The Guidelines for Hand Hygiene in Health-Care Settings released by the CDC in 2002 and the WHO Guidelines on Hand Hygiene in Health Care released by the WHO in 2009 consider that the use of waterless alcohol-based hand rubs is effective and that the fingernails should be less than 6.35 mm long in the clinical setting. We examined the effect of fingernail length on the bacterial flora of the hands of 17 volunteers. Comparison of long fingernails (5.4 mm) with short (2.4 mm) revealed significantly more bacteria on the fingers after hand hygiene (short: 4.3 CFU; long: 40 CFU). Although we did not find any significant difference between the numbers of bacteria under the fingernails before and after hand hygiene, bacteria were detected at more than 1.6×103 CFU/mm2 despite hand hygiene. The bacteria detected at high rates under the fingernails and on the fingers were Gram-positive cocci, including coagulase-negative staphylococci, and Gram-positive bacilli, including Bacillus spp. Moreover, methicillin-resistant Staphylococcus aureus and S. aureus remained on the fingers and under the fingernails and were difficult to remove. These findings suggest that the waterless alcohol-based hand rub method is difficult to use adequately if the fingernails are long.
Integrated rehabilitation for disabled children includes physiotherapy, occupational therapy, speech therapy, and group nursing therapy. Group nursing therapy is for promoting social skills. Therefore, one-to-one therapy in isolation is inappropriate for this activity. Patients with severe disabilities are sometimes carriers of methicilline-resistant Staphylococcus aureus (MRSA). These MRSA-carrier patients usually receive therapies in isolation to prevent the spread of MRSA to other patients, so cannot join group therapy. After strengthening the standard precautions for MRSA management and examination of culture of nasal swabs in all patients in 2001, we started group therapy without isolation from 2002. We monitored the spread of MRSA by repeating nasal swab culture twice a year until 2007. As the culture was performed only once in 2001, when the carriers were still isolated, the detection sensitivity should be lower than that in the following years. The prevalence of MRSA carriers in 2001 was 5 of 56 patients (9%). The prevalence from 2002 through 2007 without isolation ranged from 6/61 (10%) to 7/53 (13%) (median, 12.5%). These differences were not statistically significant. We also monitored the sensitivity patterns to various antibiotics in each strain of MRSA detected. We did not detect the spread of any MRSA strain with any particular sensitivity pattern. There were no significant differences in the prevalence between the years when all carriers showed small amounts of MRSA and the years when some carriers had large amounts of MRSA. We conclude that isolation is not necessary for MRSA carriers as long as standard precautions are strictly observed.
The spread of drug-resistant bacteria is becoming an important issue, not only in medical facilities but also in communities. To understand the present situation of home-visit nursing care stations regarding prevention and reduction in transmission of drug-resistant bacteria, questionnaires were sent to 1694 home-visit nursing care stations from January to May in 2009, and 222 valid questionnaires were returned with a recovery rate of 13.1%. Analyses of the questionnaires revealed that 65.3% of the stations had advisers providing information about infectious diseases and infection control measures, and 53.2% of the stations obtained information about colonization with drug-resistant bacteria in patients on admission. The ratio of the stations sharing information about colonization with drug-resistant bacteria in patients was significantly higher in the stations having nurses involved in the practical care of the patients with drug-resistant bacteria (p<0.01). Moreover, 41.0% of the stations provided information to patients taking antibiotic about correct use of antibiotics. In particular, the stations had quite low motivation to prevent environmental contamination of bacteria by sputum aspiration or bladder catheterization. Taken together, the stations and related medical facilities rarely shared information about colonization with drug-resistant bacteria in patients. The infection control measures for drug-resistant bacteria were also inadequate in most home-visit nursing care stations. These findings indicate that establishment of a system for sharing information about drug-resistant bacterial infections between medical facilities and home-visit nursing care stations is essential. The procedures of nursing skills and education of the patients and their family members must also be reevaluated focusing on prevention and reduction in transmission of drug-resistant bacteria in home care.
The number of patients who were diagnosed with fungal infection and the amount of the antifungal agents used in the medical ward for blood diseases both increased in the National Hospital Organization Kagoshima Medical Center in 2008. At that time, we had surveyed the use of antimicrobial agents except for antifungal agents; so we could not detect the outbreak at the early stage. Therefore, we retrospectively investigated the amount of the antifungal agents used in the ward, and determined whether the outbreak could have been detected by the surveillance of the amount of the antifungal agents used. We calculated the monthly and weekly antimicrobial usage density (AUD) of the antifungal agents from January 2007 to December 2009. The monthly AUD showed an abrupt increase in August 2008, and the highest usage was three times the monthly average usage in November 2008. When we compared mean values of AUD every half year, we found the AUD predominantly increased. The weekly AUD gradually increased in the first week of August and then abruptly increased at the end of August 2008. Cleaning of the filter, fan coil, and exhaust vents of the air-conditioning machines was carried out in this ward on July 17, 2008; the cleaning was thought to be the reason for the fungal infection, especially the increase in the number of patients with Aspergillosis, although this could not be proven. The present study suggests that surveillance of the AUD can detect an outbreak of fungal infection at the early stage.
