OBJECTIVE  To diagnose eight common clinical infection control practice problems, proposes targeted solutions based on the "gear-transmission" system theory for sustainable infection control, and to analyze their impact on different practical models for infection control.

METHODS  The "gear-transmission" system theory for sustainable infection control was taken as the analytical framework, behavior-based infection control was likened to the "driving gear", data-driven infection control to the "transmission", four models （including traditional infection control） to the "driven gears", policy resource systems to the "chain", and the external environment to the "road". Combining clinical realities, eight issues, such as repeated submission of unqualified sputum specimens and underreporting of healthcare-associated infections, were dissected one by one. The "fault points" of each issue within the theoretical framework were identified, and systematic solutions were then formulated. In addition, we also explored the impact mechanisms of these solutions on traditional infection control, evidence-based infection control, precision infection control and green infection control.

RESULTS  The eight practical issues of infection (repeated submission of substandard sputum specimens, repeated submission of asymptomatic urine cultures, underreporting of infection cases, fluctuating control effects of multidrug-resistant bacteria in ICUs, difficulty in differentiating colonization from infection of multidrug-resistant bacteria, irrational use of antibiotics, low awareness of infection control among clinicians, and excessive control measures by nurses) all corresponded to "functional abnormalities" in different components of the "gear-transmission" theory, The proposed solutions for each issue encompassed multiple dimensions, including optimization of the "driving gear", upgrading of the "transmission", adaptation of the "driven gears", strengthening of the "chain" and improvement of the "road". Different solutions had varying focuses in promoting the four infection control models. For example, precision infection control played a vital role in data-related issues, while evidence-based infection control provided a scientific basis for behavioral interventions.

CONCLUSIONS  The "gear-transmission" system theory for sustainable infection control can effectively identify core issues in clinical infection control practices. Its multidimensional solutions enable the collaborative optimization of various "components," thereby facilitating the transformation of infection control practices from traditional models to precision-based, green and sustainable approaches. This provides innovative and practical approaches to enhancing infection control efficiency.