{"id":"https://openalex.org/W7201859679","doi":"https://doi.org/10.1016/j.jhin.2026.07.028","title":"Environmental, economic, and labour burden of time-related sterility maintenance and the potential reductions from event-related sterility maintenance: a single-centre gate-to-gate modelling study","display_name":"Environmental, economic, and labour burden of time-related sterility maintenance and the potential reductions from event-related sterility maintenance: a single-centre gate-to-gate modelling study","publication_year":2026,"publication_date":"2026-08-07","ids":{"openalex":"https://openalex.org/W7201859679","doi":"https://doi.org/10.1016/j.jhin.2026.07.028","pmid":"https://pubmed.ncbi.nlm.nih.gov/42567325"},"language":"en","primary_location":{"id":"doi:10.1016/j.jhin.2026.07.028","doi":"https://doi.org/10.1016/j.jhin.2026.07.028","is_oa":true,"landing_page_url":"https://doi.org/10.1016/j.jhin.2026.07.028","pdf_url":null,"source":{"id":"https://openalex.org/S87161179","display_name":"Journal of Hospital Infection","issn_l":"0195-6701","issn":["0195-6701","1532-2939"],"is_oa":false,"is_in_doaj":false,"is_core":true,"listed_in":["anvur-scientific","cwts-core","dongbi-b","doyens","jufo-1","ki-jl-1","medline","norway-1","poland-100","russia-white-list-1","vabb-shw"],"host_organization":"https://openalex.org/P4310320990","host_organization_name":"Elsevier BV","host_organization_lineage":["https://openalex.org/P4310320990"],"host_organization_lineage_names":["Elsevier BV"],"type":"journal"},"license":"cc-by","license_id":"https://openalex.org/licenses/cc-by","version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"Journal of Hospital Infection","raw_type":"journal-article"},"volume":null,"type":"article","is_traditional":true,"indexed_in":["crossref","pubmed"],"open_access":{"is_oa":true,"oa_status":"hybrid","oa_url":"https://doi.org/10.1016/j.jhin.2026.07.028","any_repository_has_fulltext":false},"authorships":[{"author_position":"first","author":{"id":"https://openalex.org/A5085316055","display_name":"Kentaro Hara","orcid":"https://orcid.org/0000-0002-2677-3816","observed_orcids":["https://orcid.org/0000-0002-2677-3816"]},"institutions":[{"id":"https://openalex.org/I159385669","display_name":"Chiba University","ror":"https://ror.org/01hjzeq58","country_code":"JP","type":"education","lineage":["https://openalex.org/I159385669"]},{"id":"https://openalex.org/I4210118695","display_name":"Nagasaki Medical Center","ror":"https://ror.org/02qv90y91","country_code":"JP","type":"healthcare","lineage":["https://openalex.org/I4210118695","https://openalex.org/I4210137409"]},{"id":"https://openalex.org/I96036126","display_name":"Kumamoto University","ror":"https://ror.org/02cgss904","country_code":"JP","type":"education","lineage":["https://openalex.org/I96036126"]}],"countries":["JP"],"is_corresponding":true,"raw_author_name":"Kentaro Hara","raw_affiliation_strings":["Department of Fundamental Nursing, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan; Clinical Research Center, NHO Nagasaki Medical Centre, Nagasaki, Japan; Healthcare Management Research Center, Chiba University, Chiba, Japan. Electronic address: kentaro-hara@kumamoto-u.ac.jp"],"raw_orcid":"https://orcid.org/0000-0002-2677-3816","affiliations":[{"raw_affiliation_string":"Department of Fundamental Nursing, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan; Clinical Research Center, NHO Nagasaki Medical Centre, Nagasaki, Japan; Healthcare Management Research Center, Chiba University, Chiba, Japan. Electronic address: kentaro-hara@kumamoto-u.ac.jp","institution_ids":["https://openalex.org/I159385669","https://openalex.org/I4210118695","https://openalex.org/I96036126"]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5064036486","display_name":"Reika Tachibana","orcid":"https://orcid.org/0009-0000-2782-303X","observed_orcids":["https://orcid.org/0009-0000-2782-303X"]},"institutions":[{"id":"https://openalex.org/I4210118695","display_name":"Nagasaki Medical