A thorough hand hygiene program initiated at our hospital in September 2005 under the guidance of the Infection Control Team resulted in fewer detections of Staphylococcus species, etc., but increased detection of Bacillus cereus. Investigation of the backgrounds of patients with B. cereus detected in blood culture revealed that most patients had undergone peripheral catheterization. B. cereus was also detected at the peripheral catheter tip in several of these patients with positive blood culture for B. cereus, and these patients were found to have B. cereus bloodstream infection. Contaminated hospital linens and catheter handling procedures are often involved in B. cereus bloodstream infections. However, with many uncertainties remaining with regard to the link between catheter contamination and hospital linen contamination, we decided to investigate the effects of infusion fluid type on microbial growth and the impact of temperature and environmental factors. Our investigation of the effects of infusion fluid type and storage time showed B. cereus to grow substantially more rapidly in infusion fluid compared to Staphylococcus aureus and Staphylococcus epidermidis. Environmental testing showed B. cereus to be present on cultured towels at 0 to 1×106 cfu/mL. Settling plate testing showed a tendency for greater microbial prevalence in patient rooms than in the general environment. Many B. cereus organisms were detected over a short period in airborne microbial testing performed after linen replacement. These findings suggest the importance of the environment in which drug preparation, catheter insertion and catheter route change are performed.
The present study investigated the risk of blood contamination during nursing care related to hemodialysis. The care-related actions of nurses were observed at the dialysis centers of five facilities in the Chubu region of Japan between June 2006 and February 2007. Screening for blood on used gloves and in the environment was also conducted. The nursing care was observed for infection control equipment usage and hand hygiene of 17 nurses during all aspects of treatment from puncture at the start of dialysis to needle removal and hemostasis at the end of dialysis. Used gloves were collected and the presence or absence of blood on the gloves was investigated using the luminol reaction. The presence or absence of blood in the environment and on objects touched by used gloves was investigated using leucomalachite green. Blood was detected on 61 of 274 used gloves (22.7%; puncture, 26; needle removal, 31; hemostasis, 4). Furthermore, blood was detected on five surfaces touched by gloves that had tested positive for blood. With regard to needle removal, the number of times environmental surfaces were touched by used gloves was significantly higher when care was performed by one nurse rather than two (p<0.001). These findings suggest that contact with used gloves may contaminate the environment. Needle removal should be performed by two nurses to reduce the risk of environmental contamination.
Elementary schools are thought to be amplifiers for infections in influenza epidemics in communities, considering the poorer immunity against the disease among school children, compared with the adult population, and the high activity and communal school life. Therefore, infection control in schools might be one of the key issues for mitigation of influenza endemics in communities. However, little information has been available on the dynamics of influenza transmission among school children or introduction of the disease into schools. In this study, we analyzed the incidence profiles of A(H1N1) pdm09 pandemic influenza in Shimo-miito elementary school, Meiwa-cho, Mie, Japan, from October 2009 to January 2010, where 49.1% children developed influenza during the estimated epidemic period of 79 days. The mean incidence rate was 1.01 cases a day. New cases were detected in 43.0% of days during the period, 80.0% of days with less than three cases, and only 13.3% with more than 5 new cases, suggesting that the epidemic in the school was gradual and intermittent rather than rapid and explosive. We estimated the possible infection linkages among the children by analyzing the relationships between the onset day and the incubation period, under the presumption that infected children could be the source of infection within 24 hours before the onset day. The results indicated that the source of infection for 50.0-66.7% of cases was inside the same class, showing that 33.4-50.0% of children who develop influenza might be infected through other routes. Most of the infection linkages in classes were found to be terminate rapidly. Repeated new emergences and terminations of infection linkages was the typical pattern of the influenza epidemic in this elementary school in 2009.
