Objective:To analyze the cost-effectiveness of administering two doses of different types of human papillomavirus (HPV) vaccines to 12-year-old female adolescents.Methods:A decision tree Markov model with genital warts and cervical cancer as target diseases was established to analyze the effects, costs, and Quality Adjusted Life Years (QALY) of strategies such as no vaccination, two doses of bivalent HPV (HPV-2), two doses of quadrivalent HPV (HPV-4), and two doses of nine-valent HPV (HPV-9) in a 12-year-old female adolescent cohort in 2023 using 50% of the procurement price or self-funded vaccination price in pilot provinces. The number of avoided cases of cervical cancer and genital warts and the incremental cost-utility ratio (ICUR) were compared between different strategies.Results:Compared with non-vaccination, female adolescents who received two doses of HPV-2, HPV-4 and HPV-9 were able to avoid 55.2% of cervical cancer cases with HPV-2, 77.11% and 78.68% of genital warts with HPV-4, and 54.99% and 73.46% of cervical cancer with HPV-9, respectively. The ICUR of strategies HPV-2, HPV-4, and HPV-9 was -28 470.44 yuan/QALY, 29 328.26 yuan/QALY and 48 106.85 yuan/QALY, respectively. HPV-2 was the most economical strategy and could achieve net cost savings. Single-factor sensitivity analysis showed that the results were robust, and the most influential factors were discount rate, vaccine prices and direct medical costs for low-grade precancerous lesions. The probability sensitivity analysis showed that compared with the national gross domestic product (GDP) per capita in 2023, the probability of cost-utility of HPV-2, HPV-4 and HPV-9 compared with non-vaccination was 99.51%, 89.03% and 67.81%, respectively. Only when the price of a single dose of HPV-4 and HPV-9 vaccines was lower than 26.12% and 20.68% of the current self-funded vaccination price, respectively, could there be a net cost saving.Conclusion:In the case where HPV-2 adopts the pilot province procurement price and the multivalent vaccine adopts a 50% self-funded vaccination price, the vaccination of 12-year-old female adolescents with HPV-2, HPV-4 and HPV-9 has cost-effectiveness, and HPV-2 is the most economical strategy.

Objective To investigate the bacterial contamination of water specimens at different pre-discharge time of flexible endoscopic final rinse water before daily use,and provide reference basis for choosing the optimal pre-dis-charge time in clinical work.Methods From August to December 2023,the water produced by the purified water equipment of the digestive endoscopy centers of 4 tertiary first-class medical institutions in Jiangxi Province,as well as the final rinsing water at the terminal-point at different pre-discharge times(before pre-discharge,discharge of 1,3,5,and 10 minutes)were subjected to on-site sampling,the collected water specimens were performed microbio-logical cultures by pouring and filter membrane methods,unqualified water specimens were performed bacterial i-dentification.Results 48 specimens of water produced by purified water equipment were collected,with qualified rate of 100％.480 final water specimens were collected,with a qualified rate of 0 before pre-discharge.The quali-fied rates of pre-discharge at 1,3,5,and 10 minutes were 0,21.88％,55.21％,and 73.96％,respectively.Bac-terial colony counts in the final rinse water with different pre-discharge times in 4 medical institutions showed statis-tically significant differences(all P＜0.001).As the pre-discharge time increased,bacterial colony counts in the fi-nal rinse water of all four medical institutions showed a decreasing trend.The pairwise comparison of the overall bacterial colony count of the final rinse water at different pre-discharge time showed that there was no statistically significant difference in the bacterial colony count of the final rinse water at 5 and 10 minutes of pre-discharge(P＞0.05),while the pairwise comparison between other time points showed statistically significant differences(all P＜0.001).Environmental contaminated bacteria such as Micrococcus luteus,Cupriavidus paucula,and Sphin-gononas paucimobilis were detected from the unqualified water specimens.Conclusion With the extension of pre-discharge time,the degree of bacterial contamination in the final rinse water significantly decreases.All levels of medical institutions need to pre-discharge the final rinse water daily,and the pre-discharge time should last for at least 5 minutes.

