Hygiene

The growing integration of artificial intelligence (AI) into hygiene management is offering new opportunities to strengthen infection prevention in healthcare. From real-time environmental monitoring to predictive risk assessment, AI may support proactive, continuous, and data-driven approaches to hygiene practice. Building on the concepts of Industry 4.0 and Health 4.0, this Opinion article introduces the term Hygiene 4.0 as a conceptual framework for the integration of AI with digital, automated, and data-driven technologies into hygiene management. Applications include AI-supported hand hygiene surveillance, automated robotics-assisted disinfection, and machine learning for identifying patterns associated with healthcare-associated infections. While these technologies may augment human decision-making and improve the efficiency of hygiene processes, important ethical, legal, and operational challenges remain, including data governance, algorithmic transparency, and the risk of over-reliance on automated systems. A human-centered and interdisciplinary approach is essential to ensure that AI systems are trustworthy and aligned with evidence-based hygiene practices and regulatory standards. As a proposed conceptual framework, Hygiene 4.0 requires further empirical evaluation to determine its potential impact on infection prevention, patient safety, and public health. Full article

Oral health education is a fundamental component of preventive dentistry, but children’s engagement across different educational approaches remains an important area of investigation. This study aimed to comparatively evaluate observed behavioural engagement associated with interactive, demonstrational, and game-based educational approaches among school-age children. A pilot, school-based comparative observational study was conducted among 60 second-grade students at a primary school in Sofia, Bulgaria. A standardized 40 min educational session included three approaches: interactive PowerPoint presentations, demonstrations with dental models and visual tools, and game-based activities emphasizing toothbrushing skills and dietary habits. Children’s engagement was assessed using three indicators: active participation and willingness to engage, confidence, and interaction with the educational materials. The game-based approach demonstrated the highest proportion of children classified in the “Very High” engagement category across all indicators. The average proportion of “very high” performance was 63.4% for the game-based approach, compared with 27.8% for the demonstrational approach and 22.8% for the interactive approach. Children participating in game-based activities demonstrated higher observed levels of participation, confidence, and interaction with educational materials. Game-based educational activities were associated with higher observed engagement during oral health education. These findings highlight the potential value of game-based activities for engaging children in oral health education. Further research using randomized designs, validated assessment instruments, and independent observers is needed to determine whether these differences in observed engagement are reproducible. Full article

Edible packaging is commonly assessed through good manufacturing practice (GMP), hazard analysis and critical control point (HACCP) systems, food-contact-material (FCM) compliance, and microbial risk assessment (MRA). These approaches respectively control production hygiene, process hazards, constituent migration, and pathogen exposure, but none routinely requires an integrated demonstration that an externally handled package remains suitable for intentional ingestion at the end of its lifecycle. This critical narrative review therefore proposes Edible Packaging Hygiene (EPH) as a conceptual, not yet validated, framework that adds a point-of-consumption endpoint and links the surface history of the edible article with microbial, chemical, allergenic, and physical exposure. Direct evidence on commercially relevant edible-package surfaces is limited; consequently, the review distinguishes direct edible-packaging evidence from indirect low-moisture-food, conventional-packaging, and hand-transfer evidence, regulatory requirements, and author-proposed controls. EPH combines process stabilisation, prevention of post-process contamination, moisture and package-integrity control, realistic handling verification, and chemical assessment of both migration and ingestion of the residual package. It also frames the need for secondary protection as a product-specific, testable design hypothesis rather than a universal disadvantage. Priority research comprises finished-surface challenge and transfer studies, gastrointestinal transformation of nanoforms, realistic retail and consumer simulations, and integrated safety-lifecycle assessment. The principal contribution is the operational integration of established food-safety principles around hygienic integrity of an intentionally consumed surface at the point of consumption. Full article

