Underwater delivery is one of the most popular of the various delivery methods currently available among parturient women in Japan. However, this method carries several risk factors for infection that can affect both the mother and child: influx of bathtub water contaminated with opportunistic bacteria into the vagina and uterus, as well as laceration of the vagina after giving birth, may affect the mother, and bacterial infection by opportunistic bacteria present in the bathtub water at the time of birth may affect the neonate. The present study investigated the safety of underwater delivery from the bacteriological perspective. Samples of bathtub water before and after delivery, and the oral fluid of newborns were collected from 7 cases of underwater delivery during 2004 from a maternity center in Tokyo that agreed to participate in this study. Total bacterial and coliform bacteria counts were determined, and the presence of Staphylococcus spp., Escherichia coli, and Pseudomonas spp. was determined in each sample. The total bacterial count had increased in the bathtub water after delivery in all but one case. The total bacterial count in the oral fluid of the newborns was higher in the underwater delivery group than in the labor relaxation group. Staphylococcus aureus, E. coli, and Pseudomonas putida were detected in the bathtub water after delivery in some cases. In particular, P. putida was isolated from the oral fluid of one newborn and from three samples of the bathtub water after delivery. The similarity values of the SpeI-PFGE profiles of these P. putida isolates were over 90%, suggesting that there was a common contamination source. Although the survey was small and discontinuous, this study suggests that there is a risk of infection during underwater delivery for both mothers and infants via the bathtub water, and that the risk of infection depends on their health status, as well as the presence of birth canal lacerations and incomplete uterine cervical atresia.
Medical instruments may be reservoirs for the transmission of bacteria. Nursing support systems used in the hospital and 51 systems were inspected by swab analysis. As a result, 14 types of bacteria were detected, CNS in 90.2%, MRSA in 5.9%, and Pseudomonas sp. in 3.9%. A hospital information paper was distributed to all sections. Medical instruments including nursing support systems may be reservoirs for transmission of bacteria, so education of staff, and rounds by infection control teams, and hand washing are important.
Recent inappropriate use of carbapenem antibacterial drugs (CBPM) in Japan may lead to increased medication costs and more resistant strains of bacteria. To ensure the appropriate use of CBPM, notification of the Infection Control Committee after prescription of CBPM has become mandatory in our hospital since April 1 2006. We investigated the reasons for CBPM administration and corresponding information on the identification of pathogens between April 1, 2006 and January 31, 2007. The amounts and cost of the CBPM used and cultured pathogen patterns before and after the implementation of the use notification policy were compared. There were 388 cases of CBPM use in the study period. Pathogens were identified before CBPM administration in 66 cases, whereas CBPM were given as empiric therapy in 238 cases after specimens were collected. Pathogens were later identified in 146 of these 238 cases. On the other hand, 84 cases received CBPM therapy without prior specimen collection. After the use notification policy was implemented, use of CBPM decreased by 33% and cost by approximately 16 million yen. Among all antibacterial drugs, CBPM use decreased by 7% and cephems use increased by 6%. No significant changes were found in the pathogens identified in the sputum, urine and blood samples collected. CBPM use notification policy is likely to decrease both the amounts and costs of antibacterial drugs used.
Teicoplanin (TEIC) is active against Gram positive bacteria including methicillin-resistant Staphylococcus aureus (MRSA) and Enterococcus spp.. TDM studies have indicated that serum TEIC concentrations are important for determining efficacy in patients. TEIC is known to be extensively bound to serum proteins such as human serum albumin. Therefore, the clinical pharmacokinetics of TEIC are expected to be considerably affected by protein binding with albumin. This study evaluated protein binding of TEIC in human serum, and determined the albumin-dependent relationship between the unbound and total serum TEIC concentrations in hypoalbuminemic patients. Consequently, more accurate and effective trough concentration ranges of TEIC were established, with effective unbound concentration over the minimum inhibitory concentration against MRSA (MIC90). The effective loading doses of TEIC are proposed, especially in hypoalbuminemic patients on the basis of the unbound serum concentrations.
