In recent years, the number of emergency response teams exposed to infectious diseases during ambulance transportation in Japan has increased. This study investigated the level of understanding of standard precautions and the use of personal protective equipment by emergency response teams in Saitama, Japan. Data from 384 emergency response teams from fire stations in Saitama Prefecture were collected. The study was approved by the Ethical Committee of Saitama Prefectural University. There was a discrepancy between the level of understanding of standard precautions in emergency response teams depending on qualifications. Additionally, there was a difference in the level of understanding of standard precautions and the use of personal protective equipment among emergency life saving technicians. To improve standard precautions practices in emergency response teams in local facilities, greater educational intervention for emergency response teams is needed to increase standard precautions practices.
The Particulate Respirator type N95 (US National Institute of Occupational Safety and Health) is recommended for the prevention of respiratory infection by airborne microbes. Adequate fitting is required to prevent leakage, but little scientific data is available on the leakage rate. Standardization of the training technique for fitting is also necessary. This study evaluated the leakage of N95 respirators clinically available. Using the standard face model of the Japanese Industrial Standards, the leakage rate of the N95 particulate respirators was measured. Leakage test were carried out by the Roken-type Mask Fitting Tester (type MT-03, SHIBATA co. ltd.) equipped with a particle counter. Nine types of N95 particles respirator and N100 disposable particulate respirators were tested, repeated 15 times for each type of respirator. The respirators were classified into cone and a flat-folded types. Four domestic and six imported masks were investigated. The Welch t-test showed that the value of the leak rate varied significantly (F=7.9365, p<0.0001*). The results of the comparison between the production countries and the types was χ2=135.00, p<0.0001*, and the average of the domestic types was smaller than that of the imported types. In addition, i Pearson's chi-square test showed that the average for the flat-folded type was smaller than that for the cup type (χ2=135.00, p<0.0001*). Three of the products, 1870 (3M Co. Ltd.), Sakai expression high lac 350 type (Koken Ltd.), and DD01-N95 (Shigematsu Works Co. Ltd.), had lower leakage rates than the others in the experiment repeated five times. We found no significant differences between these three types.There was no difference in average leak rate or variance between these three equivalent products. This study found more leakage and less adherence with the cone type than the flat-folded type, and with imported products than domestic masks quantitatively. These results indicate that the size of masks adequately fit Japanese people. Moreover, the three products with the lowest leak rate showed no variation.
A nationwide postal survey was conducted to investigate the differences in infection control systems, infection control education, and urinary catheter practice among five categories of hospital size. Hospitals with ≥100 beds were selected by systematic sampling, and link nurses or chief nurses were requested to respond. The overall response rate was 40%, and 1,318 responses were analyzed. Larger hospitals are more likely to have full-time or full-time-equivalent infection control practitioners (p<0.001), a link nurse system (p<0.001), and an Infection Control Team or ICT (p<0.001) than smaller ones. Further, 69%-82% of the hospitals with <700 beds held study sessions on healthcare-associated infection at least twice a year; the corresponding proportion was 92% for hospitals ≥700 beds. Availability of a textbook of urinary catheter care practice at the ward was higher at larger hospitals than smaller ones (p<0.001), and the trend was the same for training sessions for urinary catheter care practice (p<0.001). Bladder washout was less commonly practiced in larger hospitals than smaller ones (p<0.01). Almost all respondents reported the use of gloves by the staff when draining urine. However, the practice of changing gloves and urine collection containers between patients was performed in a significantly greater number of large hospitals (p<0.001). Our survey suggests that larger hospitals had greater resources for infection control systems and infection control education systems than smaller ones, and larger hospitals tended to implement evidence-based urinary catheter care compared with smaller ones.
The recommended rubbing volume of liquid type quick-drying antisepsis in Japan is 3 mL based on the Guidelines of the Centers for Disease Control and Prevention. Therefore, few studies that evaluate the appropriate volume of these type antiseptics have been carried out in Japan. In this study, hand antiseptic effects were compared with rubbing volumes of commercial 0.2 w/v% benzalkonium chloride/liquid-alcohol. The appropriate rubbing volume of these antiseptics was 2 mL regardless of subject physical size.
