Parametric and non-parametric frontier applications are typical for measuring the efficiency and productivity of many healthcare units. Due to the current COVID-19 pandemic, hospital efficiency is the center of academic discussions and the most desired target for many public authorities under limited resources. Investigating the state of the art of such applications and methodologies in the healthcare sector, besides uncovering strategical managerial prospects, can expand the scientific knowledge on the fundamental differences among efficiency models, variables and applications, drag research attention to the most attractive and recurrent concepts, and broaden a discussion on the specific theoretical and empirical gaps still to be addressed in future research agendas. This work offers a systematic bibliometric review to explore this complex panorama. Hospital efficiency applications from 1996 to 2022 were investigated from the Web of Science base. We selected 65 from the 203 most prominent works based on the Core Publication methodology. We provide core and general classifications according to the clinical outcome, bibliographic coupling of concepts and keywords highlighting the most relevant perspectives and literature gaps, and a comprehensive discussion of the most attractive literature and insights for building a research agenda in the field.

Background: The objective of this study was to assess public hospital efficiency, including quality outputs, inefficiency determinants, and changes to efficiency over time, in an Italian region. To achieve this aim, the study used secondary data from the Veneto region for the years 2018 and 2019. Methods: A nonparametric approach—that is, multistage data envelopment analysis (DEA)—was applied to a sample of 43 hospitals. We identified three categories of input: capital investments (Beds), labor (FTE), operating expenses. We selected five efficiency outputs (outpatient visits, inpatients, outpatient visit revenue, inpatient revenue, bed occupancy rate) and two quality outputs (mortality rate and inappropriate admission rate). Efficiency scores were estimated and decomposed into two components. Slack analysis was then conducted. Further, DEA efficiency scores were regressed on internal and external variables using a Tobit model. Finally, the Malmquist Productivity Index was applied. Results: On average, the hospitals in the Veneto region operated at more than 95% efficiency. Technical and scale inefficiencies often occurred jointly, with 77% of inefficient hospitals needing a downsizing strategy to gain efficiency. The inputs identified as needing significant reductions were full-time employee (FTE) administrative staff and technicians. The size of the hospital in relation to the size of the population served and the length of patient stay were important factors for the efficiency score. The major cause of decreased efficiency over time was technical change (0.908) rather than efficiency change (0.974). Conclusions: The study reveals improvements that should be made from both the policy and managerial perspectives. Hospital size is an important feature of inefficiency. On average, the results show that it is advisable for hospitals to reorganize nonmedical staff to enhance efficiency. Further, increasing technology investment could enable higher efficiency levels.

Hospital-acquired infections (HAIs) remain a major clinical and economic burden, with pathogens such as Escherichia coli contributing to high rates of morbidity and mortality. Traditional manual disinfection methods are often insufficient, particularly in high-risk hospital environments. In this study, we investigated innovative strategies to enhance surface decontamination and reduce infection risk. First, we assessed the efficacy of the SMEG BPW1260 bedpan washer-disinfector, a thermal disinfection system for human waste containers. Our results demonstrated a reduction in Clostridium difficile and Escherichia coli contamination by >99.9% (>3 log reduction), as measured by colony-forming units (CFU) before and after treatment. Molecular techniques, including spectrophotometry, cell counting, and quantitative PCR (qPCR) for DNA quantification, confirmed reduction in bacterial contamination. Specifically, Clostridium difficile showed a reduction of approximately 89% in both optical density (OD) and cell count (cells/mL). In the case of Escherichia coli, a reduction of around 82% in OD was observed, with an even more pronounced decrease in cell count, reaching approximately 99.3%. For both bacteria, DNA quantification by qPCR was below detectable limits. Furthermore, we optimized the energy efficiency of the disinfection cycle, achieving a 45% reduction in power consumption compared to standard protocols without compromising antimicrobial efficacy. Secondly, we developed a sustainable cleaning solution based on methyl ester sulfonate surfactants derived from waste cooking oil. The detergent’s antibacterial activity was tested on contaminated surfaces and further enhanced through the incorporation of nanoassemblies composed of silver, electrostatically bound either to biomimetic magnetic nanoparticles or to conventional magnetic nanoparticles. Washing with the detergent alone effectively eliminated detectable contamination, while the addition of nanoparticles inhibited bacterial regrowth. Antimicrobial testing against E. coli revealed that the nanoparticle-enriched formulations reduced the average MIC values by approximately 50%, with MIC₅₀ values around 0.03–0.06 mg/mL and MIC₉₀ values between 0.06 and 0.12 mg/mL, indicating improved inhibitory efficacy. Finally, recognizing the infection risks associated with intra-hospital transport, we tested the SAFE-HUG Wheelchair Cover, a disposable non-woven barrier designed to reduce patient exposure to contaminated wheelchair surfaces. Use of the cover resulted in a 3.3 log reduction in surface contamination, based on viable cell counts. Optical density and bacterial DNA were undetectable in all covered samples at both 1 and 24 h, confirming the strong barrier effect. Together, these approaches—thermal no-touch disinfection, eco-friendly detergent boosted with nanoparticles, and protective transport barriers—respond to the urgent need for effective, sustainable infection control methods in healthcare settings. Our findings demonstrate the potential of these systems to counteract microbial contamination while minimizing environmental impact, offering promising solutions for the future of infection prevention in healthcare settings.