In 2006, the Korean Society for Healthcare-associated Infection Control (KOSHIC) launched the Korean National Healthcare-associated Infections Surveillance System (KONIS) program under the auspices of the Korea Centers for Disease Control and Prevention (currently the Korea Disease Control and Prevention Agency, KDCA). Since then, KONIS has served as the nationwide platform for intensive care unit (ICU) surveillance in Korea. This narrative review summarizes the evolution and performance of KONIS-ICU over the past 20 years and discuss its future directions. Building on standardized case definitions, indicators, and a webbased data-reporting platform, the KONIS has expanded from a single ICU module to seven surveillance modules and now engages a large proportion of acute-care hospitals, enabling interhospital benchmarking and policy support. The data quality was strengthened over time through uniform manuals, routine training, helpdesk support, and regular internal and external validity assessments. Trends in the KONIS-ICU reports have indicated a sustained decline in the burden of healthcare-associated infections (HAIs) over the past two decades. In a recent report (July 2023 to June 2024), the overall HAI incidence was 3.15 per 1,000 patientdays; device-associated infection rates were 1.16 per 1,000 urinary catheter-days for catheterassociated urinary tract infection, 2.35 per 1,000 central line-days for central line-associated bloodstream infections, and 0.87 per 1,000 ventilator-days for ventilator-associated pneumonia. Gram-negative bacilli accounted for the largest proportion of HAI pathogens, followed by gram-positive cocci and Candida spp.. Antimicrobial resistance remains a major concern, with high methicillin resistance in Staphylococcus aureus and carbapenem resistance in Acinetobacter and Pseudomonas. Findings from the KONIS, including its periodic official reports and peer-reviewed publications, have informed hospital infection control practices and national strategies, and have provided solid evidence for targeted interventions. The KONIS has been incorporating risk-adjusted indicators, such as the standardized infection ratio (SIR) and standardized utilization ratio (SUR), while enhancing data reliability and surveillance efficiency by strengthening auditing, continuous training, and digital automation of data collection. Over the past two decades, the KONIS-ICU has been established as the cornerstone of the national infection surveillance in Korea. The continued leadership of the KOSHIC is crucial for maintaining the sustainability of the KONIS-ICU, advancing its data quality, and aligning it with global surveillance initiatives.

Background: This study develops a job-based performance evaluation tool to assess the level of task performance among infection control nurses in response to changes and increases in their duties following the COVID-19 pandemic. Additionally, the study evaluates the validity and reliability of the developed instrument. Methods: The study participants were infection control nurses who had been working for at least one year in the infection control departments of healthcare institutions. Department heads were excluded from participation. Data collection was conducted from November 15 to December 15, 2024. Results: The final instrument consisted of 37 items categorized into the following four factors, with an explanatory power of 73.68%: 1. Operation of infection control systems and programs; 2. Management of infectious diseases and outbreaks; 3. Promotion of hand hygiene, standard precautions, and transmission-based precautions; and 4. Support for medical device reprocessing and environmental management. The instrument demonstrated both convergent and discriminant validity. Internal consistency was high, with a Cronbach’s alpha of .95 for the overall tool, and the Cronbach’s alphas for each factor ranged from .93 to .97. Conclusion This study developed a valid and reliable evaluation tool that systematically assesses the performance of infection control nurses in clinical practice, reflecting the expanded and evolving roles of these professionals in the aftermath of the COVID-19 pandemic. The tool offers practical evidence that may be utilized in various domains such as education, competency development, and policy-making for infection control personnel.