Frequent use of broad-spectrum antimicrobials is known to lead to the emergence of multidrug-resistant bacteria, so methods to optimize use such as establishing a reporting and permitting system are being discussed. To allow for appropriate selection of antimicrobials, we generated antibiograms based on the drug sensitivity rates for bacteria isolated in our hospital to provide information to guide the selection of antimicrobials most likely to be efficacious against the bacteria identified by gram staining. In addition, to allow for appropriate design of the dosage regimens of the antimicrobial treatment, we developed PK/PD analysis software that can calculate the estimated blood drug concentrations over time and the time above minimum inhibitory concentration, which serves as the basis for determining the appropriate dosage regimens, and provided physicians with information on dosage regimens. As a result of these approaches, the antimicrobial use density of fourth generation cephem antimicrobials, which had been commonly used in the hospital, decreased from 2.72 to 1.12. Drug sensitivity rates (%) of Pseudomonas aeruginosa significantly (p<0.05) increased for cefpirome (58.2 in fiscal 2009 vs. 72.9 in fiscal 2010), cefepime (68.8 vs. 87.7), meropenem (91.0 vs. 95.9), and pazufloxacin (68.3 vs. 87.5). Our approaches appear to have reduced inappropriate use of broad-spectrum antimicrobials and increased the drug sensitivity rates of Pseudomonas aeruginosa.
A workshop on healthcare-associated infection control was held for the medical staff to improve training in appropriate hand hygiene using fluorescent dye. Fluorescent lotion (2 mL) was rubbed on both hands in a manner similar to rubbing in antiseptic hand rub. The remaining fluorescent areas were then sketched under UV light to assess the effectiveness of the rubbing method. Afterwards, the staff applied fluorescent lotion to both hands and performed the scrub method for more than 30 sec with soap under running water. Then, the remaining fluorescent areas were sketched to assess the effectiveness of the scrub method. The areas that were missed by the rubbing method were rather smaller compared to the areas that were missed by the scrub method. The missed areas on the back of hands were rather large compared to the palm. A positive relationship was observed between the number of untouched parts in the scrub method and rubbing method. Therefore, the missed areas in both the back of hands and the palm were compared. Significant difference was found between the pharmacists and the medical clerks in the rubbing method. Both pharmacists and medical clerks might touch tablets directly with bare hands under the management of pharmacists. It is important to continue the training of appropriate hand hygiene for medical staff.
Without the addition of albumin, 0.0125-0.1% (125-1,000 ppm) sodium hypochlorite and 0.012% (120 ppm) dichloroisocyanurate killed Clostridium difficile spores within 5 min. In the presence of 0.1% albumin, 0.0125-0.02% sodium hypochlorite and 0.012% dichloroisocyanurate did not show adequate sporicidal activity even after 60-min contact, whereas 0.05-0.1% sodium hypochlorite killed the spores within 5 min. These results indicate the excellent sporicidal effects of 0.0125-0.1% sodium hypochlorite and 0.012% dichloroisocyanurate on C. difficile spores in the absence of soil (organic matter). These results also show the excellent sporicidal effects of 0.05-0.1% sodium hypochlorite on C. difficile spores even in the presence of soil.
In September 2010, we administered a self-reporting measure with open-answer questions to 60 outpatient nurses at a major hospital for HIV/AIDS treatment, regarding years of experience, departmental affiliations, experience dealing with HIV/AIDS patients, anxiety upon contacts with HIV/AIDS patients, and specific anxiety. We obtained responses from 58 of 60 outpatient nurses (96.7% response rate). Thirty-nine nurses (65%) indicated that they had experience caring for HIV/AIDS patients. Among them, 35 nurses (89.7%) stated that they had anxiety when caring for those patients. Among those without experience, 16 nurses (84.2%) stated that they had anxiety. The anxieties felt by the nurses can be roughly divided into two categories: fears over the risks of themselves becoming infected, and concerns over how they should relate to the HIV/AIDS patients. Then, we performed group comparisons of each anxiety category between the respondents who had contacts with HIV/AIDS patients on a daily basis and those who did not. There was a significant difference (p=0.025) in the anxiety of HIV infection, indicating that those who had less contact with HIV/AIDS patients demonstrated stronger anxiety. The matter of how relate to HIV/AIDS patients showed a statistically significant difference (p<0.01) among the subjects interviewed. Among the units receiving visits from the patients, as the frequency of nurses' encounters with the patients increased, so did nurses' anxiety and confusion over how they should behave and assist them. With regard to fears over infection risks felt by nurses caring for outpatients, it is possible for nurses to reduce such risks by exercising preventive measures on a regular basis and making them part of their routine. However, to address the concerns felt over their relationship to the patients, it is deemed necessary to create a professional training program for HIV/AIDS patient nursing and establish a system to enable nurses to take part in the program.