Oral diseases remain widespread, while concerns about antimicrobial resistance, microbiome disruption, and adverse effects from prolonged antiseptic use encourage interest in plant-based approaches. This structured narrative review synthesises literature published predominantly from 2010 to 2026, including mechanistic, in vitro, biofilm, preclinical, clinical, and formulation studies addressing medicinal plants, isolated phytochemicals, and plant-derived oral healthcare products. We examine how these interventions may influence oral health through mechanisms extending beyond direct bacterial killing. We synthesise evidence on major phytochemical classes, including polyphenols, terpenoids, alkaloids, sulfur compounds, and glycosides, together with their effects on biofilms, quorum sensing, inflammation, oxidative stress, and tissue repair. We also assess clinical evidence for botanical formulations and emerging delivery systems designed to improve stability and local retention. Current evidence indicates that several plant-derived compounds can inhibit biofilm formation, interfere with bacterial virulence, modulate inflammatory signalling, and support tissue recovery. Green tea, pomegranate, cranberry, turmeric, neem, aloe vera, mangosteen, and propolis show promising clinical or experimental activity, although evidence strength varies considerably among plants and formulations. Nanoemulsions, lipid-based carriers, and mucoadhesive systems may improve phytochemical stability and local exposure, but clinical validation remains limited. Overall, phytotherapy appears most useful as an adjunct to established oral hygiene rather than a replacement for conventional care. Standardized extracts, well-characterized formulations, microbiome-based outcomes, long-term clinical trials, and clearer regulatory pathways remain essential before wider clinical adoption. Full article

Airborne fungal contamination poses an occupational health risk in environments where engineering-controls are essential for maintaining indoor air quality. However, evidence integrating assessments of engineering-control readiness and airborne fungal contamination in forensic pathology facilities remains limited, particularly in low- and middle-income countries. This study assessed engineering-control readiness, indoor environmental conditions, and airborne fungal contamination in three public forensic pathology facilities in Gauteng Province, South Africa, and explored factors associated with airborne fungal contamination. A cross-sectional occupational hygiene study was conducted in three public forensic pathology facilities. Engineering-control readiness was assessed using structured walkthroughs and summarised using a study-specific Engineering Control Readiness Index (ECRI). Indoor temperature, relative humidity, carbon dioxide (CO₂), and airborne fungal concentrations were measured concurrently. Duplicate fungal air samples were collected at predefined locations over three consecutive sampling days. For the primary regression analysis, duplicate fungal measurements were averaged within each physical sampling location and sampling day, yielding 54 indoor location-day observations from 18 physical indoor sampling locations. Multivariable log-linear regression included facility, functional work area, area-specific ventilation and environmental-control deficiency, temperature, relative humidity and CO₂, with cluster-robust inference accounting for repeated measurements within physical sampling locations. Overall ECRI scores ranged from 50.1% to 53.9%, with ventilation and environmental control representing the weakest domain. Airborne fungal concentrations differed significantly between facilities, with FPF G recording the highest indoor median concentration (740 CFU/m³). Cladosporium spp. and Penicillium spp. predominated. After adjustment for facility, functional work area and environmental conditions and accounting for repeated sampling, engineering-control deficiency was not independently associated with fungal concentration (adjusted change per 10-percentage-point increase: −16.3%; 95% CI: −70.9% to 140.9%; p = 0.727). Substantial engineering-control deficiencies and airborne fungal contamination were identified; however, the independent contribution of engineering-control deficiency could not be estimated with adequate precision in this three-facility study. Larger longitudinal studies incorporating objective ventilation-performance measurements are required to clarify the contribution of specific engineering controls to occupational bioaerosol exposure. Full article

