jhin.2026.04.013","DOIUrl":"https://doi.org/10.1016/j.jhin.2026.04.013","url":null,"abstract":"<p><strong>Background: </strong>Peripheral intravenous catheters (PIVC) are widely used in acute care and are an important source of preventable peripheral line-associated bloodstream infections (PLABSI). Evidence on sustainable, nurse-led strategies to improve PIVC care and reduce PLABSI remains limited.</p><p><strong>Aim: </strong>To describe a longitudinal multimodal quality improvement strategy combining nurse-led peer audits and real-time digital feedback to improve PIVC care and reduce PLABSI in an acute care hospital.</p><p><strong>Methods: </strong>A longitudinal multimodal quality improvement strategy was conducted between June 2022 and December 2025 on adult internal medicine, surgical and geriatric wards in a Belgian acute secondary care hospital. Weekly bedside audits of PIVC care bundle elements were introduced, initially led by an infection prevention and control (IPC) nurse and later transitioned to a structured nurse-led peer audit model using a digital questionnaire. Audit data were visualised in interactive dashboards alongside surveillance data.</p><p><strong>Results: </strong>A total of 6,718 PIVC audits were performed. Compliance with directly observable bedside practices improved substantially, including insertion site visibility (12.7% in 2023 to >90% in 2024 and 2025) and dressing quality. Documentation- and time-dependent processes showed more limited improvement. PLABSI incidence declined progressively from 0.81 per 10,000 patient-days in 2022 to 0.29 in 2025. Several wards achieved sustained PLABSI-free periods exceeding 90 days.</p><p><strong>Conclusions: </strong>A nurse-led peer audit strategy supported by real-time digital feedback was associated with sustained improvement in PIVC care and reduction of PLABSI incidence. Embedded within a multimodal approach, this strategy enhanced ownership and actionable feedback. Further improvement may require targeted strategies addressing time-dependent processes.</p>","PeriodicalId":54806,"journal":{"name":"Journal of Hospital Infection","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-05-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147846416","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}

{"title":"AI-enabled digital wound monitoring after cardiac surgery: a randomised controlled feasibility, safety and acceptability trial.","authors":"Melissa Rochon, Judith Tanner, Karen Cariaga, James Jurkiewicz, Jacqueline Beckhelling, Roy Harris, Keith Wilson, Luxmi Dhoonmoon, Sarah Bolton, Daniel Davis, Janet Bouttell, Mr Alex Shipolini, Rosalie Magboo, Faruk Oezalp, Victoria Chester","doi":"10.1016/j.jhin.2026.04.020","DOIUrl":"https://doi.org/10.1016/j.jhin.2026.04.020","url":null,"abstract":"<p><strong>Background: </strong>Surgical site infection after cardiac surgery is a common cause of morbidity and unplanned healthcare use, with most infections developing after hospital discharge. Remote wound monitoring using smartphone technology and artificial intelligence (AI) may support earlier identification of complications.</p><p><strong>Aim: </strong>To evaluate the feasibility, acceptability, and safety of an AI-enabled digital wound monitoring platform plus usual care (Isla-AI) compared with usual care (UC) alone.</p><p><strong>Design, setting, and participants: </strong>This multi-centre, two-arm randomised controlled feasibility trial was conducted at two UK hospitals between August 2024 and January 2025. Adults undergoing cardiac surgery were randomised to receive Isla-AI or UC. The study was not powered to assess effectiveness.</p><p><strong>Results: </strong>120 patients were randomised and participated (Isla-AI n=62; UC n=58). Feasibility targets were exceeded: 60% of eligible patients approached consented, 95% of Isla-AI participants submitted at least one image, and 92% completed the study. 98% of images were suitable for clinical assessment. Clinician agreement with AI priority flags was 87%. AI prioritisation performance was slightly better for patients with darker skin tones. More than half of participants required assistance to capture or submit wound images. Patient and staff acceptability of AI was largely favourable. Adverse and serious adverse event rates were similar across both groups. The proportion of patients accessing NHS resources for wound-related problems and antibiotics was lower in the Isla-AI group.</p><p><strong>Conclusions: </strong>These findings support progression to a large, definitive multi-centre effectiveness trial, with further attention to equity, usability, and workflow integration.</p><p><strong>Trial registration: </strong>IRAS 338141; local project UHDB/2022/024. ISRCTN16900119 CLINICALTRIALS.GOV: NCT06475703 Date registered: 20/06/2024.</p>","PeriodicalId":54806,"journal":{"name":"Journal of Hospital Infection","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-05-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147846420","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}

