The effectiveness of waterless presurgical antiseptic with 1.0 w/v% chlorhexidine gluconate (CHG)/ethanol preparation (waterless method) was compared with a 4 w/v% CHG scrub followed by application of 0.2 w/v% benzalkonium chloride (BAC)/ethanol preparation (two-stage method). Ten volunteer surgical personnel were enrolled in this study. The effectiveness was evaluated by the glove juice test based on the FDA monograph tentative final. Colony counts were significantly reduced with both the waterless and two-stage methods immediately and 3 hours after hand antisepsis. The waterless method showed superior persistent antiseptic effect. The reduction factor (RF) was used to compare the two methods. The RF value showed no significant difference between the waterless method and the two-stage method immediately after hand antisepsis, but the waterless method had significantly superior antiseptic effect after 3 hours (2.99±0.49 vs 2.01±0.70, respectively). These findings suggest that the waterless method with 1.0 w/v% CHG is an effective presurgical hand antiseptic method.
HBV, HCV, and HIV are primary infectious agents that can be transmitted via exposure to body fluids. This study examined the current situation of sharp injuries and other blood and body fluid exposures among home health care nurses and the implementation of preventive measures. A total of 319 home health care nurses completed and returned our questionnaire survey, yielding an overall response rate of 31.9%. Approximately 35.7% of nurses had experienced at least 1 sharp injury during their home health care career; and 36.4% reported other blood and body fluid exposures. The annual incidence rate for sharp injury was 5%; and for other blood and body fluid exposure was 27.3%. The annual incidence rate of other blood and body fluid exposures was almost 5.5 times that of sharp injury. The percentages of nurses who did not report the incidence of sharp injury and other blood and body fluid exposures at their workplace were 23.0% and 75.7%, respectively. The incidence of other blood and body fluid exposures was 3.3 times less reported than that of sharp injury. This study revealed for the first time the incidence rates of blood and body exposures among home health care nurses in Japan. Based on our observations of exposure conditions, we suggest the following interventions to address this issue: education of nurses, prohibiting unsafe behaviors that contribute to sharp injuries, use of personal protective equipments, education on HBV vaccine, and development of a prevention and post-exposure manual on blood and body fluids.
Issues of introducing cost-effectiveness analysis in the field of infection control are inevitably controversial. However, cost of illness studies, which are essential for cost-effectiveness analysis, have not been adequately carried out in Japan. This study estimated postoperative resource consumption attributable to surgical site infection (SSI) in gastrectomy patients who underwent gastrectomy between July 2007 and December 2010 at six participating hospitals. The JANIS/DPC Integrated Database was developed after collecting JANIS-related data and administrative DPC data. The generalized linear model was used to estimate excess postoperative length of stay (LOS) and charges (based on fee-for-service) attributable to SSI. A total of 42 SSI cases were identified among 857 surgeries. The generalized linear model was used to estimate the impact of SSI and revealed that compared with non-SSI patients, postoperative LOS and charges increased by 6.6 days and 206,000 yen for superficial SSI patients, 12.8 days and 398,000 yen for deep SSI patients, and 18.3 days and 1,021,000 yen for organ/space SSI patients, respectively. The JANIS/DPC Integrated Database was developed by combining JANIS-related data and DPC data and used to estimate postoperative extra resource consumption in gastrectomy patients at six hospitals. These data may prove useful in cost-effectiveness analysis for future infection control programs in Japan.
The notification from Ministry of Health, Labor, and Welfare in June 2011 required that health care facilities should build regional networks for mutual assistance. This survey tried to clarify the problems which now confront us, and to assess the need for infection control support in a regional network. The survey asked about the difficulties in infection control activities. Anonymous questionnaires were distributed to 577 medical institutions located in X prefecture in February 2012. Two hundred and eighty-eight (49.9%) medical institutions filled out the questionnaire. We have found many problems; the common weaknesses are education of staff, lack of experts, and isolated examination rooms. Most of the institutions plan to report or consult a public health center in case of an outbreak regardless of their scale. Small clinics have specific problems; they need help from large hospitals in case of outbreak; 86% of the clinics will not ask for infection control fees; they have difficulties in informed consent at the point of outbreak. Large medical centers have different problems; they have troubles in education of staff and lack of information at the time of transfer. Based on these findings, we should build a regional network in which large medical centers will help both medium hospitals and small clinics in case of an outbreak. A public health center should operate as a window. We should further tighten the cooperation of similar scale hospitals since the problems are different depending on the facility scale. Finally, a new infection fee to be claimed by small clinics will be necessary.