Wastewater-based epidemiology (WBE) is a rapidly evolving discipline that employs the analysis of human excreted biomarkers in untreated, community wastewater to provide near real-time population-level health assessments. While its popularity to support public health decision-making and intervention grew during the COVID-19 pandemic, understanding its utility and acceptability in healthcare is currently underexplored. This study aimed to generate evidence to support the integration of WBE into the healthcare setting via an educational webinar with the following objectives: (i) assess change in perspectives of WBE via surveys, (ii) understand major applications of interest and applicability to healthcare, and (iii) capture perspectives on its utility in this context. Comparative findings indicated an overall increase in support of WBE (95% to 100%), a reduction in concerns regarding data accuracy (40% to 25%), and an increase in support for the use of WBE to influence public policy (65% to 75%). Follow-up, open-ended survey responses indicated the workshop was an effective method to educate on WBE and its wide variety of applications. Overall, this pilot study revealed there is merit in further investigating the utility of integrating WBE data into the healthcare setting, as its integration demonstrates high levels of potential acceptability in clinical practice. Future work that reaches a wider audience and tests specific educational interventions is needed to further confirm utility, determine best educational outreach methods, and explore relevant and useful applications in the healthcare setting. Full article

Background: Histone deacetylase inhibitors (HDACis) have been suggested as novel pharmacological agents for various clinical conditions, including cancer and neurodegenerative, inflammatory, autoimmune, and metabolic diseases. Periodontitis is a complex, multifactorial disease characterised by chronic inflammation, a dysbiotic microbiota, and the degradation of tooth-supporting tissues. It is influenced by factors such as immune capacity, genetic and epigenetic changes, lifestyle, and comorbidities. Objective: This systematic review with narrative synthesis examines the therapeutic potential of HDACis in the management of periodontitis. Method: The PubMed, ScienceDirect, and Web of Science databases were comprehensively searched to identify relevant articles published between 2000 and 2026. The systematic review is reported according to the 2020 PRISMA guidelines. Results: HDACis consistently attenuated periodontal inflammation, reduced alveolar bone loss, and inhibited osteoclast differentiation and activity by downregulating proinflammatory cytokines and osteoclastogenic markers. Trichostatin A, MS-275, and valproic acid were the most extensively investigated compounds. Conclusion: Overall, the findings indicate that HDAC inhibition may have therapeutic potential, although substantial methodological heterogeneity and limited translational evidence precluded conclusions regarding clinical efficacy. Full article

Background: Acute respiratory infections (ARIs) are a leading cause of infant morbidity and hospitalization, with respiratory viruses being the predominant etiological agents. Data on clinical profile and outcomes of viral ARIs in term infants from India remain limited. Our objective was to evaluate the epidemiology, clinical profile, laboratory profile, and outcomes of respiratory syncytial virus (RSV) and other viral ARIs in hospitalized infants (aged ≤ 12 months) born at term (>37 weeks gestation). Methods: This prospective, multicenter, hospital-based observational study was conducted in Eastern India between July 2023 and March 2025. Respiratory viruses were detected using real-time RT-PCR. Demographic, clinical, laboratory, radiological, treatment, and outcome data were analyzed. RSV-positive infants were compared with RSV-negative infants and with infants infected with other respiratory viruses. Results: Among 224 infants, respiratory viruses were detected in 56.3%, with RSV being the most common pathogen (19.6%). Compared with infants infected with other respiratory viruses, RSV-positive infants had a significantly higher frequency of fast breathing (72.7% vs. 53.6%, p = 0.03), higher levels of inflammatory markers, and a longer median hospital stay (8 vs. 6 days, p = 0.02). In exploratory multivariable analysis, RSV infection (adjusted OR [aOR] 2.4, 95% CI 1.3–6.1), low-flow oxygen requirement at admission (aOR 1.9, 95% CI 1.4–5.3), and feeding difficulty (aOR 1.3, 95% CI 1.0–2.9) were independently associated with severe disease. Conclusions: RSV was the leading viral cause of ARI in hospitalized term infants and was associated with greater respiratory involvement, a heightened inflammatory response, and prolonged hospitalization compared with other viruses. These findings highlight the importance of early recognition and appropriate supportive care in hospitalized term infants with RSV infection. Full article