{"title":"Use of ANCHOR viruses to validate radiative, physical and chemical decontamination systems in operational conditions.","authors":"Franck Gallardo, Valentine Poirier, Charlotte Quentin-Froignant, Thomas Figueroa, Romain Volmer, Anais Proust, Camille Menard, Manuel Rosa-Calatrava, Morgane Mousnier, Olivier Authier, Dani Lainisalo, Pertti Lainisalo, Tero Ingelius, Marc Grandadam, Elie Marcheteau","doi":"10.1016/j.jhin.2026.01.031","DOIUrl":"https://doi.org/10.1016/j.jhin.2026.01.031","url":null,"abstract":"<p><strong>Objectives: </strong>Effective disinfection is essential in settings such as high-containment laboratories, healthcare environments and public spaces, particularly for controlling the spread of pathogenic viruses. Current methods for evaluating disinfection efficacy are time-consuming, often lacking adaptability to real-world conditions.</p><p><strong>Methods: </strong>In this study, we used ANCHOR tagged auto-fluorescent viruses enabling the detection of infectious particles by high-throughput microscopy. These models were used to mimic viral contamination and evaluate disinfection procedures, such as UV-C LED systems, self-decontaminating surface or chemical disinfection of sensitive areas such as BSL-4 showers and pressurized suits.</p><p><strong>Results: </strong>Replicative ANCHOR-tagged viruses demonstrated high environmental persistence (particularly hAdV5 and VACV) and retained infectivity profiles suitable for disinfection studies.</p><p><strong>Conclusions: </strong>Viral models based on ANCHOR provide a rapid (16h readout), low-risk and miniaturized tool for evaluating disinfection methods. This technology is a significant asset for early development, quality control and validation of disinfection systems under operational conditions. Albeit it cannot replace normative testing yet, this method enables the accelerated and cost-effective development of new disinfection systems.</p>","PeriodicalId":54806,"journal":{"name":"Journal of Hospital Infection","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-05-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147846378","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}

{"title":"Respiratory Cross Infection in Non-Invasive Ventilator Devices (ResCIND).","authors":"George T P Tay, Kimberley Smith, Congrong He, Brett Dyer, Rachel M Thomson, David W Reid, Lidia Morawska, Scott C Bell","doi":"10.1016/j.jhin.2026.04.021","DOIUrl":"https://doi.org/10.1016/j.jhin.2026.04.021","url":null,"abstract":"<p><strong>Background: </strong>Non-invasive ventilation (NIV) is considered an aerosol-generating procedure, yet the extent of the risk of airborne pathogen transmission remains uncertain. To address this, we conducted three studies assessing bioaerosol generation, device contamination, and cough-related dispersion during NIV.</p><p><strong>Method: </strong>Studies 1 and 2 utilised a purpose-designed rig supplied with high-efficiency particulate air (HEPA)-filtered air ensuring the detection of particles only produced by the NIV system. Study 3 utilises a flow-tunnel rig to compare aerosol dispersion during NIV, sham NIV, tidal breathing, and uncovered coughing.</p><p><strong>Result: </strong>In the controlled laboratory setting (Study 1), NIV-generated aerosol particles were measured. Viable Pseudomonas aeruginosa was detected when inoculum concentrations were ≥1 × 10⁵ CFU/mL, and the use of inline antibacterial filters prevented bacterial emission. In Study 2, demonstrated low risk of NIV device contamination (1 in 10) during short-term use. While in study 3, NIV with therapeutic pressure generated higher physical aerosol counts than tidal breathing or sham NIV, but less than with uncovered coughing. Among 13 participants, viable pathogens were detected in uncovered coughs from seven (54%) participants (median 9, IQR 3-12 CFU), while only one participant had a positive result during NIV (2 CFU with sham and 3 CFU with therapeutic NIV).</p><p><strong>Conclusion: </strong>Our findings demonstrate that NIV devices may be contaminated after use and can aerosolise viable bacteria. While the World Health Organization classifies NIV as a high-risk aerosol-generating procedure, we demonstrate low likelihood of infectious particle release, particularly when effective interfaces, leak control, and robust infection prevention measures are implemented.</p>","PeriodicalId":54806,"journal":{"name":"Journal of Hospital Infection","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147846423","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}