Center","ror":"https://ror.org/02qv90y91","country_code":"JP","type":"healthcare","lineage":["https://openalex.org/I4210118695","https://openalex.org/I4210137409"]}],"countries":["JP"],"is_corresponding":true,"raw_author_name":"Reika Tachibana","raw_affiliation_strings":["Department of Operation Centre, NHO Nagasaki Medical Centre, Japan"],"raw_orcid":"https://orcid.org/0009-0000-2782-303X","affiliations":[{"raw_affiliation_string":"Department of Operation Centre, NHO Nagasaki Medical Centre, Japan","institution_ids":["https://openalex.org/I4210118695"]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5111175798","display_name":"Ryosuke Kumashiro","orcid":"https://orcid.org/0009-0009-1472-5997","observed_orcids":["https://orcid.org/0009-0009-1472-5997"]},"institutions":[{"id":"https://openalex.org/I20831749","display_name":"Fukuoka Prefectural University","ror":"https://ror.org/014jyaw47","country_code":"JP","type":"education","lineage":["https://openalex.org/I20831749"]}],"countries":["JP"],"is_corresponding":true,"raw_author_name":"Ryosuke Kumashiro","raw_affiliation_strings":["Department of Fundamental Nursing, Faculty of Nursing, Fukuoka Prefectural University, 4395 Ita, Tagawa, Fukuoka, Japan"],"raw_orcid":"https://orcid.org/0009-0009-1472-5997","affiliations":[{"raw_affiliation_string":"Department of Fundamental Nursing, Faculty of Nursing, Fukuoka Prefectural University, 4395 Ita, Tagawa, Fukuoka, Japan","institution_ids":["https://openalex.org/I20831749"]}]},{"author_position":"last","author":{"id":"https://openalex.org/A5047979474","display_name":"Misa Tomooka","orcid":"https://orcid.org/0000-0002-4640-6810","observed_orcids":["https://orcid.org/0000-0002-4640-6810"]},"institutions":[{"id":"https://openalex.org/I96036126","display_name":"Kumamoto University","ror":"https://ror.org/02cgss904","country_code":"JP","type":"education","lineage":["https://openalex.org/I96036126"]}],"countries":["JP"],"is_corresponding":true,"raw_author_name":"Misa Tomooka","raw_affiliation_strings":["Department of Fundamental Nursing, Kumamoto University, 4-24-1 Kuhonji, Chuo-ku, Kumamoto City, Kumamoto, Japan"],"raw_orcid":"https://orcid.org/0000-0002-4640-6810","affiliations":[{"raw_affiliation_string":"Department of Fundamental Nursing, Kumamoto University, 4-24-1 Kuhonji, Chuo-ku, Kumamoto City, Kumamoto, Japan","institution_ids":["https://openalex.org/I96036126"]}]}],"institutions":[],"countries_distinct_count":1,"institutions_distinct_count":4,"corresponding_author_ids":["https://openalex.org/A5047979474","https://openalex.org/A5064036486","https://openalex.org/A5085316055","https://openalex.org/A5111175798"],"corresponding_institution_ids":["https://openalex.org/I159385669","https://openalex.org/I20831749","https://openalex.org/I4210118695","https://openalex.org/I96036126"],"apc_list":{"value":4000,"currency":"USD","value_usd":4000},"apc_paid":{"value":4000,"currency":"USD","value_usd":4000},"fwci":0.0,"has_fulltext":false,"cited_by_count":0,"citation_normalized_percentile":{"value":0.0,"is_in_top_1_percent":false,"is_in_top_10_percent":false},"cited_by_percentile_year":null,"biblio":{"volume":"176","issue":null,"first_page":"77","last_page":"86"},"is_retracted":false,"is_paratext":false,"is_xpac":false,"primary_topic":{"id":"https://openalex.org/T12744","display_name":"Medical Device Sterilization and Disinfection","score":0.9829000234603882,"subfield":{"id":"https://openalex.org/subfields/2404","display_name":"Microbiology"},"field":{"id":"https://openalex.org/fields/24","display_name":"Immunology and Microbiology"},"domain":{"id":"https://openalex.org/domains/1","display_name":"Life Sciences"}},"topics":[{"id":"https://openalex.org/T12744","display_name":"Medical Device Sterilization and Disinfection","score":0.9829000234603882,"subfield":{"id":"https://openalex.org/subfields/2404","display_name":"Microbiology"},"field":{"id":"https://openalex.org/fields/24","display_name":"Immunology and Microbiology"},"domain":{"id":"https://openalex.org/domains/1","display_name":"Life Sciences"}},{"id":"https://openalex.org/T10435","display_name":"Environmental Impact and