The prevention and control of pathogen transmission in populations rely fundamentally on isolation, widely regarded as one of the most effective strategies for interrupting transmission. A review of the history of medicine shows that surgical gloves and medical masks have made substantial contributions to infection control. Their widespread global adoption has also driven the development of extensive industrial supply chains. Today, these disposable, convenient, accessible, and affordable medical products are available in virtually every clinic worldwide.
Prior to the introduction of surgical gloves, surgical procedures in the 19
th century were commonly performed with bare hands. Although antiseptic principles proposed by Joseph Lister had been introduced, infection control relied mainly on handwashing and instrument disinfection, and postoperative infections remained highly prevalent, with surgical mortality reported to be extremely high, often driven by wound infections [
1]. In 1894, Dr. William Halsted introduced sterile surgical gloves at Johns Hopkins Hospital, a practice that transformed surgery and substantially reduced postoperative infections [
2].
Major public health emergencies have historically driven the development and adoption of medical masks. During the 1910–1911 pneumonic plague outbreak in Harbin, China, Dr. Wu Lien-Teh developed a multilayer gauze mask that was inexpensive, easy to use, and widely implemented, contributing to the control of person-to-person transmission and representing a milestone in the history of public health [
3]. During the 1918 influenza pandemic, face masks were widely used by both healthcare workers and the general public, contributing to the early recognition of masks as a public health intervention [
4]. During the COVID-19 pandemic in 2020, masks once again became one of the most important tools for personal protection and population-level intervention worldwide [
5].
The use of gloves and masks by healthcare workers constitutes a fundamental measure for preventing healthcare-associated infections. Although these measures cannot eliminate all nosocomial infections, the principle of pathogen isolation on which they are based provides important insights for preventing pathogens transmitted via the gastrointestinal route or through contact.
Recently, a study by Wen et al. published in the
International Journal of Infectious Diseases offered a noteworthy solution [
6]. A single-use full-bed protective barrier containment (PBC), also referred to as a "bed cover," can significantly reduce environmental contamination with
Clostridioides difficile in endoscopy units and lower the incidence of nosocomial infections. This finding raises an important question: If the single-patient use of disposable full-bed covers can effectively block pathogen transmission from the environment to patients, should it become a standard requirement in infection-control practice?
Clostridioides difficile infection (CDI) is one of the most common healthcare-associated infections worldwide. Its spores exhibit strong resistance to routine disinfection and can persist on environmental surfaces for prolonged periods [
7]. Endoscopy units, as high-volume clinical settings, represent high-risk areas for
C.
difficile transmission due to procedure-related aerosol generation and contamination of high-touch surfaces during patient transport. Several studies have even detected
C.
difficile in endoscopes after disinfection [
8,
9]. In this study, sampling of high-touch surfaces in endoscopy units across three tertiary hospitals revealed a contamination rate of 17.2% for transfer beds, with all positive samples originating from beds with incomplete sheet coverage [
6]. These findings highlight a critical vulnerability. Although terminal disinfection is essential, high-touch surfaces on transfer beds can easily become "transit hubs" for pathogens during continuous use.
The intervention implemented in this study involved the use of a disposable full-bed PBC for each patient during endoscopic procedures. Specifically, for every patient, nursing staff applied a new disposable bed cover in the patient's presence, ensuring complete coverage of all surfaces that might come into contact with the patient, including the mattress, bed edges, and side rails. This approach not only achieved physical isolation but also enhanced patient trust and perceived safety. After 1 year of intervention, the contamination rate of
C.
difficile on transfer beds decreased from 31.3% to 0%, and the incidence of CDI declined from 0.15 to 0.10 cases per 1000 patient-days [
6]. Importantly, these improvements were observed without changes in other infection-control measures, such as hand hygiene, antibiotic stewardship, or terminal disinfection, suggesting that PBC may have contributed substantially to the observed reduction.
From a cost-effectiveness perspective, the value of PBC is equally compelling. Based on the study's estimates, nationwide implementation of PBC in China, using 2024 data, could reduce healthcare expenditures by approximately 5.74 billion RMB (about 0.81 billion USD) annually, accounting for 0.19% of total national healthcare spending [
6]. This estimate was derived from the average cost of CDI treatment (46, 604 RMB per case) and total inpatient days nationwide. Although these figures are projections rather than real-world data, they underscore the substantial economic and societal benefits of PBC as a low-cost intervention.
