Klebsiella pneumoniae and Klebsiella oxytoca are commonly isolated from hospital patients and the isolation ratio of these bacteria is 4 : 1 in Japan according to the JANIS surveillance. We observed similar isolation frequencies of these bacteria in three general hospitals from August 2008 to July 2009, and found that the isolation rate of K. oxytoca was especially high in the bile of patients as compared with that of K. pneumoniae in a general hospital. Epidemiological study based on biological characters and antibiograms revealed at least 2 small outbreaks in the bile isolates of K. pneumoniae and 4 small outbreaks in K. oxytoca during the observed year. Measurement of the bile resistance of representative isolates (12 of K. pneumoniae and 12 of K. oxytoca) from various specimens found that 108 of K. pneumoniae and K. oxytoca were eliminated to 105-102 after 2 hours incubation in the bile, indicating that both bacteria were similarly sensitive to human bile, except one K. pneumoniae strain isolated from the urine of a patient. The high isolation rate of K. oxytoca from bile in our general hospital was not due to bile resistance, but was related to small outbreaks among patients in this hospital.
Pandemic (N1H1) influenza A (H1N1 flu) has been causing large outbreaks in Japan since May 2009. Our university launched enhanced influenza infection surveillance (including suspicion) via phone covering all students in June. This study describes the outbreak after two university festivals held in autumn; Festival A was held for three days between 31 Oct. and 2 Nov., with about 1,400 students and about 15,000 visitors; and Festival B was held on 14 and 15 Nov., with 550 medical and nursing students and about 1,600 visitors. There was no change in the incidence of self-reports from students after Festival A, but self-reports increased greatly after Festival B. What caused this considerable disparity between the two festivals? The preventive measures against H1N1 flu taken by the Academic Affairs Section were different between the two festivals. In Festival A, the Academic Affairs administration required the students to submit a list of the names and health conditions of all participating students four days before the opening. In Festival B, the Academic Affairs administration advised the students to check their body temperature for two weeks. Apparently students who felt sick participated in the preparations for the festival. Infection prevention measures are important, but measures to protect the prevention measures are more important.
We report infection control of a patient with neonatal tuberculosis in our pediatrics ward. We had to put a portable negative pressure tent into an independently air conditioned room and an incubator placed into the tent for the prevention of spread of tuberculosis, because our ward has no negative pressure room. Furthermore, we used a closed suction circuit. The nurse responsible for care of the patient did not come into contact with other patients in the ward.
An outbreak of MRSA occurred in two wards of our medical center, which is an acute-care hospital. Ward A is an intensive care unit and Ward B is a ward for many burn inpatients. Both the wards treat high-risk inpatients with infections. An environmental investigation to identify the MRSA infection source and route was carried out using bacteriological test samples obtained from the wards. The strains isolated from the patients with MRSA infection were also detected from the touch panel of an artificial respirator in Ward A, and from the surrounding environment and a shower-related instrument used to treat patients with MRSA infection in Ward B. Since the MRSA infection was considered to have spread among patients in the environment of both wards, countermeasures against the spread of MRSA were taken, especially centering on environmental improvement. No newly detected MRSA strains were observed in the two wards after the countermeasures were taken, and the outbreak of MRSA infection was terminated after the one-month observation period. Routine environmental investigation is not usually necessary, but since identical strains of MRSA were detected from patients and the surrounding environment in the two wards, urgent countermeasures were taken, especially centering on the environmental improvement, and the outbreak of MRSA was terminated. These results suggest that an outbreak of MRSA can be prevented within an extremely narrow range by immediate environmental investigation using sufficient information collected at the time of the outbreak.
Overuse of antimicrobial agents may lead to increased drug resistance in various strains of bacteria. Our institution started a use monitoring policy for broad spectrum antimicrobial agents. In this study, Antimicrobial use density (AUD) of carbapenem (CBPM) and fluoroquinolone (FQ) antimicrobial agents for every half year between April 1, 2007 and March 31, 2009 and the trends of resistance to IPM/CS and CPFX of Pseudomonas aeruginosa were analyzed to evaluate the use monitoring policy. The resistance rates to IPM/CS and CPFX were decreased from 29% and 20% to 21% and 15%, respectively. Mean administration days and long-term administration rates of CBPM were decreased from 7 days and 32% to 6 days and 24%, respectively, and the AUD of CBPM showed slightly decreasing trends. In contrast, the AUD of FQ showed little change. The present study indicates that the use monitoring policy was effective for reducing carbapenem antimicrobial agent use, and reduces the antimicrobial resistance of P. aeruginosa.
The PHS (personal handy-phone system) is widely used to facilitate communications between staff in hospitals, but may also be an important factor in the spread of infections. The present study investigated bacterial contamination of the PHS by analyzing 127 swab samples. Ten different species of bacteria were detected as follows: coagulase-negative staphylococci in 104 samples (81.9%), Corynebacterium spp. in 36 (28.3%), methicillin-susceptible Staphylococcus aureus in 13 (10.2%), and Bacillus spp. in 11 (8.7%). Most bacteria were identified as normal inhabitants except for two cases of methicillin-resistant S. aureus (MRSA), which were detected on PHS used by otolaryngologists, because MRSA usually inhabits the nasal cavity so can easily transfer to the PHS after medical intervention. The findings suggest that the PHS may be an intermediate in the infectious chain between doctors and patients in the hospital. Hand-washing, scrubbing, and regular sterilization of the PHS are essential.
Infection control in hospitals is extremely important, but patients with infectious diseases and other patients may also gather in community pharmacies, thus allowing infectious diseases to spread. Therefore, infection control was examined in cooperation with the members of the Pharmaceutical Association in Higashi-yodogawa-ku using a questionnaire survey. The content of the questionnaire was proposed by the infection control committee in our hospital.The questionnaire was mailed to 55 community pharmacies in February 2009, and the response rate was 89%. Community pharmacies provide an important consultation service about infection control. The responses to the survey will contribute to infection control in the community.