Japanese Journal of Infection Prevention and Control
Online ISSN : 1883-2407
Print ISSN : 1882-532X
ISSN-L : 1882-532X
Volume 27, Issue 1
Displaying 1-10 of 10 articles from this issue
Original Article
  • Hiroshi YONEYAMA, Haruhisa IKEGAMI, Hiromi IKEDA
    Article type: Original Article
    2012 Volume 27 Issue 1 Pages 1-7
    Published: 2012
    Released on J-STAGE: March 23, 2012
    JOURNAL FREE ACCESS
      The Clostridium difficile infection (CDI) rate increased from the baseline in our hospital (4 units, 180 bed, secondary care hospital) in June 2009. Despite compliance efforts for contact precautions, the CDI outbreak was not controlled. Therefore, we started infection control programs consisting of hospital-wide educational campaigns and care-bundles from April 2010. Educational campaigns were introduced for all hospital staff about CDI and the care-bundle at the beginning of the intervention. We started to implement hand washing with soap and water before and after each contact, and the use of gloves and aprons with patients with suspected CDI or any diarrhea. Patients with the diagnosis of CDI were isolated in single rooms or cohorts. Cleaning and disinfection of rooms used by patients with CDI was performed with 5000 ppm sodium hypochlorite solution. Thermometers, pulse oxymeters, sphygmomanometers, and stethoscopes were limited to single patient use. As a result, the incidence of CDI significantly decreased from mean 2.2 cases per 1000 patient-days in the preintervention period (August 2009 through March 2010) to 0.68 cases per 1000 patient-days in the postintervention period (July 2010 through January 2011). CDI rate decreases were observed in three of our four units. These findings confirm the effectiveness of hospital-wide campaigns using care-bundles to control an outbreak of CDI in small/medium hospitals.
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  • Takahiro IMAIZUMI, Kumiko TANAKA, Hironaga OKAWA, Masamitsu MATSUDA, Y ...
    Article type: Original Article
    2012 Volume 27 Issue 1 Pages 8-12
    Published: 2012
    Released on J-STAGE: March 23, 2012
    JOURNAL FREE ACCESS
      Catheter-related Candida bloodstream infection (CR-BSI) is difficult to treat, especially in patients with refractory complications such as Candida endophthalmitis. In our hospital, the infection control team (ICT) is conducting surveillance of all blood culture-positive cases. From the database of all samples of positive blood culture in this hospital, we examined all CR-BSI cases involving intravascular catheters newly inserted from April 2008 to September 2010 to analyze the primary causative organism, the background factors, and the ICT intervention for coexisting illness. A total of 72 CR-BSI cases occurred during the investigation period, including 28 cases of Candida infection, and 44 cases of bacterial infection. Three background factors were significant in the Candida infection group: duration of hospitalization of more than 4 weeks, receiving total parental nutrition, and administration of broad spectrum antibiotics within the past four weeks. Furthermore, the proportion of patients with two or more such factors was significantly high in the Candida group. The period before initial treatment was 1.5±0.6 days for the bacterial group and 2.7±0.7 days for the Candida group (p<0.01). Five patients had Candida endophthalmitis. There was no significant difference in the period before appropriate treatment between the endophthalmitis group and the other group. Interventions were made by the ICT in 20 of the 28 cases (71%). There was no significant difference in the period before treatment between the intervention group and the other group. The ICT has intervened as soon as the blood culture was positive so far. However, this study suggests that we should consider starting antimycotic therapy to reduce the complications and the delay for initial treatment in patients with high risk of Candida infection.
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  • Hiromi MORISHIGE, Yoko MANO, Hideyuki SASAOKA, Teiichi NAKAMURA, Mamor ...
    Article type: Original Article
    2012 Volume 27 Issue 1 Pages 13-19
    Published: 2012
    Released on J-STAGE: March 23, 2012
    JOURNAL FREE ACCESS
      Bacterial contamination of contact lens (CL) cases and lens care solution and the use of slightly acidic electrolyzed water as disinfectant for the disinfection of CL cases were investigated. Seventeen species of bacteria were identified in 16 (45.7%) of 35 cultures from CL cases and 27 (41.5%) of 65 cultures from lens care solution samples. The most common bacterium was Serratia marcescens, accounting for 25.9% of isolates, followed by Bacillus spp. (14.8%). When contaminated CL cases after decantation of all content solution were filled with slightly acidic electrolyzed water and incubated overnight at room temperature, 18 (66.7%) of 27 sample cases were completely sterilized. Time-kill studies of bacteria in dry conditions using experimentally contaminated CL cases measured about 107 to 80∼1.2×104 CFU/mL over a 24-h period, as well as in CL cases washed once in sterile distilled water. In contrast, no bacteria species could be detected just after drying in CL cases washed once in slightly acidic electrolyzed water. In our investigation, bacteria causing healthcare-associated infection were frequently found in CL cases and lens care solutions, and slightly acidic electrolyzed water was effective for the disinfection of reusable CL cases.