Preventing occupational infections is one of the most important activities of the infection control team. It is recommended that all healthcare workers be protected from vaccine-preventable diseases (VPDs) by administering vaccines. We conducted a vaccination drive at our facility because of disseminated varicella-zoster virus (VZV) infection in a patient in the intensive care unit and the upcoming operation of a patient with mumps. A total of 984 persons were evaluated for antibody titers of measles, rubella, mumps, and VZV, and individuals were vaccinated if the titers indicated the need for vaccination. It took approximately 7 months from the planning to the completion of the vaccination drive. Inoculation rates were as follows: measles, 81.9%; rubella, 76.9%; mumps, 76.2%; and VZV, 60%. Our vaccination drive was conducted successfully in a relatively short period of time and we achieved a high vaccination rate mainly due to the following 4 reasons: we recognized the need for vaccination intensely after we came across 2 cases of VPDs at our facility; the vaccination drive was carried out at the same time as the business improvement plan of the hospital was implemented; the hospital covered the entire antibody titer testing and half of the vaccination costs; simultaneous vaccination was allowed with different vaccines.
Shorter hospital stays and post-discharge home treatment are being promoted in Japan due to the advent of an aging society and reductions in medical costs. Accordingly, patients must acquire new skills related to any ongoing home treatment during the short hospitalization period. In the present study, we investigated the state of initial and ongoing instruction provided to 10 patients undertaking clean intermittent self-catheterization (CIC). Initial CIC instruction sometimes comprised only verbal explanation. In addition, even if nursing procedural instruction was provided, the results clarified that patients' individual requirements and physical abilities, dealing with unexpected situations, and understanding of home situations were not considered during instruction. Patients also lacked comprehension of bladder hyperdistention prophylaxis and the purpose of completing urination records. Ongoing instruction including procedural confirmation and postural adjustments to avoid urinary retention after voiding was not conducted on an outpatient basis. These findings indicate the importance of ongoing instruction focused on understanding bladder hyperdistention prophylaxis and completing urination records to facilitate appropriate urine volume and voiding intervals under CIC. Based on the issues identified in the present study, we created a continuous leading checklist.
A total of 33 patients treated with meropenem (MEPM) at this institution between January 2007 and January 2012 following detection of P. aeruginosa infection were divided into a non-resistant group with no change of MIC or eradication of P. aeruginosa and a resistant group with increased MIC. Univariate analysis and multivariate analysis were performed using the two response variables of “non-resistance” and “resistance,” and the following eight risk factors for resistance to P. aeruginosa: age, CCr, duration of hospitalization, daily dose of MEPM, 24 hr %time above MIC (%T>MIC) of MEPM, duration of MEPM treatment, pretreatment MIC of P. aeruginosa, and admission or non-admission to the ICU. The results of univariate analysis showed significant differences with respect to two variables, “%T>MIC” and “pretreatment MIC of P. aeruginosa,” and multiple collinearity of four variables, “CCr,” “daily dose of MEPM,” “%T>MIC,” and “pretreatment MIC of P. aeruginosa.” These findings suggested that “%T>MIC” and “pretreatment MIC of P. aeruginosa” were risk factors for resistance to P. aeruginosa with a confounding relationship. Prior to administration of MEPM, the MIC of P. aeruginosa should be confirmed and treatment should be designed to prolong %T>MIC. The results of multivariate analysis did not show significant influence for any of the variables, but the small p value for “admission or non-admission to ICU” suggested that careful attention is required.
