in 150 - 200 words summarize and rephrase this article, and write one sentence the most takeaway and one-sentence criticism from this article (The application of the plan, do, check, act (PDCA) quality management in reducing nosocomial infections in endoscopy rooms: It does work). Abstract The role of the plan, do, check, act (PDCA) cycle quality management in reducing nosocomial infections in endoscopy rooms remains unclear; we aimed to evaluate the effects of PDCA in the nosocomial infections control of endoscopy rooms. 1 BACKGROUND Endoscopy is one of the most important methods for clinical diagnosis and treatment of digestive system diseases. It has the advantages of less pain, simple operation and shortened hospital stay after operation.1 However, the complex structure of the endoscope contains many delicate and small components, making that the endoscope is not easy to clean. Besides, the frequent cross-use of digestive endoscopes between patients put more challenges and requirements to the disinfection of endoscope.2 If the disinfection and sterilisation process is not strictly conducted and achieve complete sterilisation, it is easy to cause nosocomial infections and affect the medical quality and patients' safety.3 In recent years, the incidence of nosocomial infections related to digestive endoscopy has been increased from 4.25% to 9.12%.4, 5 It is been reported that for patients undergoing digestive endoscopy, the incidence of digestive endoscopy-related nosocomial infections ranges from to 3.18%11.9%.6, 7 The causes of nosocomial infections are multisourced including the contacts between patients, medical invasive operation, ineffective disinfection and sterilisation.8 Therefore, the prevention and treatment of nosocomial infections in endoscopy rooms are essential to the medical quality and the prognosis of patients. Many patients received examinations and treatments in the outpatient endoscopy room every day, and endoscopy is an invasive operation, thus patients are prone to nosocomial infections.9 According to previous reports,10, 11 the factors of nosocomial infection in the outpatient endoscopy room are related to the patient's age, comorbidities, the season of diagnosis and treatment, and the endoscopy standardised disinfection that the pathogenic microorganisms on the upper surface of the endoscopy are killed. Relevant studies have found that the frequency of endoscopy use, the layout of the endoscopy room environment, the correct hand washing and corresponding preventive measures are the most important factors that are associated with nosocomial infections in the endoscopy room.12 The meaning of the PDCA cycle is to divide the quality management into four stages, namely, plan (P), do (D), check (C), and act (A).13 The PDCA cyclic nursing management adopts scientific and standard cyclic management methods. Reducing the hospital's cross-infection rate, enhancing the hospital's disinfection management and hygiene knowledge education and other aspects have important clinical significance.14 Currently, there are very few studies15, 16 on the application of PDCA cycle management to the endoscopy room, yet no systematic principles and measures on the nosocomial infection have been reported. Besides, the sample size is not large; more associated studies on the PDCA applications in the endoscopy room are needed. Therefore, we aimed to explore the value of PDCA cyclic nursing management in improving the nosocomial infection of endoscopy and provide evidence support for clinical nosocomial infection control. 4 DISCUSSIONS The results of this study have found that the PDCA is beneficial to reduce the incidence of nosocomial infections, improve the medical staff's knowledge on the nosocomial infection and hand hygiene, and improve the disinfection effects and reduce the occupational exposures. The endoscopy room is a common place where nosocomial infections occur. Infection control in the endoscopy room is of great significance to the control of infections in the entire hospital.18 Infection control in the endoscopy room is a dynamic, continuous and direct process.19 If nosocomial infection occurs, it will cause cross-infection between patients and medical workers, causing serious losses to the hospital and endangering the health of patients.20 Therefore, as an auxiliary department that provides diagnosis and treatment services to clinical departments, its diagnosis and treatment quality directly affects the hospital's diagnosis and treatment level.

It must be aware that in China, it is fairly common to include patients directly in endoscopy rooms, but in many high-income countries that would not be the case and patients would be appointed in advance, this does not mean that our results are less relevant, effective management measures for the endoscopy room will not only help protect the lives of medical staff and patients but also help control the occurrence of nosocomial infections.21 At present

5 CONCLUSIONS

In conclusion, the results of this study indicate that PDCA cyclic nursing management can minimise the probability of infection in the endoscopy room, effectively reduce the risk of infection, and help the nursing staff of the endoscopy room to effectively enhance the awareness of infection control to reduce occupational exposure events. However, the follow-up period of this study is relatively short, and the sample size is limited; it is necessary to further evaluate the use of PDCA in clinical settings in future studies.