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  • Toshiya SATO, Yumiko NAKAJIMA, Michie SAKASHITA
    Article type: Original Article
    2012 Volume 27 Issue 1 Pages 20-24
    Published: 2012
    Released on J-STAGE: March 23, 2012
    JOURNAL FREE ACCESS
      A school lunch contaminated with Salmonella enteritidis (O-9) in broccoli salad was served to 2640 children and teachers in elementary and junior high schools on February 9. The first group of 1600 patients presented with high fever, abdominal pain, vomiting, diarrhea, and bloody diarrhea. A total of 30 people were admitted to hospital, and the incubation period was about 3 days. The second group of 70 patients included 6 admitted to hospital, and the incubation period was about 25 days. Almost all secondary patients were intrafamilial transmissions from the primary patients. Evaluation of Pulsed-Field Gel Electrophoresis patterns suggested that the Salmonella strain isolated from the secodary patients was the same as that from the broccoli salad and the primary patients. The third group of patients presented from days 27-40. Salmonella was detected from a long time carrier with no symptoms and unknown origin in little children under school age. The number of patients decreased after environmental interventions in the school lavatory. Early intervention and long-time observations are needed during Salmonella outbreaks.
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Report
  • Masami IIGUSA, Yoshimasa KOBAYASHI, Akiko OKAMURA, Kayoko KURIHARA, Ei ...
    Article type: Report
    2012 Volume 27 Issue 1 Pages 25-30
    Published: 2012
    Released on J-STAGE: March 23, 2012
    JOURNAL FREE ACCESS
      Adherence of health care workers (HCWs) to recommended hand hygiene procedures for infection control has been unacceptably poor. Cultures from the palm of the hand were obtained to detect bacteria colonizing HCWs and reported individually with photographs of the culture medium to improve hand hygiene. Additionally a questionnaire was given to confirm the current state of hand hygiene among HCWs.
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  • Ippei MORIMOTO, Takuya HASHINO, Takashi UEJI, Masashi TERASAWA, Mayumi ...
    Article type: Report
    2012 Volume 27 Issue 1 Pages 31-37
    Published: 2012
    Released on J-STAGE: March 23, 2012
    JOURNAL FREE ACCESS
      The trend of relatively high rates of carbapenem resistance in P. aeruginosa of meropenem (MEPM) 15.4% and imipenem (IPM) 25.7%, compared to nationwide surveillance data, were observed in Yodogawa Christian Hospital during the period from January to June 2006. To examine the drug resistance rate of P. aeruginosa and the emergence of multidrug-resistant P. aeruginosa (MDRP), hospital antibiograms were constructed consisting of data from each ward and medical specialty since 2008. This research revealed that the rate of carbapenem resistance in P. aeruginosa was apparently high in the ICU. Therefore, the use of carbapenems was restricted and the use of piperacillin (PIPC) and piperacillin/tazobactam (TAZ/PIPC) enhanced, which have good activities against P. aeruginosa. Additionally, hospital-wide monitoring of infection control was conducted. Susequently, the resistance rates of MEPM and IPM significantly decreased to 6.1% and 7.9% during the period from July to December 2009, whereas the rate of PIPC resistance in P. aeruginosa tended to rise with increased antimicrobial use, suggesting the correlation between excessive use of antimicrobial agents and rise of resistance rate, regardless of antimicrobial class. This study illustrates the improved situation of antimicrobial resistance in our hospital, resulting from monitoring of the transition of P. aeruginosa resistance rate using hospital antibiogram data, and promoting appropriate antibiotic use.
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  • Takayuki YOKOZAWA, Taisuke HOUCHIGAI, Naoko DOBASHI, Naoki ICHINOSE, T ...
    Article type: Report
    2012 Volume 27 Issue 1 Pages 38-43
    Published: 2012
    Released on J-STAGE: March 23, 2012
    JOURNAL FREE ACCESS
      Acinetobacter spp. is one of the major bacteria strains causing ventilator-associated nosocomial infection. Emergence of antimicrobial resistant Acinetobacter strain has occurred, and patients undergoing chemotherapy or immature infant may suffer significant impacts from A. baumannii. A. baumannii which produces metallo-β-lactamase (MBL-producing A. baumannii) were detected from 4 infants in our NICU. We suspected nosocomial infections based on pulsed-field gel electrophoresis (PFGE), but no MBL-producing A. baumannii were detected by three NICU environmental investigations conducted by the ICT. However, MBL-producing A. baumannii was isolated in the ventilator circuit and environment around the water supply system in the NICU. On the other hand, examination of a tracheal tube, obtained from a patient with MBL-producing A. baumannii isolated from the endotracheal aspirates, detected only non-MBL-producing A. baumannii, suggesting that two PFGE strains originated from the same homologies. If nosocomial-infection due to antimicrobial-resistant microbes is suspected, the presence of different susceptible strains of bacteria should be considered.
