The Nagasaki Nursing Association has been implementing a long-term Infection Control Staff training (ICS training) for nurses since 1995 for the purposes of understanding the knowledge/skills of infection control, acquiring the roles/ability of execution as leaders to promote infection nursing in the facility, and providing safe/reliable medical treatments and nursing care to patients/families. Approximately 500 nurses have received such training so far, who continue to implement infection nursing at various facilities after training.
  For the participants in ICS training, we verified the effectiveness of the training by studying the nurses' knowledge, attitude, and practice regarding standard precautions before and after receiving the training. Knowledge and attitude, attitude and practice before training, and attitude and practice after training were all associated. No association was observed between knowledge and practice both before and after training. We believe that practice after acquiring knowledge, and attitude and behavior modification are vital for such training.
  Knowledge/attitude/practice scores increased before and after training, and a significant difference was observed in the practice score. We believe that this ICS training can improve ability to perform all required tasks.
  A significant difference was observed in the knowledge score in the use of individual protectors, and a significant difference was observed in the practice score for instruments/environment/coughing etiquette, which clarified the items that need to be emphasized in future training sessions.

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  High bactericidal effect depends on use of the correct maneuvers using alcohol-based hand rub. However, the method of learning right hand washing is seldom examined. How to evaluate the correct maneuver was examined. Examination was performed by identification and bacterial culture by vision. As a result, correlation was accepted if ascertainment by vision suggested inadequate disinfection, and the bacterial count was detected. Maneuver instruction for alcohol-based hand rub is important, and instruction needs a simple procedure.

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  The increase in arthroscopic procedures requires effective intratubular washing of luminal divices to assure sterility of equipment. The present experimental study tested the washing efficiency of equipment parts. The experimental equipment parts consisted of Group I silicon tube (length 40 cm, diameter 4 mm) and Group II stainless steel tube (length 40 cm, diameter 2 mm) with wire (7 strands with diameter 0.7 mm)passed through the lumen of the tubes. Human blood was injected into each device, 1 cm³ for Group I and 0.5 cm³ for Group II, and allowed to stand for 19 hours and 40 minutes. The experimental parts (5 in Groups I and II) were then washed with five different methods A to E. Methods A and B were intended to determine remnant human blood by visual contact after soaking in 1% weak alkali cleanser enzyme systems and washing with a water-gun. Method A used an ultrasonic bath Washer-Disinfector after removing the wire from the lumen. Method B was similar but used a water stream in the Washer-Disinfector. Method C used a washing machine for tubes with vacuum, suction, and water ejection functions. Method D used the washing machine with only the suction function is for D. No preliminary washing or dissolution was used for Methods C and D. Tubes were washed with a condition of anchoring exposure. Method E also used soaking in weak alkali cleanser as for Methods A and B, after which the wire was removed from the lumen for hand washing. Wash appraisal method was based on using a chromatometer to determine the amount of remnant protein(μg). Remnant protein amounts for Groups I and II ware as follows: Method A, 141 μg and 154 μg, Method B, 1410 μg and 707 μg, Method C, 5 μg and 2 μg, Method D, 14 μg and 5 μg, Method E, 2426 μg and 129 μg, respectively. The highest amount of remnant protein was 2426 μg in the silicon tube washed by hand. Tube equipment parts containing human blood are best washed by Methods C and D.

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  The waterless method using alcohol-based hand rubs has been widely investigated in Japan since the announcement of the CDC guidelines of 2002 about surgical hand antisepsis. Infection control requires that assessment of surgical hand antisepsis tests the antibacterial sensitivity, but many reports have examined only the decrease in bacteria. Therefore, we examined the effectiveness of hand antisepsis by the waterless method at operations carried out at a hospital attached to our university. The medical workers (i.e. surgeons and nurses) in charge of the operation carried out from March to August 2009 participated in the study. The number of bacteria on the hands were calculated by the glove juice method and the number of bacteria compared by the two-stage method using scrub washing and 0.2 w/v% chlorhexidine gluconate-alcohol-based hand rub to the number of bacteria by the waterless method using 0.5 w/v% chlorhexidine gluconate-alcohol-based hand rub. The change in the RF value (i.e. log₁₀ Reduction Factor on number of bacteria) by the two-stage method was from preoperative value 1.50 to postoperative value 1.35, and the change in the RF value by the waterless method was from preoperative value 2.77 to postoperative value 2.68. Therefore, hand antisepsis by the waterless method was more effective than that by the two-stage method. Furthermore, the need for effective antisepsis was suggested because antimicrobial-resistant bacteria were among the detected species. The findings suggest that surgical hand antiseptic method by the waterless method is effective without depending on the experience and education of the medical workers.

