A MRSA outbreak occurred in the emergency and critical care center of our hospital from December 2008 to February 2009. We succeeded in ending the outbreak by applying mupirocin ointment (MUP) for nasal cavities to all patients and medical workers entering the emergency and critical care center for 1 month in March 2009. According to the retrospective inspection, this short-term application of MUP decreased the hospitalization days in the emergency and critical care center from 13.6 days to 9.5 days by one-month, and the detection of MRSA sharply fell not only in the emergency and critical care center, but also in the general wards. About 8 million yen in costs for the purchase of anti-MRSA agent was saved by three-month comparison. As a result, this 1 month blanket use of MUP for all patients (including inpatients) and workers entering the emergency and critical care center is rapid, effective, and economical method to end a MRSA outbreak safely at an early stage.
Surgical site infection (SSI) frequently occurs after reconstructive mammaplasty for breast cancer using tissue expander and cohesive silicone gel implant techniques. This retrospective analysis found that silicone gel implants were the cause of SSI associated with reconstructive mammaplasty. In addition, experience with postoperative docetaxel cyclophosphamide (TC) chemotherapy, a standard method after surgery for breast cancer, found that SSI is apparently frequently associated with silicone gel implants. Review of the procedures intended to reduce the occurrence of SSI associated with silicone gel implants resulted in great reduction in SSI. Review of the procedures emphasized the importance of clear understanding of the surgical plan by both theater nurses and surgeons.
The Infection Control Team (ICT) has been regularly performing rounds to identify improvements of the environment in our hospital since 2008. Assessment sheets were developed and a logical approach to the ICT round was established by focusing on individual evaluations. ICT rounds repeated at six-month intervals achieved improvements in the hospital environment. The next step considered the dependence of the method on the ICT members. Therefore, the ICT member-led round was changed to the link nurse-led round in every ward to maintain high motivations and the favorable environment. In addition to the original assessment sheets, new assessment check sheets included self-evaluation by the link nurses. Furthermore, to define the points requiring improvement, unfavorable results of the evaluation were evaluated as scores to compare the effects of both types of rounds. Consequently, improvement of the environment was continuously observed after the new rounds, but evaluations showed some differences between wards. In contrast to the one-way evaluation provided by the ICT, self- and mutual evaluation by the link nurses on the wards enabled us to achieve closer supervision of daily work, to clarify insufficient management, and to continuously establish uniform infection control in daily care.
Syndromic surveillance was performed from September 1, 2009 for the early detection of nosocomial infection, and for the safety and health of 1350 workers at a hospital during the pandemic (H1N1) 2009 influenza. The chief of each section reports the condition of the staff by 9 o'clock every morning using a form on the web browser of the intranet to input information on workers with cough/rhinorrhea/sore throat, fever, vomiting/diarrhea, or other symptoms. Ten persons among the leaders of the infection control team (ICT) or managers were permitted to view a daily list of workers with or without symptoms. If necessary, the ICT investigated the situation of a section in which an outbreak may occur, directed some workers to take sick leave, and isolated contacts to prevent the spread of disease. Between September 1 and December 31, the percentage (median [range]) of reported workers (out of the total workforce) was 85.0% [74.4%-98.5%] on weekdays (n=78) and 43.2% [34.2%-53.0%] on holidays (n=44). The most frequent symptom was cough/rhinorrhea/sore throat, followed by fever, and vomiting/diarrhea. There were 114 workers with fever and the ICT advised them all on actions. The ICT directed 39 workers who suffered from influenza to take 7 days of sick leave. The spread of infection from staff-to-patients did not occur. Online syndromic surveillance enabled the ICT to assess the conditions of many workers easily, and to provide early advice on the appropriate steps to take.
The objective of this study was to elucidate the patterns of awareness of infection prevention among nurses responsible for care of the elderly. Using a qualitative study method, a continuous comparative analysis was conducted of 17 nurses who were experienced in the care of elderly people. The results indicated that their awareness of infection prevention could be defined by the following 6 categories: “infections that cannot be prevented by nurses alone,” “dilemma for nurses,” “sense of responsibility as professionals,” “basic knowledge of infection-prevention measures,” “discipline and individualized education required as part of measures to prevent infections,” and “desired results.” “Dilemma for nurses” and “sense of responsibility as professionals” were identified as core categories. The nurses had a sense of dilemma concerning the relationship between themselves and patients and other staff, as exemplified by “gap between knowledge and practice” and “infections that cannot be prevented by nurses alone.” These categories should be useful motivators for education on infection prevention.
We determined the side effects of measles vaccination in our hospital. The measles antibody levels were measured in all 269 staff members aged under 39 years on all and 381 aged over 40 on request in our hospital by the hemagglutination inhibition method. Vaccination was given to 165 staff members with antibody levels were 16 times or below from May 23 to 30, 2009. Using a questionnaire, we surveyed the health conditions among these staff for 28 days after their vaccinations. Questionnaires were recovered from 11 staff (67.3%). Thirty-six of the 111 staffs (32.4%) had side effects: cough and/or runny noise in 18, diarrhea in 13, fever in 5, emesis in 4, vomiting in 3, and others. No staff member suffered severe side effects. There was no correlation between first vaccination and second or third vaccination. These results are useful for devising better procedures against the side effects of vaccination.
Few medical institutions perform adequate measures for measles vaccination because of problems such as overhead and labor costs. Therefore, we developed a flowchart based on the vaccination guidelines of the Japanese Society of Environmental Infections, and used this flowchart to control vaccination against measles for the staff in our hospital. Using the flowchart showed that 14.4% of staff needed one vaccination against measles, 5.3% needed two vaccinations against measles, 43.2% did not need vaccination against measles, and 37.1% needed antibody measurement. Measles antibody measurement by the enzyme-immunoassay method showed that 23.5% of staff needed one vaccination against measles, and 5.3% needed two vaccinations against measles. The flowchart reduced cost per staff member by 49.5% compared with vaccination after measles antibody measurement in all staff. Therefore, the use of the flowchart collected all necessary information efficiently and led to reduction in expenditure.
Surveillance of injectable antimicrobial consumption was conducted at 55 institutes to elucidate the relationship between carbapenem consumption and imipenem or meropenem-resistant rates in Pseudomonas aeruginosa in the Tokai region using the Anatomical Therapeutic Chemical classification/Defined Daily Dose system. The consumption of antimicrobial agents (13.7 DDDs/100 bed days) in 2008 significantly increased compared to that (12.8 DDDs/100 bed days) in 2007 (p=0.010). In particular, cephalosporin consumption (from 5.3 DDDs/100 bed days to 5.6 DDDs/100 bed days, p=0.028) and glycopeptide consumption (from 0.4 DDDs/100 bed days to 0.5 DDDs/100 bed days, p=0.009) significantly increased. On the other hand, carbapenem consumption (1.3 DDDs/100 bed days) in 2008 was comparable to that (1.2 DDDs/100 bed days) in 2007 (p=0.418). These results are useful as an index for comparing intergroup and nationwide antimicrobial consumption. No relationship was found between the consumption of carbapenem and imipenem or meropenem-resistant rates in P. aeruginosa. Since the consumption of carbapenem seems to exert little influence on the resistance of P. aeruginosa, some factors other than carbapenem consumption should be considered.