Background: Food Service Units (FSUs) play a key role in large-scale meal provision but face significant challenges related to food waste management and environmental sustainability. Objective: To evaluate food waste generation in FSUs and investigate its association with operational factors and nutritionists’ knowledge of sustainability practices. Methods: A cross-sectional observational study was conducted in 30 FSUs belonging to a single food service company in São Paulo, Brazil. Data were collected through a structured questionnaire administered to unit nutritionists and through direct measurement of food waste. Waste was categorized into pre-preparation, overproduction, expired food, and plate waste. Measurements were performed using calibrated digital scales. Descriptive and inferential statistical analyses were conducted using non-parametric tests, with correlations assessed via Spearman’s coefficient. Results: Median total waste was 54,718 units (IQR: 32,891–81,502). Strong correlations were observed between total waste and overproduction (ρ = 0.93; p < 0.001) and pre-preparation waste (ρ = 0.85; p < 0.001). Moderate correlations were found with number of meals served and number of employees. No statistically significant association was observed between nutritionists’ knowledge and total waste. Conclusions: Operational factors, particularly production-related waste, are the main contributors to total food waste in FSUs. Although no direct association with nutritionists’ knowledge was observed, improving management practices and production planning may significantly reduce waste. Full article

The integration of occupational safety and health protection with workplace efforts to promote worker health and well-being is a well-established concept, progressively formalized through the CDC-NIOSH Total Worker Health^® (TWH) program. This scoping review aimed to map and describe the implementation and evaluation methods used in TWH approaches across occupational settings. Scopus, Web of Science, and PubMed were searched using predefined search strings based on “Total Worker Health” and “Total Worker Health approach”. The original search was conducted in January 2023 and was updated in July 2026 using the same databases and search strategies. Eligible studies were peer-reviewed articles written in English that addressed the application, implementation, assessment, or evaluation of TWH approaches in occupational settings. Sixty studies identified in the original search were fully charted and summarized using descriptive frequency tables. The updated search retained eight additional recent studies, which were reported separately and additionally charted across a focused set of core methodological domains. Across the original corpus and the updated studies, substantial heterogeneity was observed in occupational sectors, study aims, intervention components, assessment methods, analytical approaches, and reporting formats. The main tools used to evaluate TWH aspects and interventions were surveys, questionnaires, interviews, meetings, focus groups, training activities, and mixed-methods evaluations. No single standardized model for implementing or evaluating TWH approaches emerged from the mapped literature; however, more consistent reporting of implementation processes, assessment tools, study populations, and analytical approaches may improve comparability, reproducibility, and transferability across occupational settings. Full article

Background/Objectives: In this prospective clinical follow-up study, we aimed to evaluate the long-term periodontal responses over a five-year follow-up period associated with Class II direct posterior restorations placed using two different restorative approaches. Materials and Methods: Thirty-one Class II posterior restorations in 25 patients were included. Eighteen were performed using a bulk-fill approach with Admira Fusion X-tra^® (VOCO, Cuxhaven, Germany), whereas thirteen used the proximal wall approach with Admira Fusion^® (VOCO, Cuxhaven, Germany). Periodontal parameters, including plaque control record, gingival bleeding index, probing depth, and clinical attachment loss, were recorded at baseline and five years using standardized periodontal examination procedures. Data were expressed as mean ± standard deviation and analyzed using repeated-measures ANOVA. Given the limited sample size, the statistical analyses were considered exploratory. Results: The plaque control record decreased from baseline to the five-year follow-up, with a significant overall effect of time (F = 4.789, p = 0.037), while the time × restorative approach interaction was not significant (p = 0.694). The gingival bleeding index showed a slight numerical increase over the five-year period (25.52 ± 27.20% at baseline versus 27.00 ± 26.11% at five years); however, neither the effect of time (F = 0.139, p = 0.712) nor the time × restorative approach interaction (F = 0.505, p = 0.483) was statistically significant. Probing depth and clinical attachment loss remained relatively stable throughout the observation period, with no statistically significant time or interaction effects. Overall, no statistically significant time × restorative approach interactions were observed, indicating that longitudinal changes in the evaluated periodontal parameters did not differ significantly between the restorative approaches. Conclusions: Within the limitations of this exploratory clinical study, both ormocer-based restorative protocols were not associated with detectable deterioration in the evaluated periodontal parameters over the five years of follow-up. Full article