Objective To investigate the current status of cleaning and disinfection of endoscopic biopsy valves in three digestive endoscopy centers in Jiangxi Province,and evaluate the effectiveness of establishing a standard opera-tional procedure(SOP)of cleaning and disinfection for flexible endoscopic biopsy valves.Methods The cleaning and disinfection procedures of biopsy valves in three digestive endoscopy centers were recorded using on-site investi-gation method(the control group).Based on relevant literature and manufacturer manuals at home and abroad,SOP was established and cleaning and disinfection training for cleaning professional was provided(the trial group).Biop-sy valve specimens from two groups were taken.The disinfection qualified rate,microbial positivity rate before dis-infection,and microbial load after disinfection before and after procedure improvement were compared between two groups.Results A total of 180 biopsy valve specimens were taken from two groups(60 specimens from endoscopy centers A,B,and C each).On-site investigation showed that the cleaning and disinfection procedure for biopsy valves was inconsistent among the three endoscopy centers.The total qualified rate of disinfection in the trial group was higher than that in the control group(95.5％vs 83.3％),with statistically significant difference(P＜0.05).The total microbe positive rate of biopsy valves from the trial group was lower than that from the control group(25.0％ vs 57.2％),with statistically significant difference(P＜0.05).The difference in microbial load after disin-fection between two groups of biopsy valves was statistically significant(Z=-6.47,P＜0.05).Conclusion Al-though being a tiny accessory,the flexible endoscopic biopsy valve can be a potential source of infection if not tho-roughly cleaned and disinfected.Developing SOP can help improve the cleaning effectiveness of biopsy valves.At present,there is no unified standards for the cleaning and disinfection procedure of endoscopic biopsy valves.In the future,standardization of the SOP for biopsy valves should be continuously explored,so as to reduce the risk of cross infection.

Objective To compare the effectiveness of cobalt chloride test papers and borescope in evaluating the drying of endoscopes,providing a reference for clinical selection of appropriate assessment tools.Methods 10 gastroscopes and 10 colonoscopes procedures were selected from November 2023 to March 2024 for circulation experiments.After endoscope reprocessing,they were randomly divided into five groups with different drying times(30 s,3 min,6 min,9 min,and 12 min)with 200 samples.Cobalt chloride test paper and borescope were used to evaluate the drying effectiveness.Results The qualified rate of gastrointestinal endoscope by borescope was significantly higher than that by cobalt chloride test paper,but cobalt chloride test paper was obviously better than that by borescope in convenience and cost-effectiveness.The borescope had the function of visualization,and the quantitative positioning observation of residual droplets showed that there were a large number of droplets left after gastrointestinal endoscope drying for 30 s,and the number of droplets was obviously reduced after drying for 3 min.Among them,the gastroscope was mainly light(1～5 drops/strip)and none(0 drops/strip),and the colonoscope was mainly moderate(6～10 drops/strip)and light droplets.Compared with different drying times,there was a significant statistical difference in the number of residual droplets in the endoscope(P<0.01),and the localized droplets mainly remained in the distal bending part and the proximal bifurcation part of the lumen.Conclusion Both cobalt chloride test papers and borescope are important methods for assessing endoscope drying efficacy,each with its own advantages and limitations.Clinicians can use both methods in combination to comprehensively evaluate the overall dryness of endoscopes,thereby ensuring the safety and effectiveness of the endoscope reprocessing process.

Objective To understand the current status of application,management,and maintenance of automa-ted endoscope reprocessors(AERs)in China.Methods A questionnaire survey was conducted using convenience sampling method on the application,management,maintenance,and monitoring of AERs,as well as personnel training in digestive endoscopy centers of 292 medical institutions(MIs).Results A total of 316 questionnaires were distributed,and 292 were available,with an effective response rate of 92.41％.Among the 292 MIs,198(67.81％)were equipped with AERs,with equipment rates of 75.11％in tertiary MIs and 41.27％in secondary MIs.88.38％of MIs performed manual cleaning before placing endoscopes into AERs,while 2.02％of MIs still didn't perform this step,mainly in tertiary MIs.The most common problems in the application of AERs were the detachment or damage of connecting pipes(83.33％),followed by disinfectant leakage of AERs(43.94％),mal-function of control panel(43.94％),and failure or poor water flow of AER pipeline(42.93％).92.42％of MIs regularly disinfected AERs,72.73％of MIs regularly replaced AER air filters,and 80.30％of MIs regularly re-placed AER water filters.96.46％of MIs monitored the concentration of disinfectants before daily application of AERs,87.88％of MIs regularly monitored the final rinse water of AERs,and 96.97％of MIs provided professio-nal training for new employees to use AERs for the first time.Conclusion The equipping rate of AERs at all levels of MIs in China still needs to be improved.Most MIs are able to monitor and maintain AERs well,but there are still many problems in the application process.Due to the large volume of endoscopic diagnosis and treatment as well as insufficient execution rate of manual cleaning in tertiary MIs,it is necessary to optimize workflow and strengthen training.Secondary MIs face challenges such as equipment shortages and low monitoring execution rates,requiring increased funding and regulatory efforts.It is recommended that manufacturers continuously optimize AER design,MIs establish standardized AER application protocol,and relevant departments improve AER application and ma-nagement standards,in order to improve the quality of endoscopic cleaning and disinfection and ensure patient safety during diagnosis and treatment.

