A former leprosy patient was diagnosed positive for influenza B virus by using a rapid influenza virus test kit in a ward of our hospital. Seven further patients in the ward were quarantined during the following 4 days based on the presentation with similar clinical symptoms including high fever, sore throat, cough, and diarrhea. However, all 7 patients were found to be negative for influenza viru with the same kit. An emergency session of the Infection Control Committee was held to discuss and decide counter-measures to prevent further spread of the infection within the sanatorium including quarantine of affected patients, closure of the dining room in the ward, wider distribution of protective equipment, closure of the physical training room, and frequent update announcements about the situation in the sanatorium. Oseltamivir phosphate was prescribed for all 8 patients including those not found positive for the influenza virus. The exact route of infection by which the virus was brought into the sanatorium could not be identified. However, we believe that the rapid and comprehensive responses to the incident probably prevented epidemic spread.
The levels of serum (1,3)-β-D-glucan and Aspergillus galactomannan were investigated in in-patients with hematological diseases before and after constriction for the ward. No patients was identified with Aspergillosis before and after constriction. The mean level of serum (1,3)-β-D-glucan was 2.5 pg/mL in 60 patients before and 15.3 pg/mL in 21 patients after constriction. The mean serum Aspergillus galactomannan level was 0.3 C.O.I before and 0.48 C.O.I after constriction in 60 patients. However, no significant differences were found in the serum (1,3)-β-D-glucan and Aspergillus galactomannan levels before and after constriction.
We have developed a new disinfectant containing chlorine dioxide (600 ppm). Detailed microbiocidal studies using pathogenic bacteria have been carried out previously. This new disinfectant is an alkaline solution (pH 8.8), so stimulates the skin when used as a disinfectant. Therefore, the effects of newly neutralizing (pH 7.2) with a buffer solution were tested on the microbiocidal effects and stimulation activities of the topical solution in guinea pigs. After 5 minutes incubation, the neutralized (pH 7.2) chlorine dioxide solution (3000 ppm) killed various microbacteria (Pseudomonas aeruginosa, Staphylococcus aureus, Candida albicans, S. erratia marcescens, and MRSA). Application of a 4-times higher concentration of neutralized chlorine dioxide solution to the skin of guinea pigs for 10 continuous days caused no observed redness or swelling. Neutralized chlorine dioxide solution is a safe and odorless solution, and will be useful as a disinfectant for equipment, staff, and patients in medical institutions.
The healthcare-associated infection control of a case of chickenpox in a hospital physician occurred in our hospital. He was admitted to a negative pressure room, and treated with drip infusion of acyclovir. After discharge he was confined to his house until all eruptions became crusta. One hundred sixteen staff members and 44 inpatients in our hospital thought to have had contact with him were examined using IgG antibody titer of the chickenpox virus. Planned surgery was postponed until the results were available. Two staff and 2 patients proved positive (cutoff value was 4.0). The 2 patients were isolated after explanation of the results to them and their families. The 2 staff were made to stay in their houses from the day of the results until 21 days after contact. All were treated with acyclovir 40 mg/kg/day for 7 days to prevent onset. Furthermore, we explained the circumstances by telephone to patients who had already left the hospital and outpatients, and asked them to come our hospital if they recognized high fever and eruptions. Fortunately, no one including the 4 positive individuals developed secondary infection. The present case suggests that all staff should be examined with the antibody titer of any virus, and sensitive staff should receive vaccination. Moreover, the awareness of all staff to viral infection should be increased.
With occurrence of the regional epidemics of measles, measles antibody titer measurement and measles vaccination were surveyed to assess the prevention of measles infection among hospital staff and in-hospital patients. The targets were 367 employees aged under 35 who work in this hospital, including temporary staff and agency staff. Measles vaccine was recommended for individuals with negative or indeterminant measles IgG antibody reactions in the antibody test (initial test) measured by the commercially available kit. Individuals were vaccinated on request, and the antibody test (postvaccinal test) was conduct 6 weeks after the vaccination. Surveys and vaccinations were conducted by pediatricians in this hospital, and the hospital accepted all costs for the present tests and vaccinations. The initial test was conducted with 331 of 367 individuals, and 286 targets showed positive (86.4%), 26 targets showed negative (7.9%), and 19 individuals showed indeterminant (5.7%) reactions to measles antibody. All 45 individuals who showed negative results and indeterminant results in the initial test were considered for vaccination, and 41 individuals received vaccination. Four individuals were eliminated because of pregnancy or resignation. After vaccination, 40 individuals showed positive reaction and 1 showed indeterminant reaction. In addition, this individual with indeterminant reaction was negative in the initial test, and so showed favorable antibody acquirement after the measles vaccination.