{"title":"What grows in the sink splash zone.","authors":"Mark I Garvey, Robert A Moran, Martyn A C Wilkinson, Ana D Sanches Ferreira, Alyson Gardiner, Elisabeth Holden, Alan McNally","doi":"10.1016/j.jhin.2026.04.010","DOIUrl":"https://doi.org/10.1016/j.jhin.2026.04.010","url":null,"abstract":"<p><strong>Background: </strong>The hospital sink drain microbiome can harbour opportunistic pathogens and antimicrobial resistance genes. Patients may be exposed to waterborne pathogens via water outlets and sink drains. We have previously shown water from a clinical hand wash basin can splash up to two metres away from the sink/tap. Here we wanted to identify which organisms could be cultured from environmental sampling within the splash zone.</p><p><strong>Methods: </strong>Queen Elizabeth Hospital Birmingham (QEHB) is a large UK tertiary centre. We placed an SAS Super 180 air sampler within the splash zone at approximately one metre distance of a tap on a clinical hand wash basin in the critical care unit and undertook sampling both with and without the tap running. All Gram-negative organisms were cultured and any carbapenemase producing Enterobacterales (CPE) isolated were sequenced.</p><p><strong>Results: </strong>Environmental sampling undertaken when the tap was running yielded a variety of organisms, with Gram-negative isolates including Citrobacter freundii, Enterobacter kobei, Enterobacter cloacae, Enterobacter asburiae, Pseudomonas aeruginosa and Sphingobacterium multivorum. Amongst these, we identified one CPE, C. freundii isolate QE-SINK-CF1, which carried a plasmid bearing the bla_KPC-2 gene. Structural variants of this plasmid have been involved in clinical infections at QEHB. Control sampling without the tap running yielded no Gram-negative organisms.</p><p><strong>Conclusions: </strong>Here we show a variety of Gram-negative microorganisms, including CPE, can be cultured from within the 2-metre sink splash zone. This latest work provides further evidence healthcare settings should consider splash zones and waterborne pathogen transmission risk.</p>","PeriodicalId":54806,"journal":{"name":"Journal of Hospital Infection","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147846387","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}

{"title":"Hidden in plain sight: OXA-244 can be missed by phenotypic screening for carbapenemase-producing Enterobacterales.","authors":"Benjamin Querin, Nicolas Arangia, Alexandra Castanié, Muriel Bocquet, Laurent Dortet, Didier Lecointe","doi":"10.1016/j.jhin.2026.04.018","DOIUrl":"https://doi.org/10.1016/j.jhin.2026.04.018","url":null,"abstract":"<p><strong>Background: </strong>The prevalence of OXA-244-producing Enterobacterales is increasing in Europe, but their detection on screening media is limited. We assessed the proportion of OXA-244 carriage among carbapenemase-producing Enterobacterales (CPE) isolates, and specifically among OXA-48-like producers, at our hospital, addressing the challenges posed by conventional detection methods.</p><p><strong>Methods: </strong>Patients were screened with a rectal swab. For cases with a positive polymerase chain reaction (PCR) for OXA-48 but negative culture on ChromID® CARBA SMART agar, the rectal swab was inoculated on mSuperCARBA® agar, and ChromID® CPS ELITE agar if negative. An additional ChromID® ESBL agar could also be plated and incubated.</p><p><strong>Results: </strong>All patients with a CPE detection from July 2023 to July 2024 were included in the retrospective analysis. OXA-244 variant was identified in 16 cases, on the following agar plates: 13 on mSuperCARBA® (also recovered on 5 ChromID® ESBL agar), and 3 on ChromID® CPS ELITE (also recovered on 3 ChromID® ESBL agar). OXA-244 producers represented 21% of all CPE isolates and 28% of OXA-48-like producers. All isolated OXA-244 producers were Escherichia coli.</p><p><strong>Conclusion: </strong>OXA-244 variant poses diagnostic and surveillance challenges. Its high proportion among CPE isolates, and particularly among OXA-48-like producers, in our study suggests that this variant may be underdetected and highlights the need for adapted screening methods, with PCR prioritized for detecting OXA-244 carriers. Inadequate screening strategies can lead to undetected transmission and increase the risk of outbreaks.</p>","PeriodicalId":54806,"journal":{"name":"Journal of Hospital Infection","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147846370","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}