Despite the recommendation of purified water, dental unit waterlines (DUWLs) readily form biofilm and suffer persistent microbial contamination, threatening both patients and dental staff. This study aimed to evaluate the microbial contamination and practical effectiveness of chemical disinfection in reverse osmosis (RO) water-supplied DUWLs. A single-center, sequential longitudinal study involving 15 dental chairs and 60 terminal outlets was conducted. Two disinfection strategies were sequentially evaluated: shock disinfection with a chlorine-based agent and continuous disinfection using slightly acidic electrolyzed water (SAEW). Heterotrophic plate counts (HPCs) were quantified via R2A culture, and microbial communities were characterized by metagenomic next-generation sequencing (mNGS) on 12 water samples (four terminal outlets and two source-water points, both pre- and post-disinfection). Water quality assessment revealed severe microbial contamination at the terminal outlets, with 73.33% of samples exceeding the threshold (500 CFU/mL) and a median HPC level of 805 CFU/mL. Notably, mNGS identified nucleic acid sequences of Legionella pneumophila, Pseudomonas aeruginosa, and Acanthamoeba in four pre-disinfection terminal-outlet samples. Chlorine-based shock disinfection achieved 100% compliance immediately after treatment; however, by week 5, the percentage above the threshold value had risen to 73.33%, with a median HPC level of 600 CFU/mL. The continuous SAEW disinfection protocol sustained effective microbial control over 55 weeks, with an overall percentage above threshold value of only 3.33%. mNGS analysis further confirmed a reduction in microbial relative abundance following one year of continuous SAEW disinfection. In conclusion, purified RO water alone could not guarantee DUWL microbiological safety, and this study provided practical evidence to support decision-making for DUWL maintenance. Full article

Healthcare cleaning services are essential for infection prevention and control, but they also contribute to the carbon footprint of healthcare facilities through recurrent consumption of detergents, disinfectants, textiles, water, energy, and transport-related resources. This sequential, non-randomized, single-facility evaluation compared a traditional cleaning protocol with a Green protocol oriented to the Italian Minimum Environmental Criteria (Criteri Ambientali Minimi, CAM) for cleaning services at Domus Nova Hospital, a private accredited healthcare facility in Ravenna, Italy. A risk-based microbiological monitoring plan was applied to low-, medium-, and medium-high-risk areas, prioritizing high-touch surfaces and using RODAC contact plates and sterile swabs. In parallel, a comparative Life Cycle Assessment was conducted in accordance with ISO 14040, ISO 14044, and ISO 14067 principles, using Global Warming Potential over 100 years as the main impact indicator and the functional unit of one square meter of cleaned hospital surface maintained for one year. The two protocols were assessed during different monitoring periods of unequal duration; therefore, the study was interpreted as a whole-system operational comparison rather than as a randomized trial or formal equivalence/non-inferiority assessment. After cleaning, all 64 observations obtained under the Green protocol met the adopted surface-hygiene acceptability criteria, compared with 55 of 64 observations under the Traditional protocol. No predefined target pathogenic indicators were recovered from post-cleaning samples under the applied culture conditions. From a climate-impact perspective, the Green protocol reduced the carbon footprint by 39.0%, corresponding to an avoided impact of 450 g CO2e m⁻² year⁻¹ and 2663.5 kg CO2e year⁻¹ at the facility scale. The main climate-related benefits were associated with the combined effect of textile-system redesign, lower energy consumption, optimized product use, and reduced operator transport. These findings support the use of integrated surface-hygiene indicators and life-cycle metrics to inform healthcare cleaning procurement, while highlighting that the results concern culture-based surface contamination indicators from a single facility and do not directly assess infection transmission or patient outcomes. Full article