Some cases of methicillin-resistant S. aureus (MRSA) infection are not resolved effectively despite the administration of anti-MRSA drugs, because patients with severe MRSA infection may have poor nutrition and body condition. To identify the factors influencing the therapeutic effect of anti-MRSA drugs, clinical data, sensitivity of MRSA to anti-MRSA drugs, and drug concentration were investigated in 64 cases from November 2003 to March 2006 by multivariate logistic regression analysis. As a result, 32 cases in the efficacious group and 32 cases in the non efficacious group were identified. Therapeutic drug monitoring (TDM) of anti-MRSA drugs found 100% vs. 71.9%, respectively (p=0.004). Age (Odds rate (OR)=0.94), and increased serum total protein (TP) during treatment of anti-MRSA drugs (OR=2.46) were found to be significant factors. Pharmocokinetic parameters of anti-MRSA drugs and sensibility of MRSA were not significant. Serum TP amount increased during treatment in many patients in the efficacy group, in whom the nutrition had been taken by oral or nasogastric tube. Increased serum TP and feeding via gastrointestinal tract may be related. Therefore, treatment of MRSA infection requires administration of anti-MRSA drugs using TDM, and improvement of nutrition and the route of feeding, together with close cooperation with the nutrition support team.
The efficacy for hand disinfection was investigated of ethanol (EtOH) containing polyquaternium-51(PQN), a novel skin-protective agent, (PQN-EtOH). Only 17.5% PQN had no antibacterial effect. The hand bacteria reduction rates were calculated by the following formula, (B-A)/B×100, where B and A are the bacterial colony numbers on the hand before and after extensive 30-second rubbing with disinfectants, respectively, and showed that 83%EtOH and 16.6%PQN-83%EtOH achieved reduction rates of 96.4% and 96.5%, respectively, indicating that PQN has no effect on the antibacterial activity of EtOH. Finally, a reduction rate as high as 99.5% was obtained by further addition of benzethonium chloride (0.2%) to PQN-80%EtOH. Spreading of 100 μL of PQN-80% EtOH or 80% EtOH on the lesions of the back skin of hairless mice twice a day for 10 days resulted in similar local skin water amounts in PQN-EtOH-treated mice as in the untreated control mice, whereas these values in EtOH-treated mice were significantly lower than those in the control mice. These data suggest that PQN-EtOH might be a useful hand disinfectant with the additional activity of preventing skin chapping.
Iwate Medical University Hospital has established and introduced its own “Transmission-based zoning system” since April 2005, intended to provide visual indications based on color coding to staff of the precautions necessary as support measures for preventing nosocomial infections. This report describes the development and introduction of the system and the effect of the new support measures on various infection control indices as follows. The five indices were i) amount used of hand-scrubbing disinfectant, ii) amount used of medical gloves, iii) number of notified cases of MRSA, iv) number of separate notifications per 10,000 of inpatients, and v) number of interventions by the ICT against suspected outbreaks in the hospital. The indices were compared before, during, and after introducing the system (2004, 2005 and 2006 respectively). i) The amount used of hand-scrubbing disinfectant was 242L, 250L and 235L (monthly average), respectively, showing no significant difference. ii) The amount used of gloves was 261,700, 338,000, and 410,100 (monthly average), respectively, indicating increases during and after the introduction. iii) The number of notified cases of MRSA was 23.6±4.3, 20.3±5.5, and 19.8±4.6 (monthly average), respectively, indicating significant decreases after the introduction. iv) The number of separate notifications of MRSA was 21.1±5.1, 14.5±3.9, and 13.6±3.1, respectively, showing significant decreases during and after the introduction. v) The number of ICT interventions in a year was 7, 5 and 3, respectively, showing a downward trend. The introduction of the “Transmission-based zoning system” was effective for improving measures against nosocomial infections and as supportive measures for eliminating contact transmission, which accounts for the majority of infection routes.