Sustainability","score":0.00839999970048666,"subfield":{"id":"https://openalex.org/subfields/2305","display_name":"Environmental Engineering"},"field":{"id":"https://openalex.org/fields/23","display_name":"Environmental Science"},"domain":{"id":"https://openalex.org/domains/3","display_name":"Physical Sciences"}},{"id":"https://openalex.org/T12920","display_name":"Healthcare and Environmental Waste Management","score":0.0032999999821186066,"subfield":{"id":"https://openalex.org/subfields/2739","display_name":"Public Health, Environmental and Occupational Health"},"field":{"id":"https://openalex.org/fields/27","display_name":"Medicine"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}}],"keywords":[{"id":"https://openalex.org/keywords/operating-room-supplies","display_name":"operating room supplies","score":0.6069999933242798},{"id":"https://openalex.org/keywords/environmental-impact","display_name":"environmental impact","score":0.3140000104904175},{"id":"https://openalex.org/keywords/co2-emissions","display_name":"CO2 emissions","score":0.7850000262260437},{"id":"https://openalex.org/keywords/water-use","display_name":"water consumption","score":0.9380000233650208},{"id":"https://openalex.org/keywords/cost-reduction","display_name":"cost reduction","score":0.4580000042915344},{"id":"https://openalex.org/keywords/autoclaving","display_name":"autoclaving","score":0.5770000219345093},{"id":"https://openalex.org/keywords/ethylene-oxide","display_name":"ethylene oxide","score":0.628000020980835},{"id":"https://openalex.org/keywords/hydrogen-peroxide-vapor","display_name":"hydrogen peroxide vapor","score":0.6769999861717224}],"concepts":[{"id":"https://openalex.org/C2776687438","wikidata":"https://www.wikidata.org/wiki/Q3749492","display_name":"Sterility","level":2,"score":0.9283000230789185},{"id":"https://openalex.org/C71924100","wikidata":"https://www.wikidata.org/wiki/Q11190","display_name":"Medicine","level":0,"score":0.9010000228881836},{"id":"https://openalex.org/C2779473830","wikidata":"https://www.wikidata.org/wiki/Q1540899","display_name":"MEDLINE","level":2,"score":0.32919999957084656},{"id":"https://openalex.org/C29456083","wikidata":"https://www.wikidata.org/wiki/Q1221899","display_name":"Gynecology","level":1,"score":0.32690000534057617},{"id":"https://openalex.org/C150903083","wikidata":"https://www.wikidata.org/wiki/Q7108","display_name":"Biotechnology","level":1,"score":0.32499998807907104},{"id":"https://openalex.org/C177713679","wikidata":"https://www.wikidata.org/wiki/Q679690","display_name":"Intensive care medicine","level":1,"score":0.2985000014305115},{"id":"https://openalex.org/C99454951","wikidata":"https://www.wikidata.org/wiki/Q932068","display_name":"Environmental health","level":1,"score":0.27889999747276306},{"id":"https://openalex.org/C148761745","wikidata":"https://www.wikidata.org/wiki/Q1563203","display_name":"Sterilization (economics)","level":4,"score":0.2700999975204468},{"id":"https://openalex.org/C2777688143","wikidata":"https://www.wikidata.org/wiki/Q179399","display_name":"Infertility","level":3,"score":0.2694000005722046},{"id":"https://openalex.org/C131872663","wikidata":"https://www.wikidata.org/wiki/Q5284418","display_name":"Obstetrics","level":1,"score":0.26440000534057617}],"mesh":[{"descriptor_ui":"D006801","descriptor_name":"Humans","qualifier_ui":null,"qualifier_name":null,"is_major_topic":false},{"descriptor_ui":"D007564","descriptor_name":"Japan","qualifier_ui":null,"qualifier_name":null,"is_major_topic":false},{"descriptor_ui":"D009873","descriptor_name":"Operating Rooms","qualifier_ui":"Q000191","qualifier_name":"economics","is_major_topic":true},{"descriptor_ui":"D013242","descriptor_name":"Sterilization","qualifier_ui":"Q000191","qualifier_name":"economics","is_major_topic":true},{"descriptor_ui":"D013242","descriptor_name":"Sterilization","qualifier_ui":"Q000379","qualifier_name":"methods","is_major_topic":true},{"descriptor_ui":"D013997","descriptor_name":"Time