Antibiotic-associated diarrhea (AAD) has recently become a more common cause of death. The factors causing AAD were investigated by analysis of antibiotic use and occurrence of AAD in our hospital during the past 4 years. The amount of antibiotics administered to patients who developed AAD was analyzed from 2003 to 2006. The antibiotics were classified and the usage rates analyzed. The amount of antibiotics decreased, but the number of patients who developed AAD increased in 2006. The difference in antibiotic use according to the classification of antibiotics was analyzed for 2005 and 2006. The results revealed that the usage of third and fourth generation cephems had increased. Therefore, use of these antibiotic groups may be important in the onset of AAD. The group of patients who developed AAD was compared with a control group. Use of the third and fourth generation cephem and carbapenem antibiotics was significantly higher in the AAD group. Therefore, we conclude that antibiotics with a broad antibacterial spectrum tended to cause the onset of AAD.
Nurses' intention to wear gloves was investigated in different situations with potential for blood exposure, to clarify the factors influencing the decision. Subjects were 1,128 nurses employed as staff nurses at university and general hospitals in Japan. The subjects were asked about the intention to wear gloves in 4 possible situations of blood exposure. Factors influencing the decision were a) organizational factors, including support from supervisors/colleagues, b) individual factors, including educational background, and c) psychological factors, including risk acknowledgement. The factors were analyzed between a high intention group and a low intention group. Analysis of the organizational factors showed the high intention group had significantly (p<0.01) higher scores than the low intention group on support from supervisors/colleagues, handiness of gloves, and organizational policy. The high intention group also showed significantly (p<0.01) higher scores on educational experience. In addition, the decision was significantly positively correlated to the risk acknowledgement, attitude toward glove wearing, and perceived control over glove wearing. These results indicate that nurses' intentions to wear gloves might be promoted by a supportive work environment and educational intervention.
Our ward is a facility for mixed management of hematopoietic malignancy and cardiovascular diseases.Central venous catheters (CVCs) are used in various medical situations for patients undergoing anticancer chemotherapy including pretransplantation management and patients with acute cardiovascular disease. The duration of CVC indwelling is generally long. Silk sutures are used to anchor the CVC to the skin at insertion. Previous antiseptic procedures used povidone iodine, which was often associated with red skin rashes at the insertion/suture site and detachment of dressing agent. Povidone iodine takes time to dry and hypoalcohol is used to observe the insertion site. Changing dressings is both time- and labor-consuming. A CVC device not requiring silk sutures was introduced together with disinfection using 70% alcohol and more elastic and sweat-absorbent dressings for some patients. A survey of the occurrence of CVC-related blood stream infection (CVC-BSI) confirmed no increase in the incidence of CVC-BSI after the change to CVC and management from February to May 2006. The revised antiseptic agent and dressing has been used for all patients since June 2006, and another survey was carried out (different fixation methods are employed currently). Five episodes of CVC-BSI were observed in patients under antiseptic management with povidone iodine and hypoalcohol (8/1000 patients) before the introduction of revised CVC management. No episodes of CVC-BSI were seen in patients managed under the new procedures. After changing the antiseptic management in all patients, 5 episodes of CVC-BSI were reported in 2/1000 patients, indicating no increase in the incidence of CVC-BSI. Red skin rash was observed in 16 of 48 patients treated with CVC with silk sutures, but none in patients undergoing CVC requiring no silk sutures.
Patients who use needles at home for self-treatment were previously advised to bring the used needles in a polyethylene bottle or milk carton to our hospital for dumping. However, a nurse suffered a needle stick injury when she received used needles in a paper bag intended for medication packages in July 2006. Since this incident, we have improved the method of collecting used needles in our hospital. Our analysis of the problems found that: 1) our recognition of the risk was low; 2) the polyethylene bottles or milk cartons were unsuitable as containers; 3) many different workers in our hospital accepted the used needles; 4) many types of needles are used for self-treatment; 5) the methods of collection differed in wards or departments; 6) patients received inappropriate advice or education. To decrease the risk of needle stick injury, we have improved the method of collection and dumping used needles in our hospital as follows; 1) the same procedure is used throughout the whole hospital; 2) suitable safe conatiners are provided to the patients for collection and dumping; 3) workers in our hospital do not accept the bottle, instead the patients dump them in a box; 4) we explained the change to the patients and asked them to follow our directions; 5) we informed all nurses, doctors and workers in our hospital about these improvements. Since the changes were made, there have been no needle stick injuries associated with self-treatment needles.
The microbial contamination of residual inhalation solutions was evaluated in jet-type nebulizers disinfected at 7-day intervals in a hospital. Contamination was observed at a level of 102-107 viable count/mL in 13 (50%) of 26 samples. The major microorganisms were Burkholderia cepacia, Acinetobacter haemolyticus, Pseudomonas aeruginosa, Pseudomonas fluorescens and Acinetobacter baumannii complex. After the frequency of nebulizer disinfection was changed to every day, evaluation of the microbial contamination of jet-type nebulizers showed no viable cells in any of the 21 samples examined.