A workshop and training in appropriate hand hygiene using fluorescent dye were held for the hospital pharmacists affiliated with the Niigata Society of Hospital Pharmacists. Afterwards, a survey was conducted. After the workshop, the pharmacists applied fluorescent cream to both hands and performed the scrub method with soap under running water. Then, the remaining fluorescent areas were sketched under black light to assess the effectiveness of the scrub method. After cleaning of these fluorescent areas, fluorescent lotion was rubbed on both hands in a manner similar to rubbing in antiseptic hand rub. The remaining fluorescent areas were then sketched to assess the effectiveness of the rubbing method. The areas that were missed by the scrub method were rather larger compared to the areas that were missed by the rubbing method. About 60% of the hand was left untouched by the scrub method, mostly on the back of the fingertips. About 10% of the palm, about 20% of the thumbs, and some wrinkles of the fingers were untouched by the rubbing method. The untouched parts in the scrub method and rubbing method showed considerable differences. In the questionnaire, most pharmacists recognized the insufficiency of their previous hand hygiene. This was the first workshop, including training, and indicated that the awareness about appropriate hand hygiene was improved. It is important to continue to training in appropriate hand hygiene and to hold workshops in infection control and prevention for clinical pharmacists.
The effect of antisepsis depends on the contact time of the microorganism and the antiseptic agent. Our evaluation of quick-drying hand antisepsis agents found that 3 mL of gel type agent required significantly longer than 3 mL of liquid type agent. Therefore, adequate disinfection efficacy using a small application volume can be expected for gel type antisepsis compared with liquid type antisepsis. The disinfection efficacy was examined by several application volumes of 0.2 w/v% chlorhexidine gluconate gel-ethanol (0.2% CHG-GE). As a result, gel type antisepsis with 1 mL suggested equal disinfection efficacy with liquid type antisepsis with 3 mL. In addition, the weight change rate of the ethanol was measured for 16 types of gel and liquid disinfectant. The weight change rate was lower for the gel type antisepsis than the liquid type antisepsis, suggesting a correlation between the viscosities and the weight change.
The purpose of this study was to compare compliance with hand hygiene between the baseline and intervention periods. A quasi-experimental study was conducted with 87 health-care professionals in the intensive care units, using the direct observation method and the calculated usage of alcohol-based hand rub and liquid soap. Computer screensaver messages on hand hygiene were developed by the investigators, and distributed to all computers in the intensive care units during the intervention period. The compliance with hand hygiene by the direct observation method during the baseline period was 38.3%, and 36.4% during the intervention period (χ2=1.01, p=0.31). The amount of the calculated usage of alcohol-based hand rub and liquid soap was increased by 19.2% during the intervention period. Although there was no improvement on the compliance with hand hygiene by the direct observation method, the increase of the calculated usage of hand rub and liquid soap showed the positive effect of the intervention. There was no difference in the compliance with hand hygiene among the types of health-care professionals. During the both periods, the proportion of the hand hygiene using liquid soap and water was over 60%. The care necessity rate (t=2.94, p<0.01) and inpatient bed occupancy rate (t=49.70, p<0.01), as the indicators of workload, showed statistically significant lower value during the intervention period. As a conclusion, the intervention of the computer screensaver messages was effective to improve the compliance with hand hygiene in the intensive care units. However, from this study results, we have to educate the appropriate hand hygiene method to the health-care professionals, that is alcohol-based hand rub as the first choice, and improve the access to the alcohol-based hand rub in the intensive care units.
An infection control team (ICT) was organized in our hospital in 2005. Before organizing the ICT, an infection control nurse had performed surveillance of multi-drug microorganisms as an additional duty. After organizing the ICT, information about screening and detection of multi-drug microorganisms were sent to all members of the ICT, who immediately started to perform this duty. Until the start of the ICT, many multi-drug microorganisms had been detected. The present study investigated the effect of surveillance of methicillin-resistant Staphylococcus aureus (MRSA) and multi-drug resistant Pseudomonas aeruginosa (MDRP) in our hospital between 2005 and 2009. After starting the ICT, the detection rate of MDRP fell to near zero and that of MRSA was reduced to one third. Detection of MDRP was limited to the fields of urinary tracts in our hospital; as decrease in the ratio of MDRP was thought to be easier and more effective than that of MRSA. The detection rate of MRSA in our hospital was affected by the rate of introduction of MRSA into our hospital from the community. To decrease the detection rate of MRSA, community-based surveillance and efforts should be started.