Patient safety policies in Mexico have evolved through the incorporation and adaptation of the International Patient Safety Goals (IPSG) within the broader Essential Actions for Patient Safety (AESP) framework. This narrative policy review aimed to analyze this evolution, compare the main characteristics of both frameworks, and examine the available evidence concerning AESP implementation and current challenges in Mexico. A structured literature search was conducted between March and July 2026 in PubMed and SciELO, supplemented by Google Scholar and official sources from the World Health Organization and Mexican health authorities; the final search update was performed in July 2026. The narrative synthesis included 26 sources: 17 scientific or academic publications and nine official or institutional documents. The evidence indicates that the AESP retained the six principal clinical safety areas of the IPSG while adding incident reporting and analysis and patient safety culture as organizational components. However, available Mexican empirical evidence is limited and does not establish national implementation levels or demonstrate that the AESP have independently reduced adverse events or improved patient outcomes. Further national, multicenter, longitudinal, and comparative evaluations are needed to assess implementation, adherence, reporting performance, safety culture, and patient outcomes. Full article

This study examined the microbial quality of air and surfaces in six elevators at a tertiary hospital in Greece in 2022. The results highlighted hospital elevators as potentially relevant environmental reservoirs of microbial contamination, with contact surfaces (buttons) exhibiting significantly higher microbial loads than the air. Strong seasonality was also documented; the elevated microbial burden observed during the October sampling period likely reflects seasonal fluctuations in occupant traffic and environmental factors, although direct traffic and microclimatic variables were not monitored. Presumptive Staphylococcus spp. strains dominated the air, while Gram-negative bacteria recovered on MacConkey agar prevailed on surfaces. Phenotypically resistant isolates were also detected, including isolates showing reduced susceptibility or resistance to clinically relevant antimicrobial agents, highlighting the potential value of incorporating AMR surveillance into environmental monitoring. The semi-quantitative environmental exposure assessment showed that, while air quality remained within acceptable limits, the surface-contact route via elevator buttons represented the largest estimated exposure component. Healthcare workers showed the highest estimated cumulative exposure because of the greater frequency of elevator use assumed in the exposure scenario. In conclusion, hospital elevators may act as environmental reservoirs of microbial contamination and potential exposure pathways within the hospital environment, highlighting the need for enhanced hygiene measures, systematic monitoring and the integration of antimicrobial resistance into exposure assessment. Full article

Food and beverage contamination by microbial and chemical hazards during product processing and handling has significant risks to quality, public health, and regulatory compliance. Cleaning and sanitation practices are essential components of food safety management systems, with their effectiveness dependent on factors such as product characteristics, residue composition, surface properties, biofilm formation, and environmental conditions during production and processing. A comprehensive analysis of cleaning agents and sanitizers, including alkaline, acidic, enzymatic, surfactants, and oxidizing compounds, as well as emerging and sustainable approaches (e.g., organic acid-based formulations, bio-based surfactants, electrolyzed water, and ozone), and their roles during the processing and handling of products, is key to minimizing risks but also to creating resilience in the entire food chain. This review highlights the importance of understanding food-soil composition when selecting appropriate cleaning solutions and methods, particularly for removing carbohydrate-, protein-, fat-, and mineral-based residues, as well as biofilms from food-contact surfaces. Sector-specific challenges, such as biofilm persistence in seafood processing, fouling in dairy operations, moisture control in low-moisture food facilities, and microbial contamination in fresh produce, meat, poultry, cereal grain, and beverage processing, are also discussed. The overall goal is to support researchers, food industry professionals, and regulatory stakeholders in selecting and optimizing cleaning and sanitizing protocols that ensure food safety and regulatory compliance across diverse food industries. Full article