{"title":"Prediction Models for Recurrence and Mortality in Patients with Clostridioides difficile Infection: A Systematic Review and Meta-Analysis.","authors":"Qianxin Wei, Yifan Cai, Guangyu Lu, Qiang Ma, Xiaoguang Liu, Hailong Yu, Zhiyao Wang, Yuping Li","doi":"10.1016/j.jhin.2026.03.039","DOIUrl":"https://doi.org/10.1016/j.jhin.2026.03.039","url":null,"abstract":"<p><strong>Objective: </strong>This study aims to systematically evaluate the methodological quality, predictive performance, associated risk factors, and clinical applicability of prediction models for recurrence and mortality in patients with Clostridioides difficile infection (CDI).</p><p><strong>Methods: </strong>We systematically searched relevant literature from the inception of PubMed, Web of Science, and Cochrane Library up to May 5, 2025.Two researchers independently conducted literature screening and data extraction, and the PROBAST tool was used to assess the risk of bias.A meta-analysis was performed on eligible risk factors.</p><p><strong>Results: </strong>The study evaluated 15 predictive models for CDI recurrence and 10 models for CDI mortality, encompassing a total of 112,640 CDI patients. A meta-analysis of risk factors for CDI recurrence identified several significant associations: Age [MD=2.56, 95% CI=0.75-4.36, p=0.005], antibiotic use [OR=2.26, 95% CI=1.46-3.48, P=0.0002], proton pump inhibitors (PPIs) [OR=2.03, 95% CI=1.36-3.04, P<0.00001], inflammatory bowel disease (IBD) [OR=1.69, 95% CI=1.31-2.21, P<0.0001], among other factors. The meta-analysis of risk factors for CDI mortality revealed associations with: immunosuppression [OR=1.83, 95% CI=1.28-2.63, p=0.001], white blood cell count (WBC) [MD=2.55, 95% CI=0.29-4.8, p=0.03], the Charlson Comorbidity Index (CCI) [MD=2.01, 95% CI=0.24-3.79, p=0.03], blood urea nitrogen (BUN) [MD=2.49, 95% CI=1.47-3.51, p<0.00001], and creatinine levels [MD=0.68, 95% CI=0.19-1.17, p=0.007], among other factors. Using PROBAST+AI , we evaluated 25 prediction models in two dimensions: model development quality and validation risk of bias. While 12 models demonstrated high development quality, 13 models exhibited high risk of bias in validation, primarily due to inadequate external validation, incomplete performance reporting, and methodological limitations in analysis. The discriminatory performance of most models for CDI recurrence was suboptimal, with area under the curve (AUC) values typically below 0.7. In contrast, CDI mortality prediction models exhibited better overall performance, with some demonstrating superior discriminatory ability (AUC up to 0.969).</p><p><strong>Conclusion: </strong>Current CDI prediction models exhibit limited clinical utility due to methodological flaws; future efforts must prioritize methodological rigor, standardized definitions, and robust external validation.</p>","PeriodicalId":54806,"journal":{"name":"Journal of Hospital Infection","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147846361","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}

{"title":"Clinical and Economic Burden of Hospital-Wide Central Line-Associated Bloodstream Infections: A Propensity Score-Matched Case-Control Study.","authors":"S Y Tao, L Z Cheng, J W Li, L W Guo, W Z Huang, B Zhou, J Huang, C X Yang, F Qiao","doi":"10.1016/j.jhin.2026.04.012","DOIUrl":"https://doi.org/10.1016/j.jhin.2026.04.012","url":null,"abstract":"<p><strong>Background: </strong>Central venous catheters (CVCs) are widely used but carry the risk of central line-associated bloodstream infections (CLABSIs), which threaten patient safety. While previous CLABSI studies have primarily focused on ICUs, we conducted a hospital-wide prospective investigation using an integrated information system. This study tracked CLABSI outcomes and associated healthcare costs across all patients with CVCs, aiming to evaluate the burden of CLABSI from the patient perspective, with particular attention to differential impacts among patient subgroups.