Contact transmission is one of the most common routes of hospital-acquired infections. To help prevent contact transmissions, monitoring bacterial contamination on frequently touched surfaces and improving awareness of the hospital environment for healthcare workers are necessary. In the present study, we performed microbial surveillance of frequently touched surfaces for the major hospital-acquired pathogens, methicillin-resistant Staphylococcus aureus (MRSA), Pseudomonas aeruginosa, and Serratia marcescens. From a total of 1,513 samples over four years, samples of 13 (0.9%) MRSA, 69 (4.6%) P. aeruginosa, and 24 (1.6%) S. marcescens were detected. The antimicrobial susceptibility and pulsed-field gel electrophoresis (PFGE) patterns of the environmental MRSA isolates were similar to those of the clinical isolates. On the other hand, ≥80% of the environmental P. aeruginosa and S. marcescens exhibited susceptibility to all drugs tested in this study. In addition, PFGE patterns of the environmental P. aeruginosa were greatly different from those of the clinical isolates. Therefore, our findings suggest that MRSA and most P. aeruginosa and S. marcescens detected from the frequently touched surfaces were derived from patients or healthcare workers and the hospital environment, respectively. Although the detection number of the bacteria was 18/89 (20.2%) in the first investigation, the detection rate (4.5%) of the bacteria was significantly reduced in the second investigation. The reduction of the bacterial number was attributed to the MRSA reduction. Our data showed that microbial surveillance leads to increased awareness among the healthcare workers in the hospital environment, and cleaning and disinfection were more frequently performed.
The first or second-year postgraduate medical residents (so-called interns) are at high risk of mucocutaneous and percutaneous exposure to blood and body fluids. This study investigated the incidence and circumstanced of exposure injuries among interns in Yokohama City University Hospital. We analyzed 320 exposure injury reports from April 2007 to August 2010 (41 months). a total of 58 (18%) were reported from interns, even though the number of interns (average 70 every year) is only 5% of medical staff. The month with the highest number of reports from interns was July, unlike doctors and nurses. Anonymous questionnaire were distributed to 60 interns in 2010 October. The survey asked about the experiences of needlestick injury and post-injury reporting, and 32 (51%) responded. Of 32 respondents, 9 (28%) reported having needlestick injuries. Half of the interns failed to report the injuries to the hospital health office. Several studies show that medical staff often fail to report their injuries, which is called “underreporting”. Strategies aimed at improving reporting systems and creating a culture of reporting should be implemented by medical centers.
In response to a report that the effectiveness of vaccination against the Influenza A(H1N1)pdm among adults in Japan was 78.6%, blood samples were taken from 62 staff members with signed consent on the day of vaccination and 4 weeks after vaccination, and the HI antibody values were measured to investigate the incidence of antibodies before and after vaccination among staff members. A total of 49 members (79%) indicated 1:40 or greater HI antibody value, which is known the index for effective preventive immunization after vaccination. With respect to the antibody value before vaccination, the incidence of antibodies of 1:10 or greater was in 12 members (19%) and 1:40 or greater in 4 members. According to the present study, the incidence rate of effective antibodies after vaccination almost agreed with the results of the domestic clinical studies. The number of antibody holders with 1:10 or greater before vaccination was 12 members (19%), but there were no episodes of illness caused by A/H1N1, suggesting the possibility of inapparent infection. The HI antibody values among the effective antibody holders were mostly concentrated around 1:40 to 1:160 and no patients were found in the group having the antibody test. The number of affected individuals found during the epidemic period was only 10 cases among all staff members. The reasons for no outbreaks in hospital were the effectiveness of the vaccine, and awareness of A/H1N1 was much greater than that of seasonal influenza, so that nosocominal infection control such as strengthening of sanitation of hands and hand hygiene and wearing masks was taken seriously.