Objective To understand the current status of application,management,and maintenance of automa-ted endoscope reprocessors(AERs)in China.Methods A questionnaire survey was conducted using convenience sampling method on the application,management,maintenance,and monitoring of AERs,as well as personnel training in digestive endoscopy centers of 292 medical institutions(MIs).Results A total of 316 questionnaires were distributed,and 292 were available,with an effective response rate of 92.41％.Among the 292 MIs,198(67.81％)were equipped with AERs,with equipment rates of 75.11％in tertiary MIs and 41.27％in secondary MIs.88.38％of MIs performed manual cleaning before placing endoscopes into AERs,while 2.02％of MIs still didn't perform this step,mainly in tertiary MIs.The most common problems in the application of AERs were the detachment or damage of connecting pipes(83.33％),followed by disinfectant leakage of AERs(43.94％),mal-function of control panel(43.94％),and failure or poor water flow of AER pipeline(42.93％).92.42％of MIs regularly disinfected AERs,72.73％of MIs regularly replaced AER air filters,and 80.30％of MIs regularly re-placed AER water filters.96.46％of MIs monitored the concentration of disinfectants before daily application of AERs,87.88％of MIs regularly monitored the final rinse water of AERs,and 96.97％of MIs provided professio-nal training for new employees to use AERs for the first time.Conclusion The equipping rate of AERs at all levels of MIs in China still needs to be improved.Most MIs are able to monitor and maintain AERs well,but there are still many problems in the application process.Due to the large volume of endoscopic diagnosis and treatment as well as insufficient execution rate of manual cleaning in tertiary MIs,it is necessary to optimize workflow and strengthen training.Secondary MIs face challenges such as equipment shortages and low monitoring execution rates,requiring increased funding and regulatory efforts.It is recommended that manufacturers continuously optimize AER design,MIs establish standardized AER application protocol,and relevant departments improve AER application and ma-nagement standards,in order to improve the quality of endoscopic cleaning and disinfection and ensure patient safety during diagnosis and treatment.

Objective To investigate the current status of cleaning and disinfection of endoscopic biopsy valves in three digestive endoscopy centers in Jiangxi Province,and evaluate the effectiveness of establishing a standard opera-tional procedure(SOP)of cleaning and disinfection for flexible endoscopic biopsy valves.Methods The cleaning and disinfection procedures of biopsy valves in three digestive endoscopy centers were recorded using on-site investi-gation method(the control group).Based on relevant literature and manufacturer manuals at home and abroad,SOP was established and cleaning and disinfection training for cleaning professional was provided(the trial group).Biop-sy valve specimens from two groups were taken.The disinfection qualified rate,microbial positivity rate before dis-infection,and microbial load after disinfection before and after procedure improvement were compared between two groups.Results A total of 180 biopsy valve specimens were taken from two groups(60 specimens from endoscopy centers A,B,and C each).On-site investigation showed that the cleaning and disinfection procedure for biopsy valves was inconsistent among the three endoscopy centers.The total qualified rate of disinfection in the trial group was higher than that in the control group(95.5％vs 83.3％),with statistically significant difference(P＜0.05).The total microbe positive rate of biopsy valves from the trial group was lower than that from the control group(25.0％ vs 57.2％),with statistically significant difference(P＜0.05).The difference in microbial load after disin-fection between two groups of biopsy valves was statistically significant(Z=-6.47,P＜0.05).Conclusion Al-though being a tiny accessory,the flexible endoscopic biopsy valve can be a potential source of infection if not tho-roughly cleaned and disinfected.Developing SOP can help improve the cleaning effectiveness of biopsy valves.At present,there is no unified standards for the cleaning and disinfection procedure of endoscopic biopsy valves.In the future,standardization of the SOP for biopsy valves should be continuously explored,so as to reduce the risk of cross infection.

