The oral condition, oral care, and microorganisms detected in the mouth and sputum were investigated in 9 patients with aspiration pneumonia (mean age 77 years) admitted to an acute care hospital. Seven patients had a past history of aspiration pneumonia. Coated tongue and dry mouth were noted in about half of the patients on admission and their oral conditions tended to be better on discharge. During admission, poor oral hygiene of these patients was noted since oral care was provided to most patients only once a day. Samples were collected from the oral cavity and sputum using an opportunistic microorganism test kit (BML) on admission, at 3 to 5 days after admission, and at discharge. Microorganisms detected in the mouth and/or sputum were: Candida spp. in 4 patients, MRSA in 3 patients, Serratia marcescens in 3 patients, Pseudomonas aeruginosa in 2 patients, and Klebsiella pneumoniae in 2 patients on admission; MRSA in 5 patients, Candida spp. in 2 patients, P. aeruginosa in 1 patient, K. pneumoniae in 1 patient, and S. marcescens in 1 patient at 3 to 5 days after admission; and MRSA in 4 patients, P. aeruginosa in 2 patients, K. pneumoniae in 2 patients, Candida spp. in 2 patients, and MSSA in 1 patient at discharge. MRSA was the most frequently detected organism, and the detection frequency increased from 3 patients on admission, to 5 patients at 3 to 5 days after admission, and 4 patients at discharge, suggesting hospital infection. Other microorganisms were detected in 6 patients at discharge, and most patients had a past history of aspiration pneumonia, suggesting the importance of more active intervention in oral care to avoid the recurrence of aspiration pneumonia. In addition, it is important to ensure adequate implementation of recommended infection control measures between acute care hospitals, long-term care facilities, and home care (regional medical liaison on infection control) to prevent the spread of antibiotic-resistant microorganisms.

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  New management systems to store data recording the quality of sterilization and the exact history of use for all types of medical instrumentation were installed in our hospital from August 2004. In addition, a reservation system for surgical operations using WEB technology was developed, so physicians can supply accurate data about the surgery in advance to the management system data server and make reservations without the need for hard copy documents. A new system for management of medicines and medical materials and for the storage of nursing reports was also installed, allowing standardization and visualization of surgical data.

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  The effect of antibiotic cycling was investigated to reduce colonization and infection with Acinetobacter baumannii and Enterobacter cloacae strains with resistance to cefotaxime. Four antibiotic regimens were used in 3-month cycles from June 2004 to May 2007. The regimens were cefotaxime, meropenem, ceftriaxone, and ampicillin+gentamicin. These antibiotics were administered for all empirical therapy to critically ill newborns with suspected bacterial infection. Comparing the period before antibiotic cycling (December 2003 to May 2004) to the study period (December 2006 to May 2007), the resistance rate to cefotaxime decreased from 40.8% to 12.5% (p<0.05) in A. baumannii and from 60.0% to 0% (p<0.05) in E. cloacae. No changes in resistance to other antibiotics were observed in A. baumannii and E. cloacae. However, the rate of extended-spectrum β-lactamase producing Klebsiella oxitoca was increased.

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  Correct use of carbapenem broad band antibiotics was promoted among clinical pharmacists in cooperation with a pharmacist specialized in infection control. Clinical pharmacists used the Antibiotics PK/PD check sheet from July, 2006 to confirm the prescription details, causative bacterial species, MIC, and kidney function, and to suggest any query of alternative prescription for the chief physician if necessary. Use of broadband penicillins, and broadband cephalosporins and carbapenems was compared before (133 examples) and after (about 470 examples) starting use of the Antibiotics PK/PD check sheet. Use of penicillin and cephalosporin dose regimens twice a day decreased from 94.7% to 75.8%, once a day increased from 3.5% to 6.6%, and three times a day increased from 1.8% to 17.2%. In addition, use of carbapenem dose regimen twice a day decreased from 94% to 73%, once a day increased from 0% to 4.9%, and three times a day increased from 6% to 21.7%. The average dosage of carbapenems increased from 1.06 g to 1.2 g per day, but the average days of use decreased from 6.76 to 6.01. The detection rate of multidrug resistant P. aeruginosa search frequency decreased significantly. Use of the Antibiotics PK/PD check sheet by clinical pharmacists was effective to promote appropriate use and dosage of antibiotics, and to suggest important queries to the chief physician.

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  Preoperative hand washing is normally based on scrubbing with 4% chlorhexidine gluconate, but the Guidelines of the Centers for Disease Control and Prevention (CDC) nows recommends waterless methods using quick-drying antiseptics. Therefore, hand antiseptic effects and costs were compared between a 0.5 w/v% chlorhexidine gluconate/ethanol lotion preparation and 4 w/v% chlorhexidine gluconate by the glove juice method in 22 nurses. No significant difference was observed in antiseptic effects between the two agents immediately and 3 hours after hand washing, but the ethanol-based preparation was more cost effective.

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  Surveillance of perinatal care systems by midwives in 2003 revealed that only 8.6% of hospitals with over 501 beds have isolated obstetric wards, whereas the majority of large hospitals in Japan have mixed wards for obstetrics/gynecology/internal/surgical adult or pediatric patients. Such mixed wards include patients with terminal illnesses and carriers of MRSA, provoking great concern for maternal and especially neonatal health. The relationship between MRSA infections and perinatal care systems for newborns of up to 28 days old was studied based on data collected from a nationwide hospital surveillance by the Japanese Nosocomial Infection Surveillance (JANIS) program from 2004 to 2005. Analysis of the data for the 27 participating hospitals revealed the following. All 37 cases of neonates with MRSA skin infections including 4 with septicemia and 1 with pneumonia came from 8 hospitals with mixed wards. However, no case of MRSA infection occurred in the 3 hospitals with isolated obstetric wards. The 5 hospitals with 2 or more cases within 2004-5 had mostly over 500 deliveries a year and the ratio of deliveries to numbers of midwives and obstetrics nurses was over 20. MRSA infections tended to be concentrated in hospitals where mothers and newborns were separated, suggesting nosocomial infections. No MRSA infections occurred in the 3 hospitals with isolated obstetric wards, 2 of which separated mothers and newborns. Annual deliveries for each of these 3 hospitals were 814 (complete rooming-in), 650 (3 days separation), and 250 (complete separation).
  These findings suggest strengthening surveillance systems as well as developing preventive measures against nosocomial infections in neonates.

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  Oseltamivir, recently the most common treatment for influenza in Japan, has been approved for post-exposure prophylaxis against influenza. A few deaths have been reported in children receiving oseltamivir due to suspected neurological causes. This study retrospectively investigated the efficacy of oseltamivir in preventing nosocomial spread of influenza during the past three influenza seasons (October-May) in St. Mary's Hospital. We studied 83 subjects receiving oseltamivir as post-exposure prophylaxis in 2004/05, 57 subjects in 2005/06, and 42 subjects in 2006/07. The subjects received oral oseltamivir capsule once daily for 5 or 7 days. The rates of subjects who developed influenza decreased from 13.3% in 2004/05, to 3.5% in 2005/06, and 2.4% in 2006/07. The usage of oseltamivir decreased markedly in the 2006/07 season. The rates of rapid influenza antigen detection and vaccination coverage among the staff were similar in all seasons. No significant adverse effects due to oseltamivir were observed in the subjects. Effective use of post-exposure prophylaxis of oseltamivir requires early detection and treatment.

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[in Japanese]

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[in Japanese]

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[in Japanese]

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[in Japanese]

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