Factors","qualifier_ui":null,"qualifier_name":null,"is_major_topic":false}],"locations_count":2,"locations":[{"id":"doi:10.1016/j.jhin.2026.07.028","doi":"https://doi.org/10.1016/j.jhin.2026.07.028","is_oa":true,"landing_page_url":"https://doi.org/10.1016/j.jhin.2026.07.028","pdf_url":null,"source":{"id":"https://openalex.org/S87161179","display_name":"Journal of Hospital Infection","issn_l":"0195-6701","issn":["0195-6701","1532-2939"],"is_oa":false,"is_in_doaj":false,"is_core":true,"listed_in":["anvur-scientific","cwts-core","dongbi-b","doyens","jufo-1","ki-jl-1","medline","norway-1","poland-100","russia-white-list-1","vabb-shw"],"host_organization":"https://openalex.org/P4310320990","host_organization_name":"Elsevier BV","host_organization_lineage":["https://openalex.org/P4310320990"],"host_organization_lineage_names":["Elsevier BV"],"type":"journal"},"license":"cc-by","license_id":"https://openalex.org/licenses/cc-by","version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"Journal of Hospital Infection","raw_type":"journal-article"},{"id":"pmid:42567325","doi":null,"is_oa":false,"landing_page_url":"https://pubmed.ncbi.nlm.nih.gov/42567325","pdf_url":null,"source":{"id":"https://openalex.org/S4306525036","display_name":"PubMed","issn_l":null,"issn":null,"is_oa":false,"is_in_doaj":false,"is_core":false,"listed_in":[],"host_organization":"https://openalex.org/I1299303238","host_organization_name":"National Institutes of Health","host_organization_lineage":["https://openalex.org/I1299303238"],"host_organization_lineage_names":[],"type":"repository"},"license":null,"license_id":null,"version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"The Journal of hospital infection","raw_type":"Journal Article"}],"best_oa_location":{"id":"doi:10.1016/j.jhin.2026.07.028","doi":"https://doi.org/10.1016/j.jhin.2026.07.028","is_oa":true,"landing_page_url":"https://doi.org/10.1016/j.jhin.2026.07.028","pdf_url":null,"source":{"id":"https://openalex.org/S87161179","display_name":"Journal of Hospital Infection","issn_l":"0195-6701","issn":["0195-6701","1532-2939"],"is_oa":false,"is_in_doaj":false,"is_core":true,"listed_in":["anvur-scientific","cwts-core","dongbi-b","doyens","jufo-1","ki-jl-1","medline","norway-1","poland-100","russia-white-list-1","vabb-shw"],"host_organization":"https://openalex.org/P4310320990","host_organization_name":"Elsevier BV","host_organization_lineage":["https://openalex.org/P4310320990"],"host_organization_lineage_names":["Elsevier BV"],"type":"journal"},"license":"cc-by","license_id":"https://openalex.org/licenses/cc-by","version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"Journal of Hospital Infection","raw_type":"journal-article"},"sustainable_development_goals":[{"display_name":"Good health and well-being","score":0.8048999905586243,"id":"https://metadata.un.org/sdg/3"},{"display_name":"Responsible consumption and production","score":0.6000000238418579,"id":"https://metadata.un.org/sdg/12"}],"study_designs":[],"awards":[{"id":"https://openalex.org/G6522968378","display_name":"Basic study to establish sterilization expiration date as event-dependent aseptic maintenance in operating rooms","funder_award_id":"23K17255","funder_id":"https://openalex.org/F4320334764","funder_display_name":"Japan Society for the Promotion of Science"}],"funders":[{"id":"https://openalex.org/F4320334764","display_name":"Japan Society for the Promotion of Science","ror":"https://ror.org/00hhkn466"}],"has_content":{"grobid_xml":false,"pdf":false},"content_urls":null,"referenced_works_count":23,"referenced_works":["https://openalex.org/W1503549320","https://openalex.org/W2070625245","https://openalex.org/W2131428092","https://openalex.org/W2165423606","https://openalex.org/W2312914809","https://openalex.org/W2417491767","https://openalex.org/W2774156456","https://openalex.org/W2798795107","https://openalex.org/W2994897055","https://openalex.org/W2996062786","https://openalex.org/W3014488149","https://openalex.org/W3201556185","https://openalex.org/W3215474642","https://openalex.org/W3217316753","https://openalex.org/W4206948769","https://openalex.org/W4317553427","https://openalex.org/W4365456987","https://openalex.org/W4388566051","https://openalex.org/W4390837673","https