Active surveillance cultures (ASC) for methicillin-resistant Staphylococcus aureus (MRSA) were performed at the time of admission to ward A of this hospital since June 2008. Ward A admits patients for cardiovascular/nephrology/apoplexy medicine and cardiovascular surgery. To assess the effectiveness of ASC, the incidence of MRSA carriage and infection was assessed for one year before and after introduction of ASC. The proportion of MRSA-positive admissions was high (approximately 10.2%) in ward A. Before introduction of ASC, the number of MRSA carriers was 34 (imported: 11; nosocomial infection: 15; unknown: 8) and the number of MRSA-infected patients was 9 (imported: 2; nosocomial: 5; unknown: 2). After introduction of ASC, the number of MRSA carriers was 66 (imported: 58; nosocomial infection: 8) and the number of MRSA-infected patients was 4 (imported: 3; nosocomial: 1). These findings suggest that ASC helped to identify MRSA reservoirs, and the introduction of contact precautions reduced the incidence of nosocomial MRSA infections. ASC performed at the time of admission in patients with higher risk for MRSA infections is effective to prevent nosocomial MRSA transmissions and occurrence of MRSA infections.
Many studies have shown that Pneumococcal Polysaccharide Vaccine (PPV) may reduce mortality and prevent invasive pneumococcal diseases, but may not prevent pneumococcal pneumonia. “The relationship between PPV immunization and occurrence of pneumococcal diseases”, and “the effect of the vaccine on the prognosis” were evaluated. Cases of PPV immunization, invasive pneumococcal diseases, and pneumococcal pneumonia were retrospectively identified from September 2006 to August 2009. PPV immunization had significantly increased, but cases of invasive pneumococcal diseases and pneumococcal pneumonia had not significantly diminished. A retrospective cohort study was conducted from September 2008 through August 2009, which included a Vaccine group (127 cases) and Control group (139 cases) containing patients who had not received PPV. PPV was associated with significant reduction in all-cause mortality (Hazard Ratio [HR] 0.29; 95% confidence interval [CI] 0.18-0.40). However, the Vaccine group showed no significant reduction in the incidence of all-cause pneumonia (HR 0.83; 95%CI 0.65-1.11). PPV immunization had significantly increased during the campaign, but the incidence of invasive pneumococcal diseases did not significantly diminish. PPV immunization might reduce all-cause mortality, but did not reduce all-cause pneumonia.
A swine influenza outbreak occurred in the closed psychiatry ward of our hospital in August 2009. The patients had difficulty in expressing subjective symptoms correctly and had characteristics like low hygiene management ability, so a larger expansion of the infection was feared. After 4 hours of initial procedures in diagnosing, treating and prevention, the first infected patient was identified and the numbers of infected patients were doubling. Therefore, prophylactic medication against influenza was administered to all patients and staff, with procedures in accordance with the increasing numbers of infected patients. As a result, 11 of the 41 patients were infected, but no staff were infected, so department isolation was ceased after 2 weeks. The general procedures including continuous actions, education of patients and staff, and administration of medication are important.
The learning outcomes were evaluated of individuals who attended a training seminar on “Infection Control in Home-care Patients on a Ventilator”—the final session of the 12 sessions of the “Infection Control Education Program for Visiting Nurses.” The subjects consisted of 15 visiting registered nurses from two visiting nurse agencies. The seminar was conducted for an hour on a weekday evening for each agency group. To evaluate their learning outcomes, we first examined their acquired knowledge and skills for 34 items regarding infection control in home-care patients on a ventilator before and after the seminar (prior and post learning), and analyzed changes. For each parameter, we calculated the mean value of each learning outcome from “not capable at all=1 point” to “fully capable=5 points.” To make a comparison between prior and post learning, we used the Wilcoxon rank-sum test, and to draw a comparison between learning outcomes and visiting nurses' attributes, we used the Spearman's rank correlation coefficient.The overall mean in learning outcomes showed an increase from 3.1 points prior to learning to 4.1 points post learning. Learning outcomes for all item parameters showed a rise in scores post learning. We discovered that participants who experienced an “increase” in overall learning outcomes were greater in ratio than participants who experienced “no change” or a “decrease.” These results enable us to conclude that our seminar helped those participants achieve their learning objectives. Nevertheless, we should further investigate learning contents and methods, particularly for the items associated with low score gains post learning.