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  • Yuji FUJIKURA, Teruo KIRIKAE, Akihiko KAWANA
    Article type: Report
    2012 Volume 27 Issue 1 Pages 44-49
    Published: 2012
    Released on J-STAGE: March 23, 2012
    JOURNAL FREE ACCESS
      At the time of the 2009 influenza pandemic, the pathogenicity in the early stage was indefinite, but individual medical facilities took infection control measures according to guidance from central government. Here the infection control measures adopted by these medical facilities during the pandemic period are evaluated. Referring to the interim guidance from the centers for disease control and prevention on infection control measures for the 2009 H1N1 influenza in healthcare settings, we created and distributed a questionnaire on infection control to 25 medical facilities belonging to the Research Group of Emerging and Re-emerging Infectious Diseases (H22-SHINKO-IPPAN-003). Almost all (88%) of the 17 responding medical facilities, with an average number of hospital beds of 610 (range 0-1300), took measures against influenza by establishing special units, sharing information, and performing influenza surveillance. Measures such as setting up triage areas to separate influenza patients (82%) and making influenza patients wear facemasks (94%) were also generally taken, but the period of implementation differed in each facility. Differences were also apparent in the implementation period and the content of personal protective equipment measures, but the wearing of facemasks was consistently adopted. In general, strict infection control measures were taken in the early stage of the pandemic, and as the pathogenicity was clarified, these measures were revised to those implemented for seasonal influenza, especially after the facility had actually encountered influenza cases. The validity and efficacy of infection control measures for pandemics as well as information sharing procedures should be evaluated to provide better central guidance to facilities nationwide in the future.
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  • Shiro ENDO, Koichi TOKUDA, Masumitsu HATTA, Hiroyuki KUNISHIMA, Shinya ...
    Article type: Report
    2012 Volume 27 Issue 1 Pages 50-56
    Published: 2012
    Released on J-STAGE: March 23, 2012
    JOURNAL FREE ACCESS
      An outbreak of influenza A occurred at the Tatekoshi Elementary School refuge center in Natori City, Miyagi Prefecture after the East Japan great earthquake disaster of March 11, 2011. Two hundred evacuees were housed at the refuge center of whom 40% were elderly people 65 years and older. Five days after the initial case on April 8, intervention was requested to deal with the influenza outbreak by the Chairperson of the Natori City Medical Association which was providing medical services at the refuge center. On April 8, we arrived to implement intervention measures, when non-pharmaceutical intervention (NPI) through the isolation of all individuals with early onset of influenza had been already been carried out. However, except for isolation, NPI including hand hygiene was not adequate. On the other hand, antiviral prophylaxis had been administered to 22 evacuees. Therefore, we focused on reinforcement of basic NPI measures including site staff education; improvement of the face mask wearing rate; emphasizing the importance of hand hygiene; implementation of adequate ventilation; aggressive detection of symptomatic individuals and monitoring family members for onset of symptoms; and isolation of persons at onset of infection. On the other hand, we also emphasized to the site physicians that antiviral prophylaxis was only effective if basic NPI measures were strictly enforced and that prophylaxis should only be considered if the outbreak expanded. On April 13, we made a second intervention visit. The last new case occurred on April 14. Influenza outbreak at a refuge center has not been previous reported and no guidelines have been established. Our experience suggests that prophylaxis should only be used to supplement NPI measures, which should be strengthened as the main intervention strategy, and should only be considered based on the extent of outbreak and patient risk factors.
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  • Masashi TERASAWA, Ippei MORIMOTO, Takashi UEJI, Mayumi YOSHIMURA
    Article type: Report
    2012 Volume 27 Issue 1 Pages 57-62
    Published: 2012
    Released on J-STAGE: March 23, 2012
    JOURNAL FREE ACCESS
      In February 2009, we conducted a survey on the level of awareness of infection control procedures among the members of the Higashi yodogawa-District Pharmacists Association (HPA). These results suggested that awareness towards infection control procedures were not adequate. Later that year, the H1N1 flu pandemic occurred, and we carried out a post-survey aimed to find out whether infection control procedures had changed at each pharmacy. In May 2010, a questionnaire was sent to all 55 pharmacies of the HPA and 44 responded (response rate; 80%). As a result, the rate of mask usage in contact with infectious patients was higher compared with the results of the 2009 survey. A number of pharmacies had changed policies such as giving medicine to infectious patients before other patients. The findings indicated that the awareness of infection control procedure was improved at pharmacies. We believe that hospitals or pharmacies and related organizations must work together through periodically scheduled workshops to consider practical infection control procedures to prevent the spread of regional infection.
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