Incidence of perioperative infections leads to increased health care costs with a decrease in the quality of medical care, as well as decreased QOL of patients, so exerts a heavy burden on people involved. In hospitals, the implementation of effective measures to prevent infection must also include validation and confirmation that measures have been properly enforced. To evaluate the implementation of measures, a survey of proposals to reduce SSI was performed. Hospitals with over 300 beds throughout (1035 hospitals) were sent a questionnaire on 18 items related to perioperative infection control measures. Recovery rate was 51.6%. From this survey, perioperative infection control measures have been performed effectively in many hospitals. On the other hand, the duties in such hospitals are difficult to change, and medical staff have low awareness of infection. Therefore, adequate infection control measures are unlikely. Further education is considered necessary to prevent SSI with clearer evidence.
Hand antisepsis is the most basic method to prevent expanding infection transmitted by the hands of medical staff. Appropriately use of hand antisepsis is very important. At present, the rubbing method with alcohol-based hand sanitizer (rubbing detergent) is recommended and is the major clinical practice if medical staff hands are not severely contaminated. How products of rubbing detergent are used remains unknown, because the market for rubbing detergent was expanded when H1N1 flu was prevalent in 2009. In this report, we researched the actual situation of marketing products of rubbing detergent by collecting the latest information, to evaluate disposition of the products and appropriate selection. We researched the legal division, effective ingredients of antisepsis, method of use and properties of the products. A total of 164 products were examined. The products were divided to four types by legal classification as ethical pharmaceuticals, nonproprietary drugs, nonmedical products and miscellaneous types. We thought that miscellaneous types were not appropriate for clinical use. The volume needed for one time hand antisepsis was not decided for almost all rubbing detergent products. We considered that about 3 mL of rubbing detergent was required that took 20-30 seconds for dryness. Additionally, properties of rubbing detergent were divided into three types, gel, liquid and bubble. We must select appropriate hand antisepsis considering the factors as efficacy of antisepsis and feeling of use. These findings should promote appropriate hand hygiene.
The Department of Hospital Pharmacy in the Ageo Medical Group (AMG) has regularly held training for support of Infectious Control Pharmacist education since 2006. In particular, from 2010, the training was managed by a working group associated with Board Certified Infection Control Pharmacy Specialist (BCICPS) and Board Certified Pharmacist in Infection Control (BCPIC) of the Japanese Society of Hospital Pharmacists (JSHP). At the start of the fiscal year, participants were asked to submit data on the activities of the infection control team and cases of infectious disease therapy. In fiscal year 2010, 36 participants from 19 centers and 47 cases were included. In the working group, the 16 most frequently encountered cases in daily life were selected by the pharmacists, presenters were determined, and the annual plan was discussed. Before starting, the content was cross-checked with the available standards, and necessary revisions were made. Training was conducted 4 times a year in the form of discussions in small groups. Out of the 36 participants, 25 participated 4 times in a row. A study conducted after the training revealed that the trainees intensely participated in discussions and showed a lot of interest towards pharmacist-oriented infection control. A study conducted on infection control at the end of the fiscal year revealed that centers that had participated in the training program had a higher execution rate than those of the centers that did not participate. This training can facilitate intergroup sharing of information and help establish a support system for infection control, as well as provide an opportunity to discuss various infection control responses. Therefore, the BCICPS or BCPIC has important roles in training for infection control and prevention.