Nevertheless, these projected savings should be interpreted alongside the operational costs associated with large-scale implementation, including procurement, storage, transportation, staff time, and disposal of single-use PBC materials. The overall economic impact, therefore, depends on the balance between prevented infection-related expenditures and implementation-related costs. Although the relatively low unit cost of disposable barriers suggests that net savings may remain favorable, comprehensive health economic analyses are needed to establish real-world cost-effectiveness under different healthcare settings.
However, the implementation of any new measure inevitably faces both cognitive and economic challenges. The history of medicine provides several instructive examples. In 1847, Ignaz Semmelweis observed that physicians were transferring "cadaverous particles" from autopsy rooms to maternity wards, contributing to fatal puerperal fever. By introducing mandatory handwashing with chlorinated lime, mortality rates reportedly declined from 18.27% to 1.27% [
10]. Despite these remarkable results, his findings encountered substantial resistance from the medical community because prevailing theories of disease transmission had not yet accepted invisible pathogenic agents. This historical example illustrates that effective preventive measures may initially face skepticism when they challenge established practice patterns.
The adoption of disposable syringes in the history of medicine provides another representative example. In the mid-20
th century, reusable glass syringes were still standard practice despite the risk of cross-infection, largely due to cost considerations. It was not until the emergence of the human immunodeficiency virus (HIV) epidemic, which heightened awareness of blood-borne pathogen transmission, that disposable syringes gradually became the global standard [
11]. Today, the necessity and importance of disposable syringes are beyond dispute. The adoption of disposable bed covers may undergo a similar transformation in perception.
It is important to emphasize that the value of PBC extends beyond CDI. For other nosocomial pathogens transmitted via the gastrointestinal tract or contact, PBC also holds preventive potential. In the context of the growing recognition of microbiota medicine, dysbiosis is both a cause and a consequence of infection [
12]. By reducing environmental exposure to pathogens, PBC may decrease the likelihood of infections requiring antibiotic treatment, thereby indirectly protecting the gut microbiota. In this sense, bed covers are not merely a physical barrier but also an ecological protective strategy. However, this potential ecological benefit should be considered alongside the environmental burden introduced by the large-scale use of disposable materials. Routine implementation of single-use PBC would inevitably increase medical waste generation and disposal requirements. Future innovations should, therefore, focus on developing biodegradable or environmentally sustainable PBC materials that preserve infection-control benefits while minimizing ecological impact.
Nevertheless, the study has limitations. The intervention was conducted in a limited number of centers and used a before–after design rather than a randomized controlled trial. Although key confounding factors remained stable before and after the intervention, unmeasured variables cannot be entirely excluded. In addition, national cost estimates are based on several assumptions, and the actual impact may vary depending on the region, hospital level, and implementation fidelity. Therefore, further studies across diverse clinical settings are needed to validate the generalizability and sustainability of PBC. In particular, multicenter cluster-randomized controlled trials are warranted to establish causality more definitively and to provide high-quality evidence supporting the integration of PBC into routine infection-control practice.
How can PBC be effectively implemented in clinical practice while minimizing disruption to frontline workflows? As illustrated in Figure 1, we propose several practical recommendations. First, PBC should be incorporated into pre-endoscopy checklists, requiring nursing staff or assistants to apply a disposable full-bed cover (not a regular disposable sheet) in the patient's presence. Because this process may increase workload in busy clinical environments, workflow optimization strategies, including integrating PBC application into existing bed preparation procedures, simplifying cover design, and providing standardized staff training, may help reduce operational burden and improve adherence. Second, PBC should be included in public health education to enhance patient awareness and understanding of medical procedures. Third, routine microbiological culture or pathogen nucleic acid testing should be conducted on high-touch surfaces in endoscopy units.
In conclusion, both medical history and the recent study on single-use full-bed PBC remind us that physical isolation remains the most fundamental and effective strategy for preventing pathogen transmission in healthcare settings. Hospitals should proactively interrupt transmission pathways before healthcare-associated infections occur, which represents a core principle of integrated prevention and treatment. Masks have transformed the prevention of respiratory infections, and single-use full-bed PBC offers a new paradigm for controlling pathogens transmitted via the gastrointestinal tract and contact. In an era marked by increasing antimicrobial resistance and emerging pathogens, there is an urgent need for simple, accessible, and effective infection-control tools. The promotion and further evaluation of single-use full-bed PBC are, therefore, warranted and may contribute to reshaping infection-control practice in endoscopy centers.
© 2026 The Author(s). Microbiota Medicine Research published by John Wiley & Sons Australia, Ltd on behalf of Higher Education Press.
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