Antimicrobial resistance (AMR) is a growing global health concern. Optimizing antibiotic use through an Antimicrobial Stewardship Program (ASP) is a key strategy. In Korea, ASPs have been mostly voluntary and have largely been implemented only in large tertiary hospitals. However, in November 2024, the Korean government launched a pilot ASP initiative with structural and activity-based indicators, performance-based incentives, and staffing requirements to promote nationwide adoption of structured stewardship systems. This paper provides an overview of the ASP pilot project and how the ASP and Infection Control Program (ICP) can collaborate to manage AMR in Korean healthcare facilities. Both programs share the common goals of reducing AMR, emphasizing patient safety, and improving clinical outcomes. ASP optimizes individual antibiotic prescriptions led by infectious disease physicians and pharmacists, whereas ICP is oriented toward environmental and organizational infection prevention led by infection control nurses and clinicians. The synergy between ASP and ICP has been increasingly recognized in the literature and in international best practices. From previous studies, we identified four key areas in which ASP-ICP integration could be particularly impactful: 1) the development of shared governance and decision-making frameworks; 2) the use of integrated electronic surveillance systems for real-time monitoring of antibiotic use, resistance patterns, and healthcare-associated infections (HAIs); 3) the creation of joint clinical guidelines and education programs to reinforce interdisciplinary collaboration; and 4) the implementation of co-managed intervention protocols for Multidrug-Resistant Organism containment. Collaborative strategies not only enhance the effectiveness of AMR control but also improve patient outcomes and operational efficiency. Positive outcomes from consolidating overlapping tasks or collaborating in common areas (e.g., surveillance, reporting, training, interventions, and outreach) have been reported based on program similarities, although limitations may arise in Korea.Successful ASP-ICP collaboration in Korea requires consideration of unique local factors, such as hospital size, organizational culture, and medical reimbursement systems. In particular, government support for smaller hospitals, including networking, standardized guidelines, and telestewardship, is necessary. Therefore, the establishment of ASP-ICP collaboration models tailored to Korea’s diverse healthcare settings is essential. This requires systematic research, including of shared experiences and evaluations of short- and long-term outcomes, from each institution.

Background: This study investigates the epidemiological characteristics of confirmed cases of COVID-19, including among inpatients and healthcare workers (HCWs), and identifies factors associated with secondary transmission within a single hospital in Korea. Methods: We retrospectively analyzed epidemiological investigation data from January 2020 to August 2022. Descriptive statistics and multivariate logistic regression were used to evaluate characteristics and identify risk factors for secondary transmission. Results: A total of 208 inpatients and 1,699 HCWs were diagnosed with COVID-19. Second-ary infections occurred in 26.4% of inpatients and 9.7% of HCWs. Among inpatients, age ≥65years (aOR: 11.31, 95% CI: 1.45-88.23), presence of respiratory symptoms (aOR: 0.27, 95% CI: 0.10-0.76), and ICU admission (aOR: 0.11, 95% CI: 0.01-0.88) were significantly associated with secondary transmission. Among HCWs, being aged 55-64 years (aOR: 1.83, 95% CI:1.13-2.95) was a significant risk factor. Notably, asymptomatic cases had significantly higher numbers of close contacts than symptomatic cases. Conclusion Our findings highlight the need for continued epidemiological surveillance and tailored infection control strategies, including proactive management of asymptomatic cases, targeted training for HCWs, and enhanced infection prevention protocols for inpatients to reduce in-hospital transmission of COVID-19.

Hepatitis C virus (HCV) infection remains one of the major causes of chronic liver disease, cirrhosis, and hepatocellular carcinoma in Korea. This review summarizes recent epidemiological trends, disease burden, diagnostic approaches, prevention strategies, and management policies based on the 2025 Korean Association for the Study of the Liver guidelines and the 2024 Liver Disease White Paper. The nationwide anti-HCV seroprevalence is approximately 0.7%, with a higher prevalence observed among older adults and high-risk populations, including those who inject drugs, patients undergoing hemodialysis, and patients with hemophilia. The introduction of pan-genotypic direct-acting antivirals has revolutionized HCV management, achieving sustained virologic response rates exceeding 95% and dramatically improving prognosis. Despite therapeutic advancements, challenges regarding early detection, limited screening coverage, and incomplete linkage-to-care remain. To achieve the World Health Organization 2030 HCV elimination goal, Korea must implement a nationwide screening program, strengthen infection surveillance, and improve public awareness and policy coordination to reduce disease burden and achieve equitable access to treatment.