A survey was conducted nationwide from August to September 2005 regarding the handling of infection-related ethical issues in Japanese hospitals. The 562 infection managers targeted were classified into three groups according to their hospital's capacity: 202 in the small-scale group (from 300 to 499 beds); 202 in the medium-scale group (from 500 to 699 beds), and 158 in the large scale group (700 beds or more). The hospitals were selected using the stratified random sampling method of local distinction and the hospital bed capacity. The survey inquired about initiatives to systemize handling of ethical issues.The response rate was 43% (244 hospitals). The results were as follows. 74% of hospitals try to conceal infected patient's information from third parties; 93% of the hospitals have an ethics committee; 60% of hospitals have guidelines for ethical issues; 35% of hospitals have manuals to solve ethical-issue problems; and 52% of hospitals hold ethical training sessions for their staff. The contents of guidelines for ethics include human rights protection (39%), protection of personal information (49%), disclosure (49%), infection control (42%), medical safety management (47%), research ethics (42%), and sexual harassment (29%). 36% of small and medium-scale hospitals directors or sub-directors tend to handle ethical problems during the early stages, and 26% of the hospitals entrust this task to their committee. 59% of the respondents described the topics undertaken by their hospital's ethics committee, of which only 1 response included an infection related case. More than half of the topics were limited to treatments and research.
Quick-drying hand disinfectants containing 2-methacryloyloxyethyl phosphorylcholine-butyl methacrylate polymer (MPC polymer) as a new moisturizer have become commercially available. Therefore, the antimicrobial and moisturizing effects were compared of two new quick-drying hand disinfectants, a liquid preparation and a gel preparation, and four conventional quick-drying hand disinfectants. The two new quick-drying hand disinfectants as well as the four conventional quick-drying hand disinfectants (2 liquid and 2 gel products) killed all eight bacterial species such as methicillin-resistant Staphylococcus aureus (MRSA) and multidrug-resistant Pseudomonas aeruginosa within 15 seconds. The six agents were used 5 times/day for 5 consecutive days, and evaluation of the effects on the hand skin showed that the corneal water content decreased after the use of each conventional agent but increased after using the two new quick-drying hand disinfectants. Therefore, these two new quick-drying hand disinfectants are less likely to cause hand roughness, and showed both excellent antimicrobial effects and good moisturizing effects.
The Hand Care Program was established to improve hand roughness. The program operates on the premise that gloves, skin protection products (barrier lotions), and moisturizing products (moisturizing lotions)will be chosen and used based on the level of hand roughness (high, intermediate or low). One of the items developed specifically for the Hand Care Program lineup is a skin protection product containing fluorinated polymers. This product was developed for use in caring for the most common case observed in the field, that is, intermediate hand roughness in healthcare professionals, and its protective effect on the skin was investigated. Test results showed that skin protection product containing flourinated polymers had a high degree of retention on the skin and that the amount of keratinocytes that flaked off (exfoliated) as a result of handwashing with soap was notably restrained. Twenty seven of 33 healthcare workers who volunteered to participate in testing during their regular routines for 2 months experienced significant decrease in transepidermal water loss and improvement in hand roughness. These results indicate that the product improved the barrier function of the keratinocyte layer of hands with intermediate roughness and improved hand roughness. Therefore, skin protection product containing fluorinated polymers can be incorporated in the Hand Care Program.
Corneal infection is a typical opportunistic infection of the cornea, and is the second most important cause of blindness after cataract worldwide. Corneal infection may be caused by bacteria, fungi, viruses, and amoeba. Keratomycosis, one type of corneal infection, is caused by fungi including yeast-like fungi (Candida) and filamentous fungi (Fusarium, Aspergillus, and others). Most cases of keratomycosis caused by filamentous fungi are considered to result from injury related with soils or vegetations. Our hospital has experienced 7 cases of keratomycosis caused by filamentous fungi between 2005 and 2008, 3 cases by Paecilomyces lilacinus, 2 cases by Fusarium oxisporum, 1 case by Aspergillus fumigatus, 1 case by Plectsporum tabacinum. Paecilomyces lilacinus was the most common filamentous fungi. Keratomycosis caused by P. lilacinus tends to have severe consequences, so early treatment with antifungal drugs is very important.
A 93-year-old female suffered from left endophthalmitis in a local hospital, and multi-drug resistant Pseudomonas aeruginosa (MDRP) was found in her urine culture immediately after transfer to our hospital for therapeutic surgery of the eye. After the operation, she developed urinary tract infection due to MDRP, so was treated with combination therapy of aztreonam (AZT) and arbekacin (ABK) at the same time as pull out of the Foley catheter and diuretic therapy. The AZT-ABK combination therapy resolved the infectious disease. The FIC index of combination therapy with AZT and ABK was 0.375, indicating agent synergy. We suggest that combination therapy of AZT and ABK is useful for the treatment of MDRP infection in the urinary tract.