://openalex.org/W4410832660","https://openalex.org/W4411154057","https://openalex.org/W7151087886","https://openalex.org/W7160646042"],"related_works":["https://openalex.org/W7151087886","https://openalex.org/W7092445828","https://openalex.org/W7160646042","https://openalex.org/W149572857","https://openalex.org/W2045901556","https://openalex.org/W85136978","https://openalex.org/W2399755137","https://openalex.org/W2398823607","https://openalex.org/W2741031193","https://openalex.org/W2413349901"],"abstract_inverted_index":{"Background":[0],"Time-related":[1],"sterility":[2,24,66],"maintenance":[3,67],"(TRSM)":[4],"remains":[5,33],"common":[6],"in":[7],"Japanese":[8],"operating":[9],"rooms,":[10],"requiring":[11],"re-sterilisation":[12,123,156],"of":[13,99,199,238,251,257],"unopened":[14],"supplies":[15,54,101],"at":[16,187],"fixed":[17],"intervals,":[18],"although":[19],"microbiological":[20],"evidence":[21],"indicates":[22],"that":[23],"loss":[25],"is":[26,124],"event-driven,":[27],"not":[28],"time-driven.":[29],"Its":[30],"avoidable":[31,61,192,215,239,252],"burden":[32,216],"unquantified.":[34],"Aim":[35],"To":[36],"quantify":[37],"the":[38,58,107,211],"annual":[39],"cost,":[40],"carbon":[41],"dioxide-equivalent":[42],"(CO":[43],"2":[44,112,114,224,241],"e)":[45],"emissions,":[46],"water":[47],"use,":[48],"and":[49,57,72,92,118,229,246,262],"labour":[50,253],"from":[51,145],"re-sterilising":[52],"expired":[53,100],"under":[55,204],"TRSM,":[56],"upper-bound":[59],"proportion":[60],"by":[62,134,171],"transition":[63],"to":[64,248],"event-related":[65,142],"(ERSM).":[68],"Methods":[69],"Single-centre":[70],"observational":[71],"modelling":[73],"study":[74],"integrating":[75],"a":[76,85,131,149,195,260],"gate-to-gate":[77],"environmental":[78],"assessment":[79],"(a":[80],"partial":[81],"boundary":[82],"rather":[83],"than":[84],"full":[86],"cradle-to-grave":[87],"life-cycle":[88],"assessment),":[89],"cost-consequence":[90],"analysis,":[91],"discrete-event":[93],"simulation":[94],"(DES).":[95],"A":[96,137],"one-month":[97],"census":[98],"(746":[102],"items)":[103],"was":[104,169,194,217],"annualised":[105],"with":[106,140],"institutional":[108],"modality":[109],"mix":[110],"(steam:VH":[111],"O":[113],":EO":[115],"=":[116],"8:1:1)":[117],"literature-derived":[119],"emission":[120],"factors.":[121],"As":[122],"predominantly":[125],"co-loaded,":[126],"costs":[127],"were":[128,166,184],"allocated":[129],"as":[130,259],"marginal":[132],"increment":[133],"load":[135],"factor.":[136],"competing-risk":[138],"DES,":[139],"an":[141],"contamination":[143],"hazard":[144],"five-year":[146],"data,":[147],"yielded":[148],"modelled":[150,196],"upper":[151,197,212],"bound;":[152],"conservative":[153,205],"scenarios":[154],"retaining":[155],"for":[157],"legitimate":[158],"non-time":[159],"triggers":[160],"(damage,":[161],"recall,":[162],"audit,":[163],"inventory":[164],"checks)":[165],"added.":[167],"Uncertainty":[168],"assessed":[170],"probabilistic":[172],"(Monte":[173],"Carlo,":[174],"5,000":[175],"iterations)":[176],"sensitivity":[177],"analysis.":[178],"Findings":[179],"An":[180],"estimated":[181],"8,952":[182],"items":[183],"re-sterilised":[185],"annually":[186],"one":[188],"643-bed":[189],"centre.":[190],"The":[191],"fraction":[193],"bound":[198],"99.9%":[200],"(95%":[201],"interval":[202],"99.6\u2013100%);":[203],"scenarios,":[206],"80\u201395%":[207],"remained":[208],"avoidable.":[209],"At":[210],"bound,":[213],"median":[214],"\u00a51.24":[218],"million/year":[219],"(\u2248US$8,300),":[220],"1,768":[221],"kg":[222],"CO":[223,240],"e/year,":[225],"10,727":[226],"L":[227],"water/year,":[228],"147":[230,249],"hours/year.":[231],"Conclusion":[232],"TRSM":[233],"generated":[234],"approximately":[235],"1.8":[236],"tonnes":[237],"e,":[242],"over":[243],"\u00a51":[244],"million,":[245],"up":[247],"hours":[250],"annually,":[254],"supporting":[255],"evaluation":[256],"ERSM":[258],"decarbonisation":[261],"efficiency":[263],"measure.":[264]},"counts_by_year":[],"updated_date":"2026-11-10T11:39:43.021295","created_date":"2026-08-08T00:00:00"}