Influenza viruses cause annual seasonal epidemics with a substantial healthcare burden, and global pandemics at multidecadal intervals. Pandemic emergence is driven by the capacity of the segmented RNA genome for antigenic drift and, critically, reassortment-mediated antigenic shift. Reassortment among avian, swine, and human influenza A lineages, facilitated by pigs that express both α2,3- and α2,6-linked sialic acid receptors, can yield viruses with efficient replication in mammalian cells and affinity for the human upper respiratory tract. Historically, the 1918 H1N1 and 1957 H2N2 pandemics likely arose from avian–human reassortants, whereas the 2009 H1N1pdm09 virus represented a quadruple reassortant involving swine, avian, and human progenitors. Age-specific mortality patterns may deviate from the U-shaped seasonal profile; the 1918 and 2009 pandemics disproportionately affected younger adults, plausibly reflecting antigenic recycling and partial immunity in older cohorts. The diagnosis of novel influenza relies on RT-PCR with subtype-specific confirmation in reference laboratories, as rapid antigen assays calibrated to seasonal antigens may fail to detect shifted viruses. Antivirals include neuraminidase inhibitors and the cap-dependent endonuclease inhibitor, baloxavir.Early administration of antivirals reduces progression to severe disease, and current H5N1 viruses remain broadly susceptible. Contemporary infection-prevention frameworks emphasize airborne transmission, across a spectrum from direct deposition of large droplets to aerosol inhalation, modulated by ventilation and procedure-related aerosol generation—implications that extend beyond traditional droplet–airborne dichotomies. Since March 2024, the highly pathogenic avian influenza H5N1 has spread across North America with sporadic human infections—mostly linked to exposure to infected dairy cattle or contaminated raw milk—typically manifesting as mild conjunctivitis. Although sustained human-to-human transmission has not been demonstrated, the virus exhibits an unusually broad mammalian host range with severe neurotropism in animal models. Wastewater detection suggests persistent animal circulation independent of human influenza activity. These features, coupled with the seasonal co-circulation of the human influenza virus, increase the risk of viral genomic reassortment. Multiple H5N1 vaccine candidates, including mRNA platforms, have been licensed or are advancing, supporting targeted pre-exposure strategies for the high-risk population. Sustained surveillance, rapid characterization and vaccination capacity, ventilation-aware infection control, and transparent risk communication, especially amid the post-COVID skepticism, remain central to mitigating the next influenza pandemic.

COVID-19 (SARS-CoV-2) has imposed a substantial global disease burden due to its high basic reproductive number and initially elevated case fatality rate. Over time, the fatality rate has declined to a level comparable to that of seasonal influenza, driven by non-pharmaceutical public health measures, advances in medical care, and the development of vaccines and therapeutics. However, the disease burden remains high among vulnerable populations, such as older adults, highlighting the importance of strengthening response capacity in long-term care hospitals and facilities in many countries, including Korea. Extensive efforts from the medical community and public health authorities have generated valuable studies and guidelines. Nevertheless, disease-specific strategies alone cannot adequately protect vulnerable populations from future infectious disease outbreaks, including pandemics. Addressing this gap requires comprehensive system-wide improvements aligned with global health security principles, with particular emphasis on expanding the infection prevention and control workforce. Collaborative research between medical and public health sectors is urgently needed to drive these improvements.

Background: This retrospective case-control study investigated the incidence and risk factors for carbapenemase-producing Enterobacterales (CPE) acquisition among patients admitted to the intensive care units (ICUs) of a university hospital in Korea. Methods: Between January 1, 2021, and December 31, 2023, a total of 9,381 patients were admitted to the ICUs of a university hospital in Korea. Among these, 2,124 patients underwent at least two active surveillance cultures for carbapenem-resistant Enterobacterales (CRE).Newly acquired CPE colonization was identified in 38 patients, who were classified as the case group. For each case, two non-CRE controls were selected by matching for ICU type and exposure period, resulting in a control group of 76 patients. We analyzed the epidemiological, microbiological, patient-related, and environmental characteristics of patients who acquired CPE, and investigated risk factors associated with CPE acquisition. Results: The proportion of patients who acquired CPE was 1.8%. Klebsiella pneumoniaewas the most frequently isolated species, accounting for 68.4% of cases, and blaKPC was the predominant genotype, identified in 89.5% of isolates. The median time from ICU admission to CPE acquisition was 14 days. In multivariable analysis, independent risk factors for CPE acquisition included prior carbapenem use (adjusted OR: 6.23, 95% CI 1.59-24.38), colonization with multidrug-resistant organisms (adjusted OR: 9.34, 95% CI 1.48-58.90), staying for more than three days in a bed within two meters of a hand hygiene faucet (adjusted OR: 7.94, 95% CI 1.45-43.44), and a higher ICU CRE incidence (adjusted OR: 1.60, 95% CI 1.11-2.30). Conclusion These findings highlight the importance of implementing targeted infection control measures and active surveillance to prevent CPE acquisition in ICU settings.