</p><p><strong>Methods: </strong>This study employed a case-control design. Patients newly diagnosed with CLABSI between January 2023 and June 2024 were enrolled as cases, while contemporaneous catheterised patients without infection were matched 1:1 as controls using propensity score matching (PSM). We adjusted for potential confounders, including demographics, comorbidities, and treatment modalities, to assess the impact of CLABSI on length of stay (LOS), in-hospital mortality, and healthcare economic burden. Stratified subgroup analyses were conducted based on the patients' departments.</p><p><strong>Findings: </strong>Among 50,862 CVC patients, the incidence of CLABSI was 0.507/1000 catheter-days, predominantly caused by gram-negative bacteria. Propensity-matched analysis (n=205 pairs) revealed that CLABSI significantly prolonged hospitalisation by 20 days (34 vs. 14 days, P<0.001), increased mortality risk by 88% (22.93% vs. 12.20%, P=0.004), and elevated direct medical costs by $13,962 (P<0.001). Department-specific analysis demonstrated the greatest economic burden occurred in ICU($29,211) and internal medicine patients ($10,781), with all differences being statistically significant (P<0.05).</p><p><strong>Conclusion: </strong>CLABSI significantly increased LOS and costs across all departments, highlighting the need for hospital-wide prevention strategies.</p>","PeriodicalId":54806,"journal":{"name":"Journal of Hospital Infection","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147823702","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}

{"title":"Chlorhexidine Gluconate vs. Povidone-Iodine for Surgical Site Infection Prevention: A Systematic Review and Meta-Analysis Stratified by Surgery Type, Wound Classification, Antiseptic Formulation, and Country Income, with Meta-Regression.","authors":"Mohammed Benhammou, Dina Elraggal, Sara Saleh, Chloe K Nobuhara, Gabrielle H van Ramshorst, Olivier Mimoz, Mohamedhen Vall Nounou, Qasim Shawesh, Methodius G Tuuli, Steven D Wexner, Fausto Catena, Joseph D Forrester, Muhammed Elhadi","doi":"10.1016/j.jhin.2026.04.015","DOIUrl":"https://doi.org/10.1016/j.jhin.2026.04.015","url":null,"abstract":"<p><strong>Background: </strong>The comparative effectiveness of chlorhexidine gluconate (CHG) versus povidone-iodine (PVI) for preventing surgical site infections (SSIs) remains unclear across surgical types and resource settings. This study compared CHG and PVI overall and within key clinical subgroups.</p><p><strong>Methods: </strong>Five databases were searched through February 2025 for randomized controlled trials comparing CHG with PVI and reporting SSI outcomes. Random-effects models generated pooled odds ratios (ORs) with 95% confidence intervals (CIs).</p><p><strong>Results: </strong>Twenty-nine RCTs involving 35,317 patients were included. CHG significantly reduced superficial incisional SSIs (OR = 0.80; 95% CI 0.67-0.95; p = 0.01; I² = 18.4%), but not overall, deep, or organ/space infections; meta-regression indicated that patient age was a significant effect modifier. In cesarean sections, CHG lowered overall (OR = 0.64; 95% CI 0.48-0.85), superficial (OR = 0.65; 95% CI 0.48-0.87), and deep incisional SSIs (OR = 0.41; 95% CI 0.22-0.75). In abdominal surgery, CHG reduced only superficial incisional SSIs (OR = 0.68; 95% CI 0.52-0.91). No significant differences were observed in gynecologic, cardiothoracic, or orthopedic procedures. By wound classification, CHG had no effect in clean surgery but reduced superficial incisional SSIs in clean-contaminated cases (OR = 0.65; 95% CI 0.48-0.89). By income level, no differences were seen in high-income countries, while in low- and middle-income countries CHG decreased overall (OR = 0.58; 95% CI 0.46-0.74), superficial (OR = 0.54; 95% CI 0.38-0.76), and deep incisional SSIs (OR = 0.48; 95% CI 0.25-0.92).</p><p><strong>Conclusion: </strong>Alcohol-based CHG and alcohol-based PVI are comparably effective in most surgical settings. However, CHG demonstrates superior prevention of SSIs in cesarean, abdominal, and clean-contaminated surgeries, with the most substantial benefit in low- and middle-income settings. Broader use may be justified pending cost-effectiveness evaluation.</p>","PeriodicalId":54806,"journal":{"name":"Journal of Hospital Infection","volume":" ","pages":""},"PeriodicalIF":3.1,"publicationDate":"2026-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147823625","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}