Objective:To analyze the cost-effectiveness of administering two doses of different types of human papillomavirus (HPV) vaccines to 12-year-old female adolescents.Methods:A decision tree Markov model with genital warts and cervical cancer as target diseases was established to analyze the effects, costs, and Quality Adjusted Life Years (QALY) of strategies such as no vaccination, two doses of bivalent HPV (HPV-2), two doses of quadrivalent HPV (HPV-4), and two doses of nine-valent HPV (HPV-9) in a 12-year-old female adolescent cohort in 2023 using 50% of the procurement price or self-funded vaccination price in pilot provinces. The number of avoided cases of cervical cancer and genital warts and the incremental cost-utility ratio (ICUR) were compared between different strategies.Results:Compared with non-vaccination, female adolescents who received two doses of HPV-2, HPV-4 and HPV-9 were able to avoid 55.2% of cervical cancer cases with HPV-2, 77.11% and 78.68% of genital warts with HPV-4, and 54.99% and 73.46% of cervical cancer with HPV-9, respectively. The ICUR of strategies HPV-2, HPV-4, and HPV-9 was -28 470.44 yuan/QALY, 29 328.26 yuan/QALY and 48 106.85 yuan/QALY, respectively. HPV-2 was the most economical strategy and could achieve net cost savings. Single-factor sensitivity analysis showed that the results were robust, and the most influential factors were discount rate, vaccine prices and direct medical costs for low-grade precancerous lesions. The probability sensitivity analysis showed that compared with the national gross domestic product (GDP) per capita in 2023, the probability of cost-utility of HPV-2, HPV-4 and HPV-9 compared with non-vaccination was 99.51%, 89.03% and 67.81%, respectively. Only when the price of a single dose of HPV-4 and HPV-9 vaccines was lower than 26.12% and 20.68% of the current self-funded vaccination price, respectively, could there be a net cost saving.Conclusion:In the case where HPV-2 adopts the pilot province procurement price and the multivalent vaccine adopts a 50% self-funded vaccination price, the vaccination of 12-year-old female adolescents with HPV-2, HPV-4 and HPV-9 has cost-effectiveness, and HPV-2 is the most economical strategy.

Objective To compare the effectiveness of cobalt chloride test papers and borescope in evaluating the drying of endoscopes,providing a reference for clinical selection of appropriate assessment tools.Methods 10 gastroscopes and 10 colonoscopes procedures were selected from November 2023 to March 2024 for circulation experiments.After endoscope reprocessing,they were randomly divided into five groups with different drying times(30 s,3 min,6 min,9 min,and 12 min)with 200 samples.Cobalt chloride test paper and borescope were used to evaluate the drying effectiveness.Results The qualified rate of gastrointestinal endoscope by borescope was significantly higher than that by cobalt chloride test paper,but cobalt chloride test paper was obviously better than that by borescope in convenience and cost-effectiveness.The borescope had the function of visualization,and the quantitative positioning observation of residual droplets showed that there were a large number of droplets left after gastrointestinal endoscope drying for 30 s,and the number of droplets was obviously reduced after drying for 3 min.Among them,the gastroscope was mainly light(1～5 drops/strip)and none(0 drops/strip),and the colonoscope was mainly moderate(6～10 drops/strip)and light droplets.Compared with different drying times,there was a significant statistical difference in the number of residual droplets in the endoscope(P<0.01),and the localized droplets mainly remained in the distal bending part and the proximal bifurcation part of the lumen.Conclusion Both cobalt chloride test papers and borescope are important methods for assessing endoscope drying efficacy,each with its own advantages and limitations.Clinicians can use both methods in combination to comprehensively evaluate the overall dryness of endoscopes,thereby ensuring the safety and effectiveness of the endoscope reprocessing process.

Objective To investigate the bacterial contamination of water specimens at different pre-discharge time of flexible endoscopic final rinse water before daily use,and provide reference basis for choosing the optimal pre-dis-charge time in clinical work.Methods From August to December 2023,the water produced by the purified water equipment of the digestive endoscopy centers of 4 tertiary first-class medical institutions in Jiangxi Province,as well as the final rinsing water at the terminal-point at different pre-discharge times(before pre-discharge,discharge of 1,3,5,and 10 minutes)were subjected to on-site sampling,the collected water specimens were performed microbio-logical cultures by pouring and filter membrane methods,unqualified water specimens were performed bacterial i-dentification.Results 48 specimens of water produced by purified water equipment were collected,with qualified rate of 100％.480 final water specimens were collected,with a qualified rate of 0 before pre-discharge.The quali-fied rates of pre-discharge at 1,3,5,and 10 minutes were 0,21.88％,55.21％,and 73.96％,respectively.Bac-terial colony counts in the final rinse water with different pre-discharge times in 4 medical institutions showed statis-tically significant differences(all P＜0.001).As the pre-discharge time increased,bacterial colony counts in the fi-nal rinse water of all four medical institutions showed a decreasing trend.The pairwise comparison of the overall bacterial colony count of the final rinse water at different pre-discharge time showed that there was no statistically significant difference in the bacterial colony count of the final rinse water at 5 and 10 minutes of pre-discharge(P＞0.05),while the pairwise comparison between other time points showed statistically significant differences(all P＜0.001).Environmental contaminated bacteria such as Micrococcus luteus,Cupriavidus paucula,and Sphin-gononas paucimobilis were detected from the unqualified water specimens.Conclusion With the extension of pre-discharge time,the degree of bacterial contamination in the final rinse water significantly decreases.All levels of medical institutions need to pre-discharge the final rinse water daily,and the pre-discharge time should last for at least 5 minutes.