Antimicrobial agent AUD value and resistant bacterium factorability were investigated in 19 hospitals of Hiroshima prefecture from January to June, 2010. The percentile (10, 25, 50, 75, 90%) of 13 antimicrobial agents was calculated from the AUD value of each hospital, and benchmarks for antimicrobial agents in Hiroshima prefecture were established. There were some hospitals where the AUD value of MEPM and IPM/CS is high, and it is necessary to investigate whether Carbapenem agent is appropriate used in these hospitals. The relationship between AUD value of each antimicrobial agent and detection rate of resistant microbe was investigated. The detection rate of MRSA and AUD value of CMZ had a negative correlation. The detection rate of ESBL of E. coli and AUD value of CFPM tended to positive correlation, AUD values of CAZ and CTRX had no correlation. There was no correlation in the detection rate of P. aeruginosa (Carbapenem resistant) and AUD value of MEPM and IPM/CS. The relationship between antimicrobial agent AUD value and resistant microbe requires more examination because there are a lot of uncertain points. More detailed surveillance will be necessary in the future because AUD and various other factors are related to the appearance of antimicrobial resistant bacteria. The surveillance of regional cooperation concerning antimicrobial agent AUD value and resistant microbe is useful for control of the detection of antimicrobial agent resistant bacteria.
A carbapenem use restriction program was developed to promote correct antimicrobial use in our hospital since December 15 2005. As a result, significant changes were found in antimicrobial consumption, but the problem was how to maintain the situation. Therefore, we promoted correct antimicrobial use continuously. Medical departments have different protocols for use of antimicrobial. So pharmacists were requested to monitor the relationship between dosage and dosage period for each medical department individually. In this study, we developed the “antimicrobial use graph” to assess the average dosage and total dosage period of each medical department or the hospital. The average dosage of penicillins, fourth-generation cephalosporins and carbapenems tended to show high dose administration in our hospital. The total dosage period of penicillins, first-generation, second-generation and third-generation cephalosporins tended to show long course administration, on the other hand oxacephems, fourth-generation cephalosporins and carbapenems tended to show short course administration in our hospital. Consequently, correct use was established in many medical departments. The antimicrobial use graph is useful as an index for comparing each medical department and the overall antimicrobial consumption.
The present study investigated the relationships between antimicrobial use density (AUD) and drug susceptibility, as well as cross-resistance, for a total of 6587 strains of Pseudomonas aeruginosa clinically isolated from April 2003 to March 2010 (previous 7 fiscal years, FY). During the investigation period, a total of 22 metallo-β-lactamase (MBL)-producing strains (0.33%) were isolated, and a total of 3 multidrug-resistant P. aeruginosa (MDRP) strains were isolated from urine in FY 2007. Isolation of MBL-producing strains was concentrated from FY 2004 to FY 2006, with 4 (0.4%), 8 (0.8%) and 6 (0.7%) strains being isolated in FY 2004, FY 2005 and FY 2006, respectively. The total AUD of carbapenem, aminoglycoside and new quinolone antibiotics increased annually, and increases in AUD were particularly marked for meropenem (MEPM), amikacin (AMK) and ciprofloxacin (CPFX). Drug susceptibility was classified as susceptible, intermediate or resistant, and AUD and susceptibility were compared between the 3-year periods before and after FY 2006. For all antibiotics other than AMK, imipenem/cilastatin (IPM/CS), and MEPM, the number of resistant strains increased significantly with AUD. In the case of IPM/CS and MEPM, the number of intermediate strains increased significantly with AUD, but no increases were observed in the number of resistant strains. With regard to CPFX, the number of resistant strains increased significantly with AUD, but no increases were observed in the number of intermediate strains. However, for AMK, neither resistant nor intermediate strains increased, despite increased AUD. Although the proportion of MEPM-resistant strains exhibiting cross-resistance with IPM/CS-resistant and intermediate strains had been 100% from FY 2003 to FY 2006, strains showing no cross-resistance were isolated from samples collected in FY 2007 and later, probably due to the effects of increased AUD of MEPM. These findings suggest that the susceptibility of P. aeruginosa to most antibiotics is closely related to AUD, and that AUD is important in the long-term monitoring of susceptibility.