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  Recently, waterless hand disinfection for surgical hand antisepsis has gradually been introduced in Japan. We evaluated the effectiveness and acceptability of alcohol-based hand rubs with waterless hand disinfection (waterless method) among 38 health-care workers in our hospital. First, efficacy of the waterless method for surgical hand antisepsis was compared with that of the 2-stage method by the glove juice test based on the FDA's tentative final monograph. As a result, the persistent effect of the waterless method was superior to that of the 2-stage method. Furthermore, the waterless method achieved higher acceptability than the 2-stage method through survey of subjects' evaluation from the viewpoint of preference and positive economic effects. These findings suggest that the waterless method for surgical hand antisepsis has both appropriate immediate and persistent bactericidal activity, meets effectiveness fulfilling healthcare worker's needs and cost performance, and may be effective in clinical practice.

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  The present conditions of infection control education were investigated in Japanese acupuncture schools. We sent questionnaires to acupuncture schools in Japan from December 2008 to March 2009. The replies were obtained from 69.9% of the schools (107 of 153 schools). In the responses, 58% of the schools used only single use needles (SUNs), 40% used both reusable and single use needles, and 2% used only reusable needles. However, in 75% of the schools encouraged use of SUNs, the needles were reused after sterilization. Furthermore, we asked whether the students were taught to use sterilized gloves and finger cots. The results illustrated that in the schools which provided instruction; constant instruction was provided in 17%, left to the instructor's option in 35%, and no requirement in 48%. This study proposes that single use devices should be strictly recommended not to be reused. In addition, the aseptic technique for puncture is not yet standardized in school education. Measures based on evidence are essential and should be included in educational programs at acupuncture schools.

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  To investigate the present situation of infection control and prevention measures for occupational infections in medical facilities in a city, questionnaires were conducted to 511 facilities during February 2008. The medical facilities were divided into three groups: hospitals, clinics with beds, and clinics without beds. The results were then analyzed by comparing these three groups. Two hundred six questionnaires (40.3%) were returned. Infection control teams were organized in 93.6%, 58.9% or 8.4% of hospitals, clinics with or without beds, respectively, and few infection control experts were present in small facilities. The HBV antibody test was most frequently performed for health-care workers in all types of facilities. In contrast, frequencies of antibody testing for other viral agents were generally lower; 6.8% of total facilities for varicella, 8.7% for rubella, 10.2% for measles, and 6.3% for mumps. However, these proportions increased limited in facilities with pediatricians and obstetricians. Financial support to the workers for immunization was not sufficient in hospitals as compared with clinics, resulting in low rates of vaccination. Follow-up antibody tests after needlestick injuries were poorly performed in clinics without beds. However, most of these clinics prepared follow-up antibody tests systematically at higher rates compared with others. Sixty percent of clinics prohibited re-capping of needlesticks. Since the introduction of equipment for safe medical services involves economic costs, development of equipment with low cost is necessary. Medical facilities with high consciousness regarding infection control and prevention were working on occupational infection control systematically, indicating that construction of a system for sharing information and consulting services seems to be an unmet need in this area.

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  The adverse effects of the 2009 H1N1 influenza vaccines against a novel swine-influenza A (H1N1) virus were evaluated in our hospital using a questionnaire on the occurrence of any adverse effects related to the vaccination. Amongst 568 healthcare personnel receiving the vaccine, a total of 415 (73.1%) consisting of 147 men and 268 women agreed to participate and completed the questionnaire. Adverse effects were reported by a total of 71 (17.1%) persons, 15 (10.2%) men and 56 (20.9%) women. The most common effects were swelling and induration at the vaccination site which occurred in 38 (9.2%) recipients, followed by malaise in 26 (6.3%), and cold-like symptoms in 15 (3.6%). No serious adverse effect (>grade 3) was reported. Only two (0.5%) recipients visited a physician after receiving the vaccine, and no causal relationship between their symptoms and the vaccine was observed. This result indicates that the vaccine against the nobel swine-influenza A (H1N1) was as safe as the other seasonal vaccines approved previously. Since the number of recipients was small and most of the recipients were healthcare providers, a larger study on safety amongst children and adults other than healthcare workers is required.

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  Ventilator-associated pneumonia caused by multidrug-resistant Acinetobacter baumannii in intensive care units has become a problem worldwide. In Japan, few reports of antimicrobial susceptibility or nosocomial infection have involved A. baumannii. We confirmed A. baumannii nosocomial infection in a neonatal intensive care unit (NICU) of general hospital A in the Tohoku region from May 2008 to February 2009, so spreading of infection and environmental contamination were examined. Antimicrobial susceptibilities of 51 clinical isolates in NICU and 2 environmental isolates, thermometer and knob, in March 2009 were determined by the micro-dilution method. Furthermore, the genotype of these strains was determined using the AP-PCR and ERIC-PCR methods. During this period, three nosocomial infections (June, September, February) caused by A. baumannii were confirmed. In this study, there was no isolation of multidrug-resistant strains. The genotype of each A. baumannii strain in these nosocomial infections was different. The genotype of the A. baumannii strain isolated from the thermometer which only patient A had used was identified with that of the nosocomial infection in February. These results showed the possibility that several A. baumannii strains were transmitted through staff of the NICU. A. baumannii surveillance may be important to prevent nosocomial infection in the NICU.

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