Healthcare-associated infections remain a major public health challenge, and primary health care (PHC) plays a critical role in preventing and interrupting transmission within communities. This study assessed knowledge and self-reported adherence to Standard Precautions and Transmission-Based Precautions among nursing professionals working in PHC. The findings were subsequently interpreted through the conceptual perspective of Infection Containment Readiness (ICR). A cross-sectional census study was conducted in 16 PHC units in Mato Grosso do Sul, Brazil, including 75 eligible nursing professionals. Knowledge was assessed using a validated instrument comprising 47 items distributed across five domains, while adherence was evaluated through 12 self-reported practice indicators. Overall knowledge was satisfactory, with a mean accuracy rate of 78.9%. Higher performance was observed in medication safety and sharps disposal (92.0%), glove use (81.8%), and hand hygiene (77.0%), whereas lower scores were identified in risk recognition (75.6%) and respiratory precautions and cough etiquette (68.2%). Important misconceptions were identified regarding tuberculosis transmission and respiratory infection control. Self-reported adherence was heterogeneous, particularly for respiratory protection measures, tuberculosis-related practices, glove use during capillary blood glucose testing, and participation in continuing education activities. Based on the observed findings and current infection prevention literature, we propose a hypothesis-generating conceptual framework for interpreting ICR in PHC. These findings suggest that strengthening infection prevention in PHC requires strategies that address not only knowledge acquisition but also risk recognition, contextual decision-making, and organizational support for preventive practices. Full article

This scoping review represents the first of 2020–2025, peer-reviewed publications investigating the possible relationships among burnout, nutrition, and nutrition/food literacy during and following the COVID-19 pandemic. The main conceptual insight is that these relationships are addressed only incidentally in existing research. Searches on 9 January 2026 were of the keywords (burnout OR job stress) AND (nutrition OR diet OR eating pattern OR food intake) AND (nutrition literacy OR food labeling) AND (food literacy OR health literacy). An eight-database search produced 160 returns. The included reports from these searches were from Google Scholar alone (n = 6). The addition of four relevant reports from a previous search of “burnout AND nutrition AND (nutrition literacy OR food literacy)” increased the included studies to ten. Although 2020 was the lower date limit, publication of the results was between 2023 and 2025. The finding is that research conducted during this period reports co-occurring issues of burnout, nutrition, and nutrition/food literacy in specific populations. The primary discovery is that assessing the relationships among these terms was not the aim of the included studies. This lack of dedicated research on this topic presents an opportunity for burnout and nutrition researchers to investigate these relationships intentionally. Full article

Background: The widespread use of online review platforms has transformed how patients evaluate healthcare providers and has created a valuable source of patient-generated feedback on healthcare quality. Negative online reviews provide valuable insights into patient experiences and sources of dissatisfaction. This narrative review aimed to synthesize the main themes and concerns expressed in negative online patient reviews across healthcare and dentistry and to explore recurring patterns reported in the available literature. Methods: A narrative literature search was conducted between January 2015 and May 2026. Results: Twenty-two studies were included in the narrative synthesis. Negative online reviews reflected multiple dimensions of the patient experience, including interpersonal, communication, organizational, financial, and clinical concerns. Although the relative prominence of these themes varied across healthcare settings and specialties, dental studies more frequently emphasized treatment expectations, professional trust, and perceived value for money. Conclusions: The findings indicate that patient dissatisfaction expressed in negative online reviews is multidimensional and cannot be interpreted solely through clinical outcomes. Rather than establishing the relative importance of different determinants of patient satisfaction, this review characterizes the themes most commonly expressed in negative online reviews. As a complementary source of patient-generated insights, online reviews may inform patient-centered quality improvement initiatives and support improvements in healthcare service delivery. Full article