We undertake health management in three social welfare facilities for inpatients with mental development disorders. We performed a questionnaire survey on infection countermeasures among the employees of these facilities, held lectures on infection based on the results of this questionnaire survey of the employees, and prepared a manual on conduct during a new type influenza epidemic. If new type influenza occurs among family members, employees do not come to work for 3 days. Prior consultation was held on treatment of cases of influenza, and the indication for oral oseltamivir prevention for persons in close contact with patients was confirmed beforehand. A test using the influenza diagnosis kit was performed, and early treatment was started after diagnosis. Patients with fever and any others in the same room were transferred to private rooms. Oseltamivir oral prevention was given to individuals in close contact with patients with diagnoses of influenza. The results indicated that even with oseltamivir oral prevention, influenza occurred in five to 11 people in each outbreak, except in one case. The basic reproduction rate was higher for people living together who did not take sufficient measures against infection. Therefore, oseltamivir oral prevention should be given to all people in the same dormitory if influenza is detected in even one person, and preparations should be undertaken by obtaining consent from the families beforehand. On the assumption that new type influenza will occur in the facilities, consent of the families of people using the facilities can be obtained, and the attending physicians can investigate the indications for oseltamivir oral prevention. Consequently, preventive medication can be started sooner and spread of infection in the facilities can be suppressed.
A novel influenza virus (A/H1N1pdm) of swine origin emerged in Mexico in early April 2009. The novel influenza virus (A/H1N1pdm) spread rapidly all over the world. In this study, we developed a detection method for this novel influenza virus (A/H1N1pdm) of swine origin based on the reverse transcription-loop-mediated isothermal amplification (RT-LAMP) assay. In preliminary examinations, A/H1N1pdm RNA positive control was detected by RT-LAMP assay, RT-LAMP products exhibited a typical ladder pattern, and after digestion with Sau3AI exhibited a single band. The A/Mie/33/2009pdm strain (1.56×106~1.86×106 pfu/mL) was used for analysis of the sensitivities of the RT-LAMP and Real-Time RT-PCR assay. The sensitivity of the RT-LAMP assay was the same as that of the Real-Time RT-PCR assay. The RT-LAMP assay was performed at temperatures of 60, 62.5 and 65℃, and the reaction at 60℃ was the most productive. We detected A/H1N1pdm corresponding to 1.56×101~1.86×101 pfu/mL by the RT-LAMP assay within 45 min. No cross-reactions of novel A/H1N1pdm with influenza A virus (H1N1), influenza A virus (H3N2), influenza B virus, influenza C virus, adenovirus, respiratory syncytial virus, human metapneumovirus, parainfluenza virus, and human boka virus were observed, confirming the specificity of the RT-LAMP assay for detection of A/H1N1pdm. These results indicate that A/H1N1pdm is detected rapidly by the RT-LAMP assay, so this method could become an available diagnostic method suitable for clinical situations requiring quick and appropriate decisions about treatment and care.
Following the 2007 measles epidemic in Japan, our hospital began to measure virus antibody titers against measles, rubella, varicella, and epidemic parotitis, and to enforce vaccination among hospital personnel. As data management was mostly performed manually for hospital personnel attributes and antibody titers, maintenance presented a major burden, with issues of both efficiency and accuracy. Thus, with the introduction of an infection control support system in 2010, we established a system for controlling hospital personnel infection and managing vaccination history. The system is in accordance with the Japanese Society of Environmental Infections Vaccine Guidelines as Measures against Nosocomial Infection Vol. 1 by the Japanese Society of Environmental Infections. Implementation of the system eliminated the need for manual consolidation of hospital personnel attributes and antibody titers, and facilitated the process of determining who needed antibody titer measurement, who did not meet criteria, and who was recommended to receive vaccination. This hospital network system decreased the burden of data management, effectively reducing manpower requirements and achieving high-quality infection control.
Antimicrobial dosage surveys are important methods to ensure the appropriate use of specific agents, but few surveys have compared dosages used in different regions. Antimicrobial dosage survey tools such as the anatomical therapeutic chemical classification/defined daily dose (ATC/DDD) system and the antimicrobial use density (AUD) are widely used. The Osaka Infection Control Pharmacists Association conducted a survey of the extent of awareness of ATC/DDD and AUD. The results showed that ATC/DDD and AUD are not widely known. The unit for measuring doses should be standardized, but the ATC/DDD and AUD allow comparison of facilities using different units, so the ATC/DDD system will be important in antimicrobial dosage surveys. In the future, we would like to construct a more practical system by creating a simple method to automatically convert existing units to AUD, and so promote surveys comparing different regions.