Although it is essential for people with severe physical or mental disabilities and the elderly in need of nursing care to receive tooth brushing assistance, the risk of contamination by blood when providing such assistance has not yet been clarified. This study examined contamination of the hands of a care provider by blood during tooth brushing assistance, and discuss whether or not correct tooth brushing techniques can prevent such contamination. Subjects were 51 pairs of care providers and recipients. A dental hygienist was selected as a subject for comparison. We asked care providers to wear gloves and brush the teeth of their partner for one minute. We did not specify any method for implementing tooth brushing assistance. Following the tooth brushing session, we retrieved the gloves and conducted a luminol test. We measured the hemoglobin concentration of the saliva before and after brushing by implementing a latex agglutination test. We assessed the Plaque and Gingival Indices on another day. The dental hygienist demonstrated correct techniques for tooth brushing assistance for one minute, and underwent the same tests as conducted for the subjects. Tooth brushing was recorded on video tape. 1. There was no significant difference in the Plaque and Gingival Indices before and after tooth brushing assistance provided by care providers and the dental hygienist. 2. There were significant increases in the hemoglobin concentration of the saliva after tooth brushing assistance was provided by care providers (from 8.0±31.0 to 90.5±221.6 μg/mL) (p<0.01) and the dental hygienist (from 5.7±21.6 to 18.2±43.0 μg/mL) (p<0.01). The results show that the hemoglobin concentration of the saliva after brushing by the dental hygienist was markedly lower (p<0.01). 3. Tooth brushing methods and the Gingival Index significantly influenced the hemoglobin concentration of the saliva after tooth brushing assistance was provided. The scrubbing method had a markedly lower influence, compared to the horizontal and vertical brushing methods. The hemoglobin concentration of the saliva after brushing was significantly lower in care recipients whose Gingival Index was 0, compared to those whose index was less or more than or equal to 1. 4. No marked difference was noted in the rate of contamination of the hands by blood between brushing by care providers (15.1%) and the dental hygienist (18.9%). The rate of contamination of the fingertips and left palm was 1.9 to 11.3 and 1.9%, respectively, and contamination was not noted in other areas of the hand. Although implementation of the scrubbing method and maintenance of gingival health reduced the risk of blood-borne infections when providing tooth brushing assistance, they did not completely eliminate contamination. It is very important to adopt standard preventive measures.
An on-site study in 1998 investigated a number of needle stick and cutting injuries among housekeepers engaged in the cleaning of hospital environments. Subsequently, training programs to prevent such injures among housekeepers were promoted strongly. However, the expected improvement was not observed. The recent situation of such injuries was restudied for the development of more effective prevention programs. Questionnaires for survey of the occurrences of needle stick and cutting injuries during cleaning procedures in clinical settings between April 2006 and March 2009 were sent to 1,368 of all qualified companies authorized as healthcare service providers with the health care service mark in 2009. Replies from 340 of 1,368 companies were obtained (response rate: 24.9%). The number of effective replies was 323/340, 23.6%, and the number of hospitals included were 1,493 in three years. Among 361 cases of occupational injuries from April 2006 to March 2009, around 100 cases of needle stick injuries, and around 10 cases of cutting injuries were reported. Among those needle stick injuries, ordinary injection needle was the main cause with 68 cases and insulin needle with 20 cases. The needles incorrectly discarded were mainly found in the wards and then in nurse stations (staff stations). The incidence of such injuries was not decreased at all whereas the effort for improving educational programs for employees had continuously progressed. The main risk factor for injuries was that the housekeepers are not aware of the needle or sharp edge within some wastes. Very thin needles for insulin injection are another risk factor for the injury. Moreover, as most housekeepers are part-time workers, education and training for preventing injuries are unfortunately insufficient in many cases. More effective short programs for the education and training of the employees have to be considered carefully again. Much better communication systems between hospital personnel and housekeepers should be established. Vaccination rates for blood-